Overview

Pericardial effusion (per-e-KAHR-dee-ul uh-FU-zhun) is the accumulation of too much fluid in the double-layered, sac-like structure around the heart (pericardium).

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 puts pressure on the heart, affecting the heart's function. If untreated, it can lead to heart failure or death.

Source: http://www.mayoclinic.com

Symptoms

You can have significant pericardial effusion without signs or symptoms, particularly if the fluid has increased slowly.

If pericardial effusion symptoms do occur, they might include:

• Shortness of breath or difficulty breathing (dyspnea)
• Discomfort when breathing while lying down (orthopnea)
• Chest pain, usually behind the breastbone or on the left side of the chest
• Chest fullness

When to see a doctor

Call 911 or your local emergency number if you feel chest pain that lasts more than a few minutes, if your breathing is difficult or painful, or if you have an unexplained fainting spell.

See your doctor if you have shortness of breath.

Source: http://www.mayoclinic.com

Causes

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

Sometimes the cause can't be determined (idiopathic pericarditis).

Causes of pericardial effusion can include:

• Inflammation of the pericardium following heart surgery or a heart attack
• Autoimmune disorders, such as rheumatoid arthritis or lupus
• Spread of cancer (metastasis), particularly lung cancer, breast cancer, melanoma, leukemia, non-Hodgkin's lymphoma or Hodgkin's disease
• Cancer of the pericardium or heart
• Radiation therapy for cancer if the heart was within the field of radiation
• Chemotherapy treatment for cancer, such as doxorubicin (Doxil) and cyclophosphamide
• Waste products in the blood due to kidney failure (uremia)
• Underactive thyroid (hypothyroidism)
• Viral, bacterial, fungal or parasitic infections
• Trauma or puncture wound near the heart
• Certain prescription drugs, including hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis drug; and phenytoin (Dilantin, Phenytek, others), a medication for epileptic seizures

Source: http://www.mayoclinic.com

Diagnosis

If your doctor suspects you have pericardial effusion, he or she will do a series of tests to look for it, identify possible causes and determine treatment.

Medical exam

Your doctor will perform a medical exam, including listening to your heart with a stethoscope.

Echocardiogram

An echocardiogram uses sound waves to create real-time images of your heart. With this procedure, a cardiologist can see the extent of pericardial effusion based on the amount of space between the two layers of the pericardium. An echocardiogram can also show decreased heart function due to pressure on the heart (tamponade).

Your cardiologist might be able to see whether one or more chambers of the heart have collapsed and how efficiently your heart is pumping blood. There are two types of echocardiograms:

• Transthoracic echocardiogram. This test uses a sound-emitting device (transducer) that is placed on your chest over your heart.
• Transesophageal echocardiogram. A tiny transducer on a tube is put down the part of your digestive tract that runs from your throat to your stomach (esophagus). Because the esophagus lies close to the heart, having the transducer placed there often provides a more-detailed image of the heart.

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

This can show an enlarged heart silhouette if the amount of fluid in the pericardium is large.

Other imaging technologies

Computerized tomography (CT) scans and magnetic resonance imaging (MRI) are imaging technologies that can detect pericardial effusion, although they're not generally used to look for the disorder. However, pericardial effusion may be diagnosed when these tests are done for other reasons.

Other tests

If there's evidence of pericardial effusion, your doctor might order blood tests or other diagnostic tests to identify a cause.

Source: http://www.mayoclinic.com

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 keeps the chambers from filling completely.

This condition, called tamponade (tam-pon-AYD), results in poor blood circulation and an inadequate supply of oxygen to the body. Tamponade is life-threatening and requires emergent/urgent attention.