In a pericardial effusion, a large amount of fluid accumulates between the lining of the heart and the pericardium within a very short time. Many people also refer to this condition as pericardial effusion, as the affected pericardial cavity is located directly next to the pericardium.
Below you will find further information and selected pericardial effusion specialists.
Pericardium is the medical term for pericardium. This is a type of sac in which the heart is located. Strictly speaking, the pericardium consists of two connected membranes with fluid between them. This fluid is also known as pericardial fluid and is constantly produced and reabsorbed by the pericardial layers. This is why the membranes of the pericardium are also referred to as serous tissue layers. In order to ensure proper function of the pericardium, a fluid of 10-50 ml is required between the layers. This layer is also known as the pericardial cavity.
In patients with a pericardial effusion, fluid accumulates between the layers of the pericardium. The fluid that builds up is continuously absorbed by the body in order to form a stable circulation. In the case of a pericardial effusion, however, much more fluid is drained into the pericardial cavity than out of it, usually within a very short time, so that it becomes increasingly full. The resulting constricted heart muscle loses its capacity and can no longer completely fill the heart chambers with blood. If the fluid increases over a short period of time, around 150 - 200 ml is enough to cause cardiac insufficiency. In the case of a chronic effusion, which builds up over weeks and months, up to 2000ml can accumulate before this causes problems.
Many people also refer to this condition as pericardial effusion, as the affected pericardial cavity is located directly next to the pericardium. Small pericardial effusions are very rarely noticed by those affected. A small pericardial effusion does not yet cause any noticeable symptoms. Only when the effusion becomes severe do numerous symptoms occur. In addition to the reduced cardiac output, there are often symptoms that indicate cardiacinsufficiency. These include a clearly visible congestion of blood in the neck veins and a blue coloration of the lips.
Numerous causes can lead to a pericardial effusion.
As a pericardial effusion can lead to a restriction or cessation of the heart's pumping capacity, every pericardial effusion is potentially life-threatening. However, there is one variant that is the most dangerous: the bloody pericardial effusion, also known as hematopericardium . This involves bleeding into the pericardium, caused by a ventricular rupture, among other things.
This refers to a tear in the heart wall, which can occur, for example, in the case of an extensive heart attack. This can be explained by the fact that muscle tissue is destroyed by the heart attack and is no longer as stable as before due to scarring. The rupture causes heavy and rapid bleeding into the pericardium, which can completely compress the heart chambers. This is also known as pericardial tamponade, which is an acute emergency.
If the bleeding is not stopped immediately and the pericardium is opened and the haematoma removed, there is an absolute danger to life. Injury to the heart, e.g. by a knife thrust or a bullet from a gun, can also lead to pericardial tamponade. Finally, a rupture of the aorta in the exit area also regularly leads to a hematopericardium or pericardial tamponade.
A hematopericardium is fortunately a very rare but serious and life-threatening complication of cardiac catheterization or implantation of a pacemaker. These cases are referred to as iatrogenic causes of a hematopericardium, which means "caused by the doctor".
Numerous infectious diseases can also lead to pericardial effusion. For example, it often accompanies tuberculosis, herpes and HIV. Furthermore, pericardial effusion and heart failure are mutually dependent. While the constriction of the heart muscle leads to a drastic reduction in performance, heart failure also triggers an accumulation of fluid in the pericardial cavity due to insufficient cardiac output. In addition, this disease often poses a risk of heart surgery. It is not uncommon for the pericardium to become slightly inflamed, which can quickly lead to an effusion.
Finally, several cancers also lead to this disease. In addition to breast and lung cancer, leukemia is also known to trigger a severe pericardial effusion. Rheumatism, ulcerative colitis and Crohn's disease also lead to these symptoms. These are three particularly serious immunological diseases.
Severe pericardial effusion can lead to numerous complications. As a rule, patients suffer from
However, if the disease remains untreated, blue lips quickly form and a so-called pericardial tamponade occurs. This is a condition in which the heart can no longer perform its functions due to the enormous pressure from the pericardial cavity. In addition, the coronary arteries are often constricted by the ever-expanding pericardium. As a result, they no longer supply the heart with oxygen and the nutrients it needs. Ultimately, this usually leads to cardiac arrest and the death of the patient.
If a pericardial effusion is suspected, action must be taken quickly. Even a mild condition can lead to a severe pericardial effusion and thus to serious complications. For this reason, an ultrasound examination of the heart(echocardiography) is ordered even if there is only a slight suspicion. In some cases, a computer tomography scan is also performed. If these examinations confirm the suspicion, it may also be necessary to remove some fluid from the pericardial cavity. This is medically known as a pericardiocentesis. The extracted fluid must then be examined for cancer cells and pathogens.
CT image of a pericardial effusion; By James Heilman, MD - Own work, CC BY-SA 3.0, Link
A medical history is then usually taken. Among other things, this serves to determine all risk factors and any hereditary diseases the patient may have. In most cases, the medical history is taken without any concrete results, but many dangerous diseases can be ruled out as a cause.
For a medical diagnosis, however, it is sufficient if the patient complains of shortness of breath and persistent fatigue and the excessive pericardial fluid is clearly visible on ultrasound examination or computer tomography. In severe cases, this fluid surrounds the entire heart and is therefore clearly visible.
The treatment of a pericardial effusion basically depends on the severity of the disease and its cause. A chronic effusion rarely leads to serious complications and is no longer treated, especially in older patients. One of the reasons for this is that every treatment has risks and can be associated with serious complications, especially in advanced age. Therefore, invasive measures (e.g. puncture or relief) are avoided in older patients with few symptoms. An acute pericardial effusion, on the other hand, represents an immediate danger that should be treated regardless of age.
In principle, treatment depends on the underlying disease. In the case of mild effusions caused by infections, the infectious disease is treated first. In some cases, especially in the case of viral diseases, bed rest for a few days is sufficient. However, a visit to the doctor is essential, as severe pericardial effusions can quickly become life-threatening. Drug treatment may be necessary and helpful in cases of pain. As a rule, smaller amounts of ibuprofen are used. In the case of a persistent infection, especially if it is caused by bacteria, specific treatment with antibiotics is prescribed.
In some cases, drug therapy does not work. A so-called pericardiocentesis may then be necessary. In this procedure, a needle is inserted into the patient's pericardial cavity and the excess fluid is then removed using a cannula.
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