Pericardial Effusion

What Is Pericardial Effusion?

Mesothelioma-associated pericardial effusion happens when too much fluid builds up in the heart sac or the membranes covering your heart called the pericardium. The extra fluid in this space creates pressure on your heart and can become fatal. 

Pericardial effusion is rare. This fluid can build up when the lining of your heart sac becomes irritated or inflamed. It can also happen if injury, surgery or disease causes blood or other fluids to enter the space.

Key Facts About Pericardial Effusions

1. Pericardial effusion can threaten your life. Fluid in the sac around your heart can cause cardiac tamponade, which is pressure that can keep your heart from filling and pumping properly, requiring quick treatment.
2. Symptoms often look like common illnesses. Chest pain, trouble breathing and fatigue can mimic heart or lung problems, so doctors usually need imaging to find the actual cause.
3. Cancer often plays a role. Lung cancer, breast cancer or mesothelioma can spread to the heart’s lining and cause fluid to collect.
4. Treatment depends on your situation. Doctors use medicine for mild cases, but severe or recurring effusions often need drainage via needle or surgery. Treating the underlying disease always matters.

Treatment needs to start as soon as symptoms are detected. The aim of treatment is to relieve pressure on the heart and treat the underlying cause. Doctors can offer tailored approaches based on symptoms and causes. Staying aware of symptoms can help you begin treatment before mesothelioma advances and you have fewer options.

Types of Pericardial Effusion

Mesothelioma pericardial effusions are classified based on their fluid source and appearance. For example, a malignant effusion occurs in those with mesothelioma. Each category potentially shifts treatment options. Some are more lethal than others.

Kinds of Pericardial Effusions

• Bloody pericardial effusion: Also called hemorrhagic pericardial effusion. Causes include cancer, chest injury (traumatic), bleeding related to heart surgery or a “spontaneous”  bleed into the space from  a torn aorta (vascular causes).
• Cancer-related pericardial effusion: A malignant pericardial effusion may or may not contain blood. Tumors like mesothelioma or metastatic cancer drive fluid to collect in the pericardium.
• Clear fluid pericardial effusion: Doctors call this a transudative pericardial effusion. Fluid collects in the sac from underlying general disease such as heart failure, kidney problems or liver disease or from radiation.
• Infection-related pericardial effusion: The formal term is purulent pericardial effusion. Severe infections with bacteria or fungi fill the space with pus.
• Milky pericardial effusion: The formal name is chylous pericardial effusion. A lymph vessel injury, sometimes after chest trauma or surgery, leads to this rare milky fluid.
• Pericardial effusion from an unknown cause: Sometimes, doctors can’t find the reason for the fluid buildup. This type is officially called “idiopathic.” 
• Protein-rich pericardial effusion: The medical name is exudative pericardial effusion. Infections, inflammatory diseases (like rheumatoid arthritis or lupus), or cancer put extra protein and cells in the fluid.

Doctors analyze the mesothelioma pericardial effusion fluid to assess the type. This analysis is crucial and dictates the next steps.

What Causes Pericardial Effusion?

Sometimes, there is no definitive cause or reason for mesothelioma pericardial effusion. This makes it imperative to analyze risk factors and treat the underlying diseases. Regular medical check-ups are essential for continued assessment.

Causes of Pericardial Effusion

• Bacterial, viral, fungal or parasitic infections
• Cancer, such as mesothelioma and lung cancer
• Certain chemotherapy drugs like doxorubicin and cyclophosphamide
• Inflammation, including that of the heart lining
• Pleural mesothelioma or other chest cancers
• Radiation therapy to the chest
• Traumatic injuries to the heart
• Underactive thyroid

Registered nurse and mesothelioma expert Sean Marchese, MS, RN, tells us that prevention isn’t always possible. He says, “Pericardial effusion is often not something we can completely prevent, especially with certain cancers like mesothelioma. The good news is that doctors are always monitoring you for it, and there are very effective ways to manage it if it does happen.” 

Learn about your diagnosis, top doctors and how to pay for treatment in our free mesothelioma guide.

Get Your Guide

Mesothelioma and Pericardial Effusion

The rarest form of mesothelioma is the pericardial variety. These tumors create inflammation inside the heart sac, causing too much fluid around the heart. Its location can make it challenging to diagnose early. Modern Pathology reports that fewer than 1% of mesothelioma patients have this type, which affects 10 to 15 people in the U.S. every year.

Many people are only diagnosed once symptoms set in. This delay is why early diagnosis and treatment are so valuable to ensure effectiveness. Doctors use imaging to detect changes that could lead to mesothelioma pericardial effusion. Acting fast can mean the difference between a swift recovery and a dangerous complication.

What Are the Symptoms of Pericardial Effusions? 

Symptoms of mesothelioma pericardial effusion, such as shortness of breath, chest pain and fatigue, mirror heart and lung issues. These symptoms aren’t definitive, with many people experiencing various symptoms at the same time. However, the European Society of Cardiology notes nearly 90% of patients with pericardial effusion experience chest pain.

Common Pericardial Effusion Symptoms

• Chest pain or discomfort
• Dizziness
• Fainting
• Fatigue
• Increased heart rate or arrhythmia
• Shortness of breath
• Swelling in the abdomen or limbs

When excess fluid develops, it creates pressure on the heart, and with more pressure, symptoms increase in severity. Many people don’t notice anything wrong at first. Symptom development can occur gradually or immediately. This variance is why early detection through imaging is key.

Complications of Pericardial Effusion

The most severe complication is cardiac tamponade. Cardiac tamponade occurs when pressure on the heart becomes too much, and the heart can’t pump effectively, necessitating emergency drainage of the fluid.

Complications of Pericardial Effusion

• Cardiac Tamponade
• Constrictive Pericarditis (a delayed effect)
• Shock

These complications can be deadly. Understanding your symptoms reduces your risk of complications associated with mesothelioma pericardial effusions. 

How Are Pericardial Effusions Diagnosed?

Doctors use core diagnostic tools that include physical exam, medical history and imaging such as CT scans and echocardiogram. Fluid can also be drained in a procedure called pericardiocentesis. 

Pericardiocentesis involves inserting a needle to drain excess fluid for testing and to relieve pressure.  The fluid is collected and analyzed to help determine the diagnosis and cause of the pericardial effusion.

How Are Pericardial Effusions Treated?

Treatment depends on the amount of fluid and the strain it places on your cardiac function. If the effusions recur, your doctor will treat the cause of pericardial effusion directly, such as cancer or viral infections. 

Pericardial Effusion Treatments

• Antibiotics: Mesothelioma patients may be prescribed antibiotics to treat or prevent infections, as cancer treatments can weaken their immune systems.
• Chemotherapy or radiation: These are common cancer treatments used to kill or slow the growth of mesothelioma cells.
• Non-steroidal anti-inflammatories: NSAIDs are used to manage pain and inflammation, which can be a significant symptom for mesothelioma patients.
• Pericardiectomy: This is a surgical procedure to remove the pericardium, the sac around the heart, which may be necessary if it becomes thickened or scarred from mesothelioma.
• Pericardiocentesis: A procedure used to remove excess fluid from the pericardium with a needle, providing immediate relief from symptoms like shortness of breath and chest pain.

These measures reduce pressure on the heart and the risk of complications. Doctors will also follow up with you to ensure the fluid level is within normal limits. Adjustments in treatment may be indicated if levels change.

Treatment for Patients With Mesothelioma

Patients with pericardial effusion from mesothelioma require multiple specialists. Oncologists and cardiologists collaborate for the best solution. Since no two patients are the same, tailored treatment is always better for patient outcomes.

People with pericardial effusions from mesothelioma require more aggressive treatment options such as pericardiectomy. This mesothelioma surgery is recommended because it can remove the tumor mass and avoid the possibility of fluid reaccumulation. Chemo or radiation can further reduce any tumors. 

Living With Pericardial Effusion

Many people with pericardial mesothelioma live with pericardial effusion as long as it doesn’t compromise their cardiac function. For people whose pericardial effusion becomes malignant, the outlook is less favorable.

A study published in the International Heart Journal in January 2024 tracked 171 patients with pericardial effusion for 2.5 years. A total of 21 patients, about 12.35%, passed away during follow-up. Additionally, 24 patients, or 14%, had to be hospitalized. 

The study showed the survival rate is higher when intervention occurs sooner with targeted drainage and treatment. The key is early detection and treatment.

Follow up with your physician for proper maintenance to avoid repeated episodes. Support from Patient Advocates is available for patients and families.

Common Questions About Pericardial Effusions

When should I see a doctor for my symptoms?

Chest pain, shortness of breath and dizziness, also known as syncope, should receive emergency care. These symptoms suggest cardiovascular compromise, which can be treated early to avoid complications later. Inform your doctor if you have a history of cancer.

How much fluid is considered a large pericardial effusion?

Anything greater than 500 milliliters, approximately more than 2 cups of liquid, constitutes a large pericardial effusion. This amount can compress the heart and require immediate intervention. Imaging can determine the amount.

Can pericardial effusion return after treatment?

Yes, especially in people with cancer. If the cancer isn’t well-managed, it may require repeat drainage or surgery. With follow-up care, the condition can be managed over time.

What are the long-term effects of untreated pericardial effusion?

An untreated mesothelioma pericardial effusion can lead to heart failure as well as cardiac tamponade. Excess fluid build-up can cause damage to the heart over time. These complications can be prevented with screening and early intervention.

Recommended Reading