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Although well tolerated for some patients, fluid buildup around the heart, particularly in excess, can cause other complications like heart failure and even death.
Pericarditis is the inflammation of the heart’s tissue layer, or pericardium. Pericardial effusion happens when the pericardium is damaged, and fluid puts pressure on the heart.
Dr. Syed Haider, a cardiologist at MedStar Washington Hospital Center, said the most common causes of pericardial effusion include inflammation caused by a virus.
“That inflammation could be due to a viral problem in developed countries, such as ours, or in less developed countries, it could be fungal or bacterial,” he said.
Other causes include autoimmune disorders such as lupus or rheumatoid arthritis, cancer, kidney failure, and bleeding from a chest trauma or surgery.
According to Dr. Haider, any irritation can trigger the lining of the heart to accumulate fluid around it.
“It could be a cardiac surgery – something as invasive as a big surgery. Or it could be something as mild or as low, intermediate risk as a catheterization or getting stents to the heart,” he said.
If untreated, pericardial effusion can cause congestive heart failure and cardiac tamponade, which would require immediate medical attention
Even though severe cases of pericardial effusion can lead to serious problems, Dr. Haider describes it as a spectrum of risk. He said in many cases, having fluid around the heart can be very well tolerated by patients for months or years as long as it’s developing slowly.
“If it develops rapidly, the heart’s layer or the pericardium, does not have enough time to accommodate for that stretch,” Dr. Haider said. “If the fluid is accumulating very rapidly, it starts compressing the heart muscle, and then the heart muscle cannot fill and cannot provide the blood that the body needs, and that can be fatal.”
If needed, Dr. Haider said doctors can conduct a pericardiocentesis, a procedure used to relieve the heart muscle of compression.
“You have to relieve the heart of that bag of fluid around it that’s completely blocking its filling.. so if it’s a dramatic urgency, where the fluid accumulated so quickly, you have to get rid of it to decompress,” he explained.
During a pericardiocentesis, doctors do an ultrasound to confirm where the fluid is and then insert a needle through the chest wall, into the pericardium.
Once it’s confirmed that the needle is truly in the pericardial space, doctors begin draining the fluid.
“You attach that needle to a drain and that drain stays there for a few days until the amount of blood is less than 50 CC’s in 24 hours,” Dr. Haider said.
Pericardial effusion can develop quickly or slowly over time. Dr. Haider said to diagnose it, he starts with analyzing a patient’s symptoms.
“Were they having any shortness of breath, any chest pain, any fatigue, or rather, any symptom that speaks to their heart’s not getting the ability that it needs to accommodate that blood,” he said.
Nausea and difficulty swallowing can also be signs of effusion.
Doctors use advanced imaging techniques like a CT scan or MRI to discover effusions. Oftentimes Dr. Haider incidentally discovers them when examining a patient for unrelated reasons, and he said those discoveries tend to be less serious.
There’s no exact way to prevent pericarditis or pericardial effusion, according to Dr. Haider.
“Not everybody who has a mundane cold or a viral upper respiratory infection will develop pericarditis, while other patients will.”
Improper treatment during a patient’s first episode is one reason some cases of pericarditis become chronic and debilitating, Dr. Haider said.
“I see many times that their first episode is either sub-optimally treated, not treated at all, or just not diagnosed,” Dr. Haider said. “As long as you have done an optimal, guideline directed approach in treating their first event, especially with Colchicine, you can dramatically reduce not only their symptoms, but their chances of their pericarditis coming back.”
Colchicine is the first anti-inflammatory drug approved by the FDA for treating cardiovascular disease related to atherosclerosis, or the buildup of plaque in the arteries. The drug is intended for the prevention of heart or blood vessel problems in patients with a history of a prior heart problem.
Ultimately, treatment for pericardial effusion will be determined by the cause, and treatment could range from medication to heart surgery.
Read more about Dr. Haider’s work and pericardial effusion on the MedStar Washington Hospital Center website.
