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Pericardial Effusion
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Pericardial effusion refers to the buildup of excess fluid between the layers of tissue surrounding the heart. It is the primary symptom of pericardial mesothelioma. Other causes of pericardial effusion include infections, inflammation, and other cancer types.
Written by Karen Selby, RN | Medically Reviewed By Dr. Jeffrey Velotta | Edited By Walter Pacheco | Last Update: July 2, 2024
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Written by Karen Selby, RN | Medically Reviewed By Dr. Jeffrey Velotta | Edited By Walter Pacheco | Last Update: July 2, 2024
What Is Pericardial Effusion?
Pericardial effusion is the buildup of excess fluid between the tissues that line the heart. This lining, known as the pericardium, contains two layers. Normally, a small amount of fluid between these layers provides lubrication and protects the heart. Extra fluid in pericardial effusion puts added pressure on the heart and results in damage.
Diagram shows the area of the pericardium where excess fluid builds up.
Pericardial mesothelioma is thought to occur when asbestos lodges itself around the heart.
Pericardial effusion can develop from mesothelioma, other cancers, infections and chest injuries. If you begin experiencing symptoms of pericardial effusion, talk to your doctor. They will drain the fluid to relieve your symptoms and determine the cause.
What Causes Pericardial Effusion?
Pericardial effusions are caused by mesothelioma, radiation therapy and infection. These conditions lead to inflammation and trigger fluid buildup.
Causes of Pericardial Effusion
- Bacterial, viral, fungal or parasitic infections
- Cancer, including mesothelioma and lung cancer
- Certain chemotherapy drugs, such as doxorubicin and cyclophosphamide
- Inflammation, including inflammation of the heart lining
- Pleural mesothelioma or other cancers of the chest
- Radiation therapy to the chest
- Traumatic injuries to the heart
- Underactive thyroid
In most cases, doctors do not know what causes pericardial effusion. This is known as an idiopathic pericardial effusion.
Types of Pericardial Effusion
There are several types of pericardial effusion, depending on the underlying cause. Doctors also divide effusions as exudative and transudative, depending on the substances found within the fluid.
Pericardial Effusion Types
- Cardiac: Develops as a result of a heart attack or heart surgery
- Idiopathic: Has no known cause
- Infectious: Develops from infections with a variety of pathogens
- Inflammatory: Develops from autoimmune disorders that cause body-wide inflammation, such as rheumatoid arthritis or systemic lupus erythematosus
- Neoplastic: Caused by primary and metastatic tumors in the chest or around the heart
- Traumatic: Forms from injuries to the heart muscle, arteries, or vessels that let fluid accumulate around the heart
- Vascular: Caused by tears in the aorta
Doctors also refer to pericardial effusions as exudative or transudative. This type is defined by the substances found in the fluid.
Mesothelioma and Pericardial Effusion
Mesothelioma can cause pericardial effusion when it develops in the pericardium. Pericardial mesothelioma is rare and it is associated with a poor prognosis or outlook.
It’s not unusual to diagnose pericardial mesothelioma as an incidental finding. You’re going to treat pericardial effusion. You’re not suspecting mesothelioma. Pericardial mesothelioma accounts for 1% to 2% of all mesothelioma, which is a rare disease.
Dr. Wickii Vigneswaran, thoracic surgeon at Loyola University Medical Center in Illinois
If you have been exposed to asbestos at some point in your lifetime, your doctor may consider that your pericardial effusion is because of mesothelioma. Pericardial effusion may be one of the first signs of pericardial mesothelioma.
What Are the Symptoms of Pericardial Effusions?
The most common symptoms of pericardial effusion is shortness of breath and chest pain. The extra fluid presses on the heart, making it harder for the heart to effectively pump blood.
Common Pericardial Effusion Symptoms
- Chest pain
- Fatigue
- Edema or swelling in the legs and feet
- Shortness of breath that worsens when you lie down and improves when you sit up
Pericardial effusion can become dangerous if it is left untreated. Many of the symptoms of pericardial effusion also mimic other heart and lung conditions. If you are experiencing any of these symptoms, it is best to talk to your doctor.
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Get Your Free GuidePericardial Effusion Diagnosis
Pericardial effusions are diagnosed using an echocardiogram and pericardiocentesis. A transthoracic echocardiogram or a transesophageal echocardiogram is the preferred test for diagnosing pericardial effusion. These methods use ultrasound waves to create pictures of the heart and visualize fluid buildup.
Diagram shows how a pericardiocentesis drains excess fluid for a biopsy.
To determine the cause of the pericardial effusion, your doctor may order a pericardiocentesis. This procedure drains the extra fluid surrounding the heart. The fluid is sent to a laboratory for analysis to determine if the effusion is from an infection, cancer, inflammation or another cause.
Pericardial Effusion Treatment
Pericardial effusion treatment varies depending on the underlying cause, your symptoms and overall health. If the effusion is small and does not affect heart function, the doctor will observe it over time. They may order additional imaging tests to check the effusion and confirm if it is not growing larger.
Medications treat the underlying cause of pericardial effusion. Doctors use antibiotic therapy to treat bacterial infections. Anti-inflammatory drugs also help prevent complications such as cardiac tamponade.
Severe pericardial effusions causing symptoms or preventing the heart from pumping effectively need to be drained. There are two methods for treating pericardial effusions.
Pericardiocentesis
Pericardiocentesis is a procedure that removes excess fluid surrounding the heart muscle. Doctors use this approach to diagnose and treat pericardial effusion.
Steps of a Pericardiocentesis
- The doctor numbs an area of the chest.
- They prepare the skin and use an ultrasound to determine where the infusion is located.
- The doctor inserts a needle into the chest and guides it to the heart, then removes the fluid.
- The removed fluid is sent to a laboratory for analysis to determine the cause of the pericardial effusion.
Pericardiocentesis is effective for treating pericardial effusions. They are also simple to perform and can be done at the bedside in the hospital. However, it is possible the effusion returns after pericardiocentesis.
Pericardiectomy
A pericardiectomy is surgery to remove the pericardium from around the heart. Doctors may remove only the affected part of the pericardium with a partial pericardiectomy. A total pericardiectomy is the removal of as much of the pericardium as possible.
The pericardiectomy procedure is more intensive than pericardiocentesis, but it is less likely that the effusion will return. Your doctor will weigh the pros and cons of each procedure with you to determine which is best. They will consider your overall health and whether you can tolerate open-heart surgery with pericardiectomy.
Complications of Pericardial Effusion
Most cases of pericardial effusion have few complications. However, it is possible to develop more severe health issues with an effusion. The more severe the pericardial effusion, the more likely it is to develop a complication.
Possible Pericardial Effusion Complications
- Cardiac tamponade: This complication develops when excess fluid compresses the heart, preventing it from pumping blood.
- Constrictive-effusive pericarditis: The loss of the heart muscle’s elasticity, making it harder to fill with blood.
- Pericardial empyema: A collection of pus in addition to the fluid surrounding the heart due to infection.
Living With Pericardial Effusion
If you have been diagnosed with pericardial effusion, you may wonder how it will affect your overall prognosis. A 2024 study followed 171 patients with pericardial effusion for an average of 2.5 years. Overall, 21 patients (12.35%) died during the follow-up period and 24 patients (14%) were hospitalized.
Your prognosis with pericardial effusion primarily depends on the underlying cause. The same study of 171 patients found that cancer was the most common cause of death in patients with pericardial effusion. Patients who were previously treated with radiation therapy and those with cancer were more likely to develop heart conditions.
Can Pericardial Effusion Be Prevented?
Pericardial effusion is difficult to predict, so preventing it may not always be possible. However, you can take extra steps to support your heart health and reduce the risk of complications. Doctors generally recommend quitting smoking and eating a heart-healthy diet when possible.
Pericardial effusion from mesothelioma is also difficult to predict. Mesothelioma is a slow-growing cancer that develops 20 to 60 years after asbestos exposure. Many people were not aware of their exposure at the time it happened. If you know you have a history of asbestos exposure (from your occupation or contact with an exposed family member), you are eligible for mesothelioma screening.
Common Questions About Pericardial Effusions
- What is the most common cause of pericardial effusion?
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The most common cause of pericardial effusion is lung cancer. Other causes include pericardial mesothelioma, infections, chest injuries, and radiation therapy.
- When should I see a doctor for my symptoms?
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Pericardial effusion is a serious condition, and you should see your doctor as soon as possible. You will need treatment to remove the extra fluid around your heart to prevent long-term damage.
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