Understanding Pericardial Effusion

Pericardial effusion is an alarming thing to experience: A common symptom of this condition is a sharp, stabbing chest pain that comes on quickly. Other common symptoms include shortness of breath and low blood pressure.

“When people have it, they typically say it feels extremely uncomfortable,” says Lee Jobe, MD, an interventional cardiologist and medical director of the cardiac catheterization labs at the North Carolina Heart & Vascular Hospital in Raleigh, on the UNC REX Healthcare campus.

Of course, these symptoms might cause people to think they are having a heart attack. But pericardial effusion is different; it means excess fluid has built up between the heart and the sac surrounding the heart, called the pericardium. In most cases, inflammation of the pericardium leads to the effusion, which can disrupt the proper functioning of the heart and cause it to pump blood less efficiently.

Symptoms of Pericardial Effusion

The chest pain and shortness of breath common with pericardial effusion can seem like a heart attack or a sign of heart failure. So getting an electrocardiogram, or EKG, to detect and record your heart’s electrical activity is an essential first step for diagnosis.

Depending on what the EKG shows, your doctor might use additional diagnostic tests, such as a chest X-ray, echocardiography, cardiac CT and cardiac MRI, Dr. Jobe says.

Causes of Pericardial Effusion

There are several potential causes of the inflammation that leads to pericardial effusion, Dr. Jobe says. These include:

  • HIV infection or AIDS
  • Viral infections that cause a cold or pneumonia
  • Some bacterial infections, including tuberculosis
  • Underactive thyroid gland
  • Kidney failure
  • Cancer
  • Heart attack
  • Lupus
  • Rheumatic fever

Pericardial effusion is typically diagnosed at the hospital after someone has been admitted because of their symptoms. To treat pericardial effusion, doctors must remove the excess fluid, Dr. Jobe says.

Untreated pericardial effusion puts pressure on the heart and impairs its function in the long run, potentially leading to heart failure or death.

Treatment for Pericardial Effusion

As an interventional cardiologist, Dr. Jobe performs a nonsurgical, catheter-based procedure called pericardiocentesis to treat pericardial effusion. During pericardiocentesis, a doctor threads a catheter into the sac surrounding the heart to drain built-up fluid and relieve symptoms. Medical professionals then test the fluid for signs of infection, cancer or other problems.

Not all patients can be treated successfully with pericardiocentesis. Some may require a surgical procedure called pericardial window. In this procedure, a heart surgeon cuts away a small piece of the pericardium. This causes the fluid to drain and prevents fluid from building back up.

In the most difficult cases, a larger part or sometimes all of the pericardium might need to be removed. This is called a pericardiectomy or pericardial stripping operation, and it is typically done only after less invasive procedures are unsuccessful.

Recovery Time for Pericardial Effusion Treatment

The time that someone must stay in the hospital after these procedures is highly variable, Dr. Jobe says, and it depends on what other treatment they might need.

For example, a patient treated with pericardiocentesis might stay in the hospital for just one or two days if he or she has no other conditions that require inpatient treatment. A patient treated with pericardial window will probably need to stay in the hospital for at least a few days, while a patient treated with pericardiectomy or pericardial stripping will probably be hospitalized for five to seven days.

But if a patient treated with one of these methods also has cancer, for example, then the hospital stay is likely to be longer and determined by the cancer treatment regimen, Dr. Jobe says.

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