Pericardial effusion

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Overview

Pericardial effusion is the buildup of extra fluid in the space around the heart. If too much fluid builds up, it can put pressure on the heart. This can prevent it from pumping normally.

A fibrous sac called the pericardium surrounds the heart. This sac consists of two thin layers. Normally, there is a small amount of fluid between them. The fluid reduces friction between the two layers as they rub against each other during each heartbeat. In some cases, extra fluid can build up between these two layers leading to a pericardial effusion.

A little fluid won’t cause much of a problem. But if too much fluid builds up, it can make it hard for the heart to expand normally. This condition is called cardiac tamponade. It usually requires emergency treatment. Because the heart can't expand normally, less blood can enter the heart from the body. This can reduce the amount of oxygenated blood going out to the body. But not all pericardial effusions cause cardiac tamponade.

In some cases, pericardial effusion develops quickly. This is known as acute pericardial effusion. Other times, the fluid builds up slowly. This is known as subacute pericardial effusion. Chronic pericardial effusion occurs when cardiac effusion happens more than once over time

Symptoms

You may not have any symptoms. This is more often the case with a mild effusion. You might be more likely to have symptoms from whatever is causing the pericardial effusion. For example, you might have fever if you have an infection of the pericardial sac.


When effusion is more severe, you may have symptoms such as:


Chest pain or discomfort

Enlargement of the veins of the neck

Fainting

Fast breathing

Increased heart rate

Nausea

Pain in the right upper abdomen

Shortness of breath

Swelling in the arms and legs

If the effusion is very severe, it can also lead to very low blood pressure. This can cause symptoms of shock. These include:


Lightheadedness or dizziness

Cool arms and legs

Clammy skin

Weakness

Rapid breathing

Nausea or vomiting

Pale skin

Less urine output

Shock is a medical emergency.

Causes

A number of conditions can cause excess fluid and inflammation in the pericardial sac, such as:


Cancer (spread from another part of the body or from the heart tissue itself)

Infection of the pericardial sac, such as from viral or bacterial infections

Inflammation of the pericardial sac (for example, because of a heart attack)

Injury (including those from medical procedures on the heart)

Immune system problems

Metabolic causes, like kidney failure with uremia

Reactions to certain medicines

Radiation

Sometimes the cause of fluid buildup is unknown.

Risk factors

Autoimmune disorders, such as rheumatoid arthritis or lupus. Cancer of the heart or pericardium. Spread of cancer (metastasis), particularly lung cancer, breast cancer or Hodgkin's lymphoma.

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Complications

A potential complication of pericardial effusion is cardiac tamponade (tam-pon-AYD). In this condition, the excess fluid within the pericardium puts pressure on the heart. The strain prevents the heart chambers from filling completely with blood.

Cardiac tamponade results in poor blood flow and a lack of oxygen to the body. Cardiac tamponade is life-threatening and requires emergency medical treatment.

Prevention

You can reduce your risk of some of the medical problems that can lead to pericardial effusion. For example, take care of your heart by:


Limiting alcohol.

Eating a heart-healthy diet.

Getting enough exercise

Staying at a healthy weight.

Seeing a healthcare provider regularly to treat your medical problems.

Many cases of pericardial effusion are not preventable.