Pericardial effusion – causes, symptoms & therapy

A fluid accumulation of more than 10 ml in the heart sac is called a pericardial effusion. The sac around the heart (pericardium) serves as a connective tissue-like sac to protect the heart and, with the help of a small amount of serous fluid, ensures that it can move freely. However, if there is an increase in the amount of fluid due to pathological processes, the pressure on the heart also increases.

This restricts their freedom of movement, often with fatal consequences. Pericardial effusion is a relatively rare finding and can be either chronic or acute.

causes

Pericardial effusion occurs rarely and is usually the result of other diseases. Infectious-inflammatory or rheumatic-inflammatory processes of the heart often play a role in their development.Tuberculosis used to be one of the main causes of this disease. Today, however, pericardial effusion most commonly develops on the basis of malignant tumor colonization in the pericardium.

In some cases, renal failure can also lead to this complication. Kidney weakness often leads to poisoning of the blood with substances excreted in the urine. As a result, in addition to a variety of symptoms, inflammation of the pericardium often occurs , which sometimes forms the starting point for a pathological accumulation of fluid in the pericardium.

A heart attack can also lead to pericardial effusion. In rarer cases, this disease occurs after heart surgery, a pacemaker implantation or drug treatment. Overall, pericardial effusion occurs only rarely, but can lead to life-threatening cardiac tamponade.

symptoms and course

Typical symptoms of a pericardial effusion:

• racing heart

• Enlarged spleen

• enlarged liver

• Low blood pressure

• cardiovascular failure

• shortness of breath

• bowel failure

• Acute renal failure

A small amount of pericardial effusion has no symptoms. However, the higher the degree of filling of the pericardium, the greater the pressure on the heart. The inflow of blood into diastole decreases and the ejection volume per heartbeat decreases. The result is blood congestion in front of the right ventricle and an increase in heart rate.

In the case of an acute extreme pericardial effusion, however, cardiac tamponade occurs with a drop in pressure and circulatory failure. This condition is very life threatening. Severe shortness of breath with suffocation occurs.

Blood congestion can also damage the liver, intestines and kidneys. The detoxification processes in the body no longer work properly. This condition requires immediate emergency medical attention. In general, however, pericardial effusion is chronic and causes little discomfort.

Diagnose

In the case of enlarged liver, jugular vein congestion, enlarged spleen, low blood pressure and enlarged heart, the suspected diagnosis of pericardial effusion should be made, among other things. An ultrasound scan is the best way to diagnose this. A CT or MRI can also demonstrate the presence of fluid accumulation in the pericardium. A characteristic low voltage can be seen in the ECG . In order to determine the cause of the disease, the pericardium is often punctured and the punctured for any bacteria or virusesor even tumor cells examined. Other differential diagnoses for the causes of pericardial effusion relate to possible autoimmune processes, tuberculous lung diseases, conditions after a heart attack or bleeding into the pericardial sac.

treatment and therapy

The pericardial effusion is often so slight that it does not require any treatment itself, since in these cases there are usually no symptoms. However, the cause of the fluid accumulation should be clarified in order to be able to treat the underlying disease. As a rule, these are diseases that can be treated well with medication. After drug therapy, the pericardial effusion usually goes away on its own.

However, if there is a large amount of fluid in the pericardial sac, a pericardial puncture should be performed. Rapid action is required in the case of cardiac tamponade because it is an extremely life-threatening condition. Cardiac tamponade marks a rapid influx of fluid into the pericardium. During the puncture, the pericardium is punctured with a needle and fluid is drained.

If there is a bacterial underlying disease, however, new liquid is constantly forming, which must be permanently removed. This is achieved with the help of a so-called drainage.The drain is a small tube that is placed in the pericardium to drain fluid regularly. To avoid complications, the pericardium puncture must be subject to constant ultrasound control.

The heart, circulation and respiration are continuously monitored, because in rare cases the puncture can lead to cardiac arrhythmias or injuries to the heart or lungs. Furthermore, a laboratory examination of the aspirate is carried out to determine any pathogens or tumor cells. These examinations form the basis for the therapy of the underlying disease.

For example, the question arises as to whether treatment with antibiotics or even cancer therapy is necessary. Overall, the puncture and accompanying examination of a pericardial effusion is so demanding that it should be left to physicians who have extensive experience in this field.

prevention

There are no concrete preventive measures to prevent pericardial effusion, as the causes can be very different. The triggers include bacteria, viruses, tumor cells, pathological changes in the heart (e.g. heart attack), renal insufficiency or postoperative conditions. However, a healthy lifestyle reduces the likelihood of developing pericardial effusion.