What is pericardial effusion. How does it affect heart function. What are the common causes of pericardial effusion. What symptoms should you watch out for. How is pericardial effusion diagnosed and treated. Can pericardial effusion be prevented. What complications can arise from untreated pericardial effusion.

The Nature of Pericardial Effusion

Pericardial effusion is a medical condition characterized by an abnormal accumulation of fluid in the pericardial space, which surrounds the heart. The pericardium, a double-layered, fluid-filled sac that envelops the heart, typically contains a small amount of fluid that acts as a lubricant between its layers. When excess fluid builds up in this space, it can lead to pericardial effusion.

Why does this fluid buildup occur? There are various reasons, ranging from infections to autoimmune disorders. The severity of pericardial effusion can vary, with some cases being mild and asymptomatic, while others can be life-threatening if left untreated.

Types of Pericardial Effusion

Pericardial effusions can be classified based on their onset and duration:

• Acute pericardial effusion: Develops rapidly
• Subacute pericardial effusion: Fluid accumulates gradually
• Chronic pericardial effusion: Recurs over time

Understanding the type of effusion is crucial for proper management and treatment. Acute effusions may require immediate intervention, while chronic cases might need long-term monitoring and management strategies.

Causes Behind Pericardial Effusion

What triggers the excessive accumulation of fluid around the heart? The causes of pericardial effusion are diverse and can be attributed to various factors:

• Cancer (primary or metastatic)
• Infections (viral, bacterial, or fungal)
• Inflammatory conditions (e.g., pericarditis following a heart attack)
• Trauma or injury (including iatrogenic causes from medical procedures)
• Autoimmune disorders
• Metabolic disturbances (such as kidney failure with uremia)
• Medication reactions
• Radiation therapy

In some instances, the cause remains unknown, a condition referred to as idiopathic pericardial effusion. Identifying the underlying cause is crucial for effective treatment and prevention of recurrence.

The Role of Inflammation

Inflammation of the pericardium, known as pericarditis, often plays a significant role in the development of pericardial effusion. This inflammation can be triggered by various factors, including infections, autoimmune reactions, and physical injury to the heart or surrounding tissues.

Recognizing the Symptoms of Pericardial Effusion

How can you tell if you’re experiencing pericardial effusion? The symptoms can vary widely depending on the severity and rate of fluid accumulation. In mild cases, individuals may be asymptomatic, with the condition discovered incidentally during routine medical examinations or imaging studies.

However, as the effusion progresses, several symptoms may manifest:

• Chest pain or discomfort
• Shortness of breath, especially when lying down
• Rapid heartbeat (tachycardia)
• Fatigue and weakness
• Swelling in the legs or abdomen
• Cough
• Low-grade fever
• Dizziness or fainting spells

In severe cases, particularly when cardiac tamponade develops, more serious symptoms may occur:

• Severe shortness of breath
• Chest pain that radiates to the neck, shoulders, or back
• Rapid, shallow breathing
• Fainting or loss of consciousness
• Signs of shock (pale, cool, clammy skin; weak pulse; decreased urine output)

It’s important to note that these symptoms can mimic other cardiac conditions, making prompt medical evaluation crucial for accurate diagnosis and appropriate treatment.

Diagnostic Approaches for Pericardial Effusion

How do medical professionals diagnose pericardial effusion? The diagnostic process typically involves a combination of clinical evaluation, imaging studies, and laboratory tests. Here’s a breakdown of the common diagnostic approaches:

Clinical Evaluation

The initial step in diagnosing pericardial effusion involves a thorough medical history and physical examination. Healthcare providers will inquire about symptoms, recent illnesses, and any underlying medical conditions that might predispose an individual to pericardial effusion.

During the physical exam, doctors may listen for specific heart sounds, such as a pericardial friction rub or muffled heart sounds, which can indicate the presence of excess fluid around the heart.

Imaging Studies

Several imaging techniques play a crucial role in confirming the diagnosis and assessing the severity of pericardial effusion:

• Echocardiogram: This non-invasive ultrasound test is the gold standard for diagnosing pericardial effusion. It provides real-time images of the heart and can accurately measure the amount of fluid in the pericardial space.
• Chest X-ray: While less specific than an echocardiogram, a chest X-ray can show an enlarged cardiac silhouette, which may suggest the presence of pericardial effusion.
• CT scan or MRI: These advanced imaging techniques can provide detailed images of the heart and surrounding structures, helping to identify the cause of the effusion and any associated complications.

Laboratory Tests

Blood tests and other laboratory studies can help identify the underlying cause of pericardial effusion and assess its impact on overall health:

• Complete blood count (CBC)
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to assess inflammation
• Cardiac enzyme tests to rule out heart attack
• Tests for specific infections or autoimmune disorders

Pericardiocentesis

In some cases, a procedure called pericardiocentesis may be performed. This involves inserting a needle into the pericardial space to remove fluid for analysis. This procedure can be both diagnostic and therapeutic, as it relieves pressure on the heart while allowing for examination of the fluid to determine its cause.

Treatment Strategies for Pericardial Effusion

How is pericardial effusion managed once diagnosed? The treatment approach depends on several factors, including the underlying cause, the amount of fluid accumulated, and the presence of any complications. Here are the main treatment strategies:

Monitoring and Observation

For mild, asymptomatic cases of pericardial effusion, close monitoring may be the initial approach. Regular follow-up appointments and echocardiograms can help track the progression of the effusion.

Treating the Underlying Cause

Addressing the root cause of the effusion is crucial for effective management:

• Antibiotics for bacterial infections
• Antiviral medications for viral causes
• Anti-inflammatory drugs for conditions like lupus or rheumatoid arthritis
• Cancer treatments if the effusion is related to malignancy

Medications

Various medications may be prescribed to manage symptoms and reduce inflammation:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin
• Colchicine to reduce inflammation
• Corticosteroids for severe inflammation or when other treatments are ineffective

Pericardiocentesis

For larger effusions or those causing significant symptoms, pericardiocentesis may be necessary. This procedure involves draining the excess fluid from the pericardial space using a needle or catheter.

Surgical Interventions

In some cases, surgical procedures may be required:

• Pericardial window: Creating a small opening in the pericardium to allow fluid drainage
• Pericardiectomy: Surgical removal of part or all of the pericardium in cases of recurrent or constrictive pericarditis

Potential Complications and Prognosis

What complications can arise from pericardial effusion, and what is the outlook for affected individuals? While many cases of pericardial effusion resolve with appropriate treatment, there are potential complications that require vigilant monitoring:

Cardiac Tamponade

The most serious complication of pericardial effusion is cardiac tamponade. This life-threatening condition occurs when the accumulation of fluid in the pericardial space puts excessive pressure on the heart, preventing it from filling properly. Cardiac tamponade can lead to shock and requires immediate medical intervention.

Chronic Pericarditis

In some cases, recurrent or prolonged pericardial effusion can lead to chronic inflammation of the pericardium, known as chronic pericarditis. This condition can cause ongoing pain and may require long-term management.

Constrictive Pericarditis

Rarely, chronic inflammation can cause the pericardium to become thick and rigid, a condition called constrictive pericarditis. This can restrict the heart’s ability to pump effectively and may require surgical intervention.

Prognosis

The prognosis for pericardial effusion varies depending on the underlying cause and the timeliness of treatment. Many cases resolve completely with appropriate management. However, some individuals may experience recurrent effusions or develop chronic pericardial conditions that require ongoing care.

Factors influencing prognosis include:

• The underlying cause of the effusion
• The amount of fluid accumulation
• The presence of complications like cardiac tamponade
• The individual’s overall health and response to treatment

Prevention and Long-term Management

Can pericardial effusion be prevented, and how can individuals manage their condition long-term? While not all cases of pericardial effusion can be prevented, there are steps that can be taken to reduce the risk and manage the condition effectively:

Preventive Measures

• Prompt treatment of infections and underlying medical conditions
• Careful monitoring of individuals at high risk, such as those undergoing certain medical procedures or radiation therapy
• Management of chronic conditions that may predispose to pericardial effusion
• Maintaining a healthy lifestyle to support overall cardiovascular health

Long-term Management Strategies

For individuals with recurrent or chronic pericardial effusion, long-term management may involve:

• Regular medical follow-ups and monitoring
• Ongoing medication regimens to control inflammation or underlying conditions
• Lifestyle modifications to support heart health
• Psychological support to cope with the challenges of a chronic condition

By working closely with healthcare providers and adhering to recommended treatments and lifestyle changes, many individuals with pericardial effusion can effectively manage their condition and maintain a good quality of life.

Advances in Research and Future Directions

What new developments are on the horizon for understanding and treating pericardial effusion? Ongoing research in cardiology and related fields continues to enhance our understanding of pericardial effusion and improve treatment options:

Molecular Insights

Scientists are delving deeper into the molecular mechanisms underlying pericardial effusion, particularly in cases where the cause is unclear. This research may lead to more targeted therapies and better prevention strategies.

Imaging Innovations

Advancements in imaging technology, such as high-resolution echocardiography and cardiac MRI, are improving our ability to detect and monitor pericardial effusions with greater precision. These tools may allow for earlier diagnosis and more personalized treatment approaches.

Novel Therapies

Research into new medications and therapeutic approaches is ongoing. This includes investigating the potential of immunomodulatory drugs for managing inflammatory causes of pericardial effusion and exploring minimally invasive techniques for fluid drainage and pericardial modification.

Genetic Studies

Genetic research is shedding light on potential hereditary factors that may predispose individuals to pericardial effusion or related conditions. This knowledge could lead to improved risk assessment and preventive strategies for at-risk populations.

As research progresses, the management of pericardial effusion is likely to become more sophisticated and tailored to individual patient needs, potentially improving outcomes and quality of life for those affected by this condition.

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What is pericardial effusion?

Pericardial effusion is the buildup of extra fluid in the space around the heart.
If too much fluid builds up, it can put pressure on the heart. This can prevent it
from pumping normally.

A fibrous sac called the
pericardium surrounds the heart. This sac consists of two thin layers. Normally, there
is a small amount of fluid between them. The fluid reduces friction between the two
layers as they rub against each other during each heartbeat. In some cases, extra
fluid
can build up between these two layers leading to a pericardial effusion.

A little fluid won’t cause much of
a problem. But if too much fluid builds up, it can make it hard for the heart to expand
normally. This condition is called cardiac tamponade. It usually requires emergency
treatment. Because the heart can’t expand normally, less blood can enter the heart
from
the body. This can reduce the amount of oxygenated blood going out to the body. But
not
all pericardial effusions cause cardiac tamponade.

In some cases, pericardial effusion
develops quickly. This is known as acute pericardial effusion. Other times, the fluid
builds up slowly. This is known as subacute pericardial effusion. Chronic pericardial
effusion occurs when cardiac effusion happens more than once over time.

What causes pericardial effusion?

A number of conditions can cause excess fluid and inflammation in the pericardial
sac, such as:

• Cancer (spread from another part of the body or from the heart tissue itself)
• Infection of the pericardial sac, such
  as from viral or bacterial infections
• Inflammation of the pericardial sac
  (for example, because of a heart attack)
• Injury (including those from medical
  procedures on the heart)
• Immune system problems
• Metabolic causes, like kidney failure with uremia
• Reactions to certain medicines
• Radiation

Sometimes the cause of fluid buildup is unknown.

What are the symptoms of pericardial effusion?

You may not have any symptoms. This
is more often the case with a mild effusion. You might be more likely to have symptoms
from whatever is causing the pericardial effusion. For example, you might have fever
if
you have an infection of the pericardial sac.

When effusion is more severe, you may have symptoms such as:

• Chest pain or discomfort
• Enlargement of the veins of the neck
• Fainting
• Fast breathing
• Increased heart rate
• Nausea
• Pain in the right upper abdomen
• Shortness of breath
• Swelling in the arms and legs

If the effusion is very severe, it
can also lead to very low blood pressure. This can cause symptoms of shock. These
include:

• Lightheadedness or dizziness
• Cool arms and legs
• Clammy skin
• Weakness
• Rapid breathing
• Nausea or vomiting
• Pale skin
• Less urine output

Shock is a medical emergency.

Many of these symptoms can be
caused by other health problems. Always see your healthcare provider for a
diagnosis.

How is pericardial effusion diagnosed?

The process starts with a health
history and a physical exam. Your healthcare provider will ask about your symptoms
and
past medical conditions. For symptoms of shock, it’s important to find the cause
quickly.

Tests may also be done, such as:

• Chest X-ray to see the heart anatomy
• Imaging of the chest or heart with a
  CT scan or MRI
• Echocardiogram (echo) to look at fluid
  around the heart and heart motion
• Electrocardiogram (ECG) to analyze the
  heart’s electrical rhythm

If a pericardial effusion is found,
healthcare providers must try to diagnose the cause. They may use tests such as:

• Analysis of the fluid removed from around the heart to check for cancer or infection
• Different blood tests to diagnose infection, immune system, and metabolic problems

How is pericardial effusion treated?

Treatment will depend on your
symptoms, age, and general health. It will also depend on how severe the condition
is
and what caused it. Chronic and acute pericardial effusions may require different
treatment.

If a pericardial effusion is not severe, treatment may include:

• Careful monitoring with repeated
  echocardiograms
• Therapy aimed at the cause of the
  effusion, such as antibiotics for a bacterial infection or medicines, such as
  ibuprofen, for inflammation
• Treatment of pain with aspirin or another medicine

A severe pericardial effusion may need to be drained. The fluid is drained with a
procedure called pericardiocentesis. This procedure uses a needle and a thin, flexible
tube (catheter) to drain the fluid.

In some cases, the pericardial sac
may be drained during surgery. The surgeon may remove a piece of the pericardium.
This
is done to help diagnose the cause of the effusion. It can also prevent the fluid
from
building up again. Your provider might be more likely to do this if you’ve had chronic
pericardial effusion.

Symptoms often improve greatly
after the excess fluid is drained. The outcome of treatment may depend on the cause
and
severity of the condition, how quickly treatment is started, and your overall
health.

What are possible complications of pericardial effusion?

Many times, there are no
complications of pericardial effusion. The most serious possible complication is cardiac
tamponade. If untreated, it can lead to shock, which can cause serious complications.
For example, reduced blood flow to the kidneys during shock can cause the kidneys
to
fail. If left untreated, shock can lead multiple organs to fail, causing death. In
rare
cases, the pericardium can become scarred and prevent the heart from filling correctly.

What can I do to prevent pericardial effusion?

You can reduce your risk of some of
the medical problems that can lead to pericardial effusion. For example, take care
of
your heart by:

• Limiting alcohol.
• Eating a heart-healthy diet.
• Getting enough exercise
• Staying at a healthy weight.
• Seeing a healthcare provider regularly
  to treat your medical problems.

Many cases of pericardial effusion
are not preventable.

When should I call my healthcare provider?

If you have any symptoms of
pericardial effusion, call your healthcare provider right away. Call
911 if you
have trouble breathing, chest pain, or symptoms of shock.

Key points about pericardial effusion

• A pericardial effusion is when excess fluid builds up in the pericardial sac around
  the heart. This can happen for a variety of reasons.
• Some pericardial effusions are small. These are unlikely to cause symptoms or major
  problems themselves.
• A large pericardial effusion can
  prevent the heart from pumping normally. This is a medical emergency.
• Healthcare providers can monitor small
  pericardial effusions and treat the underlying causes.
• A person with a large pericardial effusion might need a procedure to remove fluid
  from around the heart.
• Seek medical attention right away if
  you have symptoms like severe chest pain or trouble breathing.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask
  questions and remember what your provider tells you.
• At the visit, write down the name of a
  new diagnosis and any new medicines, treatments, or tests. Also write down any new
  instructions your provider gives you.
• Know why a new medicine or treatment
  is prescribed, and how it’ll help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you don’t take
  the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your provider
  if you have questions.

Medical Reviewer: Steven Kang MD

Medical Reviewer: Stacey Wojcik MBA BSN RN

Medical Reviewer: Stacey Wojcik MBA BSN RN

© 2000-2022 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

Pericardial Effusion: Causes, Symptoms, and Treatment

Written by Matthew Hoffman, MD

• Causes
• Symptoms
• Diagnosis
• Treatment

A pericardial effusion is excess fluid between the heart and the sac surrounding the heart, known as the pericardium. Many are not harmful, but they sometimes can make the heart work poorly.

The pericardium is a tough and layered sac. When your heart beats, it slides easily within it. Normally, 2 to 3 tablespoons of clear, yellow pericardial fluid are between the sac’s two layers. That fluid helps your heart move easier within the sac.

If you have a pericardial effusion, much more fluid sits there. Small ones may contain 100 milliliters of fluid. Very large ones may have more than 2 liters.

In most cases, inflammation of the sac, a condition called pericarditis, leads to the effusion. As it becomes inflamed, more fluid is produced.

Viral infections are one of the main causes of the inflammation and the effusions it leads to. These infections include:

• Cytomegalovirus
• Coxsackieviruses
• Echoviruses
• HIV Infection
• Lupus
• Tuberculosis

In these cases, treating the underlying medical condition will often help treat the effusion.

Other conditions that can cause these effusions include:

• Cancer
• Injury to the sac or heart from a medical procedure
• Heart attack
• Severe kidney failure, also called uremia
• Autoimmune disease (lupus, rheumatoid arthritis, and others)
• Bacterial infections, including tuberculosis

In many cases, no cause can be found. Your doctor may call these idiopathic pericardial effusions.

When inflammation of the sac causes a pericardial effusion, the main symptom is chest pain. It may get worse when you breathe deeply and better when you lean forward.

Other symptoms may include:

• Fever
• Fatigue
• Muscle aches
• Shortness of breath
• Nausea, vomiting, and diarrhea (if you have a virus)

When there’s no inflammation of the sac, there are often no symptoms.

Large, serious pericardial effusions, or smaller ones that develop quickly, may cause symptoms that include:

• Shortness of breath
• Palpitations (sensation that the heart is pounding or beating fast)
• Light-headedness or passing out
• Cool, clammy skin

A pericardial effusion with these symptoms is a medical emergency and may be life-threatening.

Because these often cause no symptoms, they’re frequently discovered after the results of routine tests are abnormal. These tests can include:

Physical examination: A doctor may hear abnormal sounds over the heart that can suggest inflammation. However, pericardial effusions usually can’t be found through a physical.

Electrocardiogram (EKG): Electrodes placed on your chest trace the heart’s electrical activity. Certain patterns on an EKG can signal a pericardial effusion or the inflammation that leads to it.

Chest X-ray film: The heart’s silhouette on one may be enlarged. That’s a sign of a pericardial effusion.

If one is suspected, the best test to confirm it is an echocardiogram (ultrasound of the heart) because your doctor would easily see any excess fluid.

Once the effusion is identified, its size and severity are figured out. Most times, it’s small and causes no serious problems. If it’s large, it can compress your heart and hamper its ability to pump blood. This condition, called cardiac tamponade, is potentially life-threatening.

To find the cause of a pericardial effusion, your doctor may take a sample of the pericardial fluid. In this procedure, called pericardiocentesis, a doctor inserts a needle through your chest, into your pericardial effusion, and takes some fluid.

It depends on its severity and cause. Small ones that don’t have symptoms and are due to known causes (for example, kidney failure) require no special treatment.

For pericardial effusions due to inflammation of the sac, treating the inflammation also treats the effusion.

In that case, you may be given:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like Aleve, Indocin, and Motrin
• Corticosteroids, like prednisone and Solu-Medrol
• Colchicine (Colcrys)

If a severe infection or heart impairment (cardiac tamponade) exists, the extra fluid must be drained immediately. Drainage is done in two ways:

Pericardiocentesis: A doctor inserts a needle through the chest into the pericardial effusion. A catheter is put into the fluid, and it’s suctioned out.

Pericardiectomy or pericardial window: A surgeon makes an incision in the chest, reaches in, and cuts away part of the pericardium. This drains the pericardial effusion and usually prevents it from coming back. The procedure requires general anesthesia.

Pericardial effusions that are 3 months old or older are called chronic. Often, no cause is known. They’re sometimes monitored without treatment. If there are symptoms or your heart is being harmed, drainage is usually done.

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Hydropericardium in cancer – description and causes

General information about the problem

Hydropericardium (another name is dropsy of the heart) – the appearance of excess fluid between the layers of the pericardium. For adequate functioning of the heart, there is 20-40 ml of transudate in the pericardial cavity (non-inflammatory effusion).

The reason for the occurrence of hydropericardium is the increased permeability of the vascular walls of the pericardial sac or venous congestion.

An increase in the volume of transudate up to 100 ml does not manifest itself clinically. If the amount of fluid exceeds 150-200 ml, you should think about the addition of inflammation.

The following signs of hydropericardium are distinguished:

• Periodic pain in the chest, aggravated by a change in body position (leaning forward).
• Lack of strength, pale skin.
• Increased perspiration.
• Rapid heartbeat, which may not be felt due to weak heart activity.
• Decrease in systolic (“upper”) pressure.
• Rapid and shallow breathing.
• Severe pastosity (swelling) of legs and feet.

How to treat hydropericardium

The accumulation of transudate is a symptom or complication of the underlying pathology, and therefore the underlying disease must be treated.

Therapy begins with the appointment of heart drugs, thyroid hormones, as well as mixtures that restore protein metabolism in the body.

With a slight excess of fluid between the sheets of the pericardium, there is no need for special preparations.

The recommendations of specialists for hydropericardium include the following appointments: potassium and magnesium preparations in combination with potassium-sparing or thiazide diuretics (diuretics). The absence of a long-term result or the detection of a significant amount of effusion may indicate the addition of an inflammatory process (formation of exudate). This is a direct indication for a therapeutic puncture (puncture with a special needle) of the pericardium.

Possible complications

The development of complications of hydropericardium is associated with the severity of heart failure. An increase in the volume of pathological effusion up to 1-1.5 liters provokes an increase in symptoms: pressure numbers decrease, shortness of breath worsens, swelling becomes more noticeable.

Running dropsy of the heart leads to the development of tamponade, in which the accumulated fluid compresses the heart muscle so much that physiological contractions become impossible. The clinical picture of the condition is accompanied by a pronounced decline in strength, weakness, asthma attacks with frequent shallow breathing, a feeling of rapid heartbeat, episodes of loss of consciousness. In this case, urgent medical attention is required.

What causes hydropericardium in cancer

The causes of hydropericardium are as follows: an increase in the production of transudate or a slowdown in its absorption. A similar pathophysiological mechanism is observed in many diseases:

1. Chronic heart failure – a condition characterized by congestion.
2. Other cardiovascular diseases: pericarditis, cardiomyopathy, congenital heart disease.
3. Intoxication with pesticides (in hazardous industries), decaying cancer cells.
4. Cachexia. With an extreme degree of exhaustion, the heart decreases in size, the organ does not completely fill the pericardial cavity.
5. Chronic kidney disease. With hydronephrosis, renal failure, pyelonephritis, acid-base metabolism and water-salt metabolism are disturbed, which provokes the development of edema of the internal organs.
6. Severe degree of anemia – a violation of the processes of cellular respiration leads to the formation of excess effusion.
7. Trauma is a common cause of cardiac tamponade (compression of the heart muscle by excessive effusion).
8. Radiation therapy in oncopathology.
9. Benign or malignant neoplasms of the mediastinum.

There are special forms of hydropericardium, in which lymph accumulates (a frequent occurrence in a metastatic process) or blood (heart injury, complicated myocardial infarction).

Diagnostic methods in Medscan

The survey begins with a survey and examination of the patient. The results of physical research methods (percussion, auscultation) indicate an enlarged heart.

Specialists resort to laboratory and instrumental studies:

• Clinical and biochemical blood tests, clinical urinalysis. Laboratory studies will assess the general condition of the body, the presence or absence of inflammatory processes.
• Chest x-ray. The method will help to see only a massive increase in effusion.
• X-ray kymography. The procedure registers the pulsation of the atria and ventricles of the heart, as well as the main vessels. With initial changes in the pericardium, a decrease in the voltage of the ventricular and atrial teeth is determined.
• Echocardiography is the leading diagnostic tool for this condition. According to the results of ultrasound, the normal gap between the wall of the heart and the inner leaf of the pericardial sac is up to 5 mm. An increase in this indicator indicates an excess of transudate.
• Diagnostic puncture. The procedure gives an understanding of the properties of the fluid of the cavity of the heart bag.

The diagnostic center at the Medscan clinic is equipped with modern and high-precision state-of-the-art equipment. The center presents a wide range of laboratory, instrumental examinations in combination with comprehensive programs.

Treatment methods in Medscan

The tactics of patient management at the Medscan clinic is based on international protocols. An individual treatment plan is drawn up for each patient. Treatment of hydropericardium depends on the amount of accumulated fluid, as well as echocardioscopy (ultrasound of the heart).

Based on the results of laboratory and instrumental studies, the doctor makes appropriate appointments.

First of all, specialists pay attention to the main pathology (oncological process), which provoked the complication. In parallel with the treatment of cancer, the fight against hydropericardium is being carried out. It begins with the use of diuretics (diuretic drugs), which “unload” the circulatory system and remove excess fluid.

A significant amount of effusion is observed with a combination of transudate and exudate (produced during inflammation), which requires a therapeutic puncture of the pericardium.

Expert opinion

The prognosis of the pathological process is determined by the degree of its intensity, as well as the timeliness of diagnosis. Favorable prospects for the treatment of hydropericardium are possible with the complete elimination of its cause, otherwise, even against the background of stabilization of the general condition, there is a possibility of a recurrent course.

There is no specific primary prevention of hydropericardium. Patients with pathologies that can be complicated by the accumulation of effusion between the sheets of the pericardium should be under the supervision of experienced specialists, regularly undergo examinations and follow all medical recommendations.

Olkin Dmitry Borisovich

Oncologist, chemotherapist

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Hydropericardium

Hydropericardium – what is it?

Hydropericardium is called an abundant accumulation of liquid mass in the heart sac. This bag itself consists of two leaves surrounding the heart. Their task is to protect it and separate it from other organs. Fluid collects in the middle of the sac (called the “pericardium”). Its quantity is insignificant, and it is designed to prevent the walls of the bag from rubbing against each other, as well as the heart. For a normal condition, the sheets are 3-5 millimeters apart, the amount of accumulated liquid is up to 50 milligrams.

If there is too much fluid, it prevents the heart from working properly, which can lead to cardiac tamponade and cardiac arrest.

The disease we are talking about dramatically increases the amount of natural fluid in the heart bag at times. If the natural amount of liquid mass ranges from 15 to 50 milligrams, then in a pathological condition this amount can be over a liter. In addition, with the development of pathology, blood or lymph enters the bag.

Reasons

What causes the disease? Let’s start with a description of the mechanism of normal functioning. So, the fluid is produced by the cells of the pericardium, they also absorb it. That is, there is a natural control of the amount of fluid, as well as its renewal. If one of these processes is disturbed, a hydropericardium occurs.

The causes of the disease are very different:

• Pericarditis;
• Heart failure;
• Chronic renal failure;
• Heart defects;
• Post-infarction condition;
• Hypothyroidism;
• Rheumatoid arthritis;
• Infections;
• Injuries of the chest;
• Allergic reactions;
• Insufficient protein level;
• Cancer and other neoplasms;
• Intoxication, etc.

As a rule, the disease belongs to the category of secondary pathologies, which must be taken into account when diagnosing and prescribing treatment. That is, it is very important to find the true cause that led to the development of the disease.

Classification

The classification is based on the main aspect – the amount and type of accumulated fluid.

Taking into account the amount of fluid in the heart sac and the distance between its leaves, they speak of three stages of the disease:

• Early stage. The amount of accumulated liquid does not exceed 100 ml, the distance between the sheets is from 6 to 10 mm;
• Moderate stage. The accumulated liquid is within 100 – 500 ml, the sheets have diverged by 10-20 mm;
• Pronounced stage. Water weight > 500 ml, sheets spread more than 20 mm.

As you can see, an increase in the amount of accumulated fluid increases not only the manifestation of symptoms, but the risk to health and life.

The moment of quality of the accumulated liquid is also important. It can be of several types, it is important to know for diagnosis:

• Accumulated natural fluid – diagnosis of hydropericardium;
• Accumulation of fluid with blood – “hemopericardium”;
• Accumulation of lymphatic fluid – “chelopericardium”;
• Accumulated pus and inflammation – “pericarditis”.

Symptoms

The volume of accumulated transudate fluid at an early stage of pathology < 100 mils. If the indicator increases, then, most likely, we are talking about the beginning of the inflammatory process.

At an early stage, external symptoms practically do not appear, at the subsequent ones they may be as follows:

• Profuse sweating;
• Pain in the chest, aggravated by stooping forward;
• General weakness;
• Pale skin;
• Manifestations of tachycardia;
• Rapid shallow breathing;
• Swelling in the legs.

Further development of the disease entails the appearance of new symptoms simultaneously with a decrease in blood pressure.

An extreme complication of the pathology is the development of cardiac tamponade. It manifests itself with strong squeezing of the heart by accumulations of fluid, in which normal contractions of the organ are impossible.

Tamponade symptoms:

• Severe weakness;
• Increasing dyspnea;
• Fear of death.

This condition requires an immediate visit to the doctor.

Diagnostic measures

Diagnosis begins with an examination and history taking.

As an instrumental study, the following are applicable:

• Chest X-ray – reveals a significant increase in fluid volume;
• X-ray kymography – registers pulsations of the heart departments and main vessels;
• Echocardiography – is the main technique used to detect pathology;
• Diagnostic pericardial puncture – allows you to determine the type of accumulated fluid.

For a deeper study, blood and urine tests are necessary, ultrasound examinations of the small pelvis, abdominal cavity, and other studies are possible.

Treatment, prognosis, prevention

Treatment tactics depend on several factors, including the volume of accumulated fluid and the condition of the heart.