Human heart is covered by pericardium which is a two layered structure. Pericardial effusion is accumulation of an abnormal amount of fluid in the space between the two layers of pericardium. Generally there is small amount of fluid present in the space between the two layers. But when the fluid builds up in excess, it can give rise to many symptoms such breathlessness and pain.
Pericardial effusion cannot be considered as a disease entity. This is because there are many different causes and clinical manifestations that can give rise to the abnormal accumulation of fluid around the heart.
Pericardial effusion usually results due to inflammation of the pericardium caused either as a result of disease or pericardial injury. There are some instances where the abnormal accumulation of fluid in pericardial space has occurred with no known reason. Pericardial effusion can be serous, hemorrhagic or purulent. An unchecked amount of water around the heart when not treated can put unnecessary pressure on the heart which may lead to its failure.
What Causes Fluid Around The Heart?
Inflammation of pericardium (pericarditis) as well as the effusion resulting from it is caused due to various reasons. The primary pathophysiology behind excess collection of fluid is due to blockage in the circulation fluid or accumulation of blood between the pericardial layers. Following are the causes:
- Tuberculosis: tuberculous pericardial effusion may be secondary to pulmonary tuberculosis.
- Viral fever may sometime give rise to pericarditis and pericardial effusion. It is often followed after upper respiratory tract infection. Coxsackie virus is the usual cause.
- Rheumatic fever which is an autoimmune disease.
- Inflammation of pericardium as a result of heart surgery.
- Acute myocardial infarction (heart attack).
- Post myocardial infarction syndrome. There may be an autoimmune reaction a few weeks or months after heart attack.
- Pyogenic pleural effusion: There are pus cells in the effusion. It can result from direct spread from lung disease such as a lung abscess or blood stream infection from distant disease such as osteomyelitis of bone.
- Kidney failure: accumulation of waste products in the blood leading to condition called uremia.
- Trauma: an injury by steering wheel in car crash or from wounds through chest wall.
- Malignant disease: this mostly arises from direct extension of bronchial carcinoma. Usually the effusion is hemorrhagic and red.
- Immune deficiency disease such as HIV/AIDS.
- Chemotherapy drugs and certain other prescription drugs.
- Idiaopathic pericardial effusion. When there is no underlying cause detected it is called idiopathic pericardial effusion.
Symptoms Of Pericardial Effusion
There are many patients who may not experience the signs and symptoms of pericardial effusion. It may be discovered accidentally on X-ray chest or an echocardiogram advised by the doctor for some other reason. Signs and symptoms of pericardial effusion are elicited when there is large collection of fluid in the pericardial space. At least 500 ml of fluid should accumulate to produce any symptoms.
The symptoms and signs of the underlying disease will often be present.
- Precordial pain: Chest pain which is sharp and aching.
- The pain becomes worse by movements, inspiration and lying flat.
- Breathing difficulty, especially when the patient is in recline position or lying down.
- Cough, usually dry cough.
- Low grade fever.
- Fullness in abdomen.
- Patient feels difficult to swallow.
- Fast pulse and rapidly beating heart.
- Fainting episodes.