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EDITOR IN CHIEF

Dr RusheeKanta Mohanta (MD.DM.)

Pericardial Effusion

FEB15-26(3)
Date : 5/17/2021
Author : Dr. Rushee Kanta Mohanta (MD, DM. AFESC)
Publisher : Heartmate
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Volume No : 26 Issue No : 3
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Pericardial effusion is collection  of excess fluid in the sac-like structure around the heart  called pericardium.Thispericardium has two layers. The space between the layers normally contains a thin layer of fluid. But if the pericardium is diseased or injured, the resulting inflammation can lead to excess fluid. Fluid can also build up around the heart without inflammation, such as from bleeding after a chest trauma.

pericardial-effusion

Symptoms

If pericardial effusion symptoms do occur, they might include:

  • 1. Shortness of breath or difficulty breathing (dyspnea)
  • 2. Discomfort when breathing while lying down (orthopnea)
  • 3. Chest pain, usually behind the breastbone or on the left side of the chest
  • 4. Chest fullness
  • 5. Swelling in the legs or abdomen

Causes

Pericardial effusion can result from inflammation of the pericardium in response to illness or injury. Pericardial effusion can also occur when the flow of pericardial fluid is blocked or when blood collects within the pericardium, such as from a chest trauma.

Causes of pericardial effusion include:

  • 1. Inflammation of the pericardium following heart surgery or a heart attack
  • 2. Autoimmune disorders such as rheumatoid arthritis or lupus
  • 3. Spread of cancer , particularly lung cancer, breast cancer, melanoma, leukemia, non-Hodgkin's lymphoma or Hodgkin's disease
  • 4. Cancer of the pericardium or heart
  • 5. Radiation therapy for cancer if the heart was within the field of radiation
  • 6. Chemotherapy treatments for cancer,
  • 7. Waste products in the blood due to kidney failure.
  • 8. Underactive thyroid (hypothyroidism)
  • 9. Viral, bacterial, fungal or parasitic infections
  • 10. Trauma or puncture wound near the heart after open-heart surgery

Complications

Depending on how quickly pericardial effusion develops, the pericardium can stretch somewhat to accommodate the excess fluid. However, too much fluid causes the pericardium to put pressure on the heart, which prevents the chambers from filling completely.

This condition, called tamponade , results in poor blood flow and a lack of oxygen to the body. Tamponade is life-threatening and requires emergency care.

Diagnosis

Echocardiogram

An echocardiogram uses sound waves to create real-time images of your heart. This test allows your doctor to see how much fluid has collected in the space between the two layers of the pericardium. An echocardiogram can also show how well your heart is pumping blood and help diagnosis tamponade or a collapse in one of the heart's chambers.

Electrocardiogram

An electrocardiogram, also called an ECG or EKG, records electrical signals as they travel through your heart. Your cardiologist can look for patterns that suggest tamponade.

Chest X-ray

If you have a lot of fluid in the pericardium, a chest X-ray may show an enlarged heart.

Treatment

Treatment for pericardial effusion will depend on the amount of fluid, the underlying cause, and whether you have or are likely to develop cardiac tamponade. Treating the cause of pericardial effusion often corrects the problem.

Medications that reduce inflammation

If you don't have tamponade or there's no immediate threat of tamponade, your doctor might prescribe an anti-inflammatory drug to reduce inflammation of the pericardium:

  • 1. Aspirin
  • 2. Nonsteroidal anti-inflammatory drugs (NSAIDs),
  • 3. Colchicine
  • 4. Corticosteroid, such as prednisone

Medical procedures and surgery

If anti-inflammatory treatments don't correct the problem or you have or are likely to have tamponade, your cardiologist may recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.

 

  • 1. Drain the fluid. Your doctor can enter the pericardial space with a needle and then use a small tube (catheter) to drain fluid — a procedure called pericardiocentesis. The doctor uses echocardiography or a type of X-ray imaging called fluoroscopy to guide the catheter to the right position. In most cases, the catheter will be left in place to drain the area for a few days to help prevent the fluid from building up again.
  • 2. Open-heart surgery. If there's bleeding into the pericardium, especially due to recent heart surgery or other complications, open-heart surgery may be done to drain the pericardium and repair damage. Occasionally, a surgeon may also create a "passage" that allows fluid to drain as necessary into the abdominal cavity, where it can be absorbed.

 

Dr. Rushee Kanta Mohanta.

MD, DM. AFESC

Heartmate Institute Pvt. Ltd.




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