01. Pericardial Effusion Definition
What Is Pericardial Effusion?
Pericardial effusion occurs when excess fluid accumulates between the layers of tissue around the heart. The layers of tissue form a sac called the pericardium.
The pericardium has three layers:
- The fibrous pericardium (outermost layer)
- The parietal pericardium (a second layer)
- The visceral pericardium (innermost layer)
The space between the two inner layers normally contains a small amount of fluid. When the pericardium becomes irritated or injured, the inflammation may lead to a buildup of excess pericardial fluid.
Pericardial effusion may put pressure on the heart. This can cause additional symptoms and cardiovascular complications.
02. Pericardial Effusion Causes
What Causes Pericardial Effusion?
Pericardial effusion may be caused by a number of conditions, including inflammation in the layers of the pericardium. The inflammation causes more fluid to build up between the pericardial layers than normal.
Inflammation or infection of the pericardium may stem from a variety of conditions, including pericardial mesothelioma. Fluid may also accumulate as a result of chest trauma or bleeding.
Causes of Pericardial Effusion
- Autoimmune conditions including lupus and rheumatoid arthritis
- Bleeding into the pericardial cavity
- Chemotherapy including doxorubicin and cyclophosphamide
- Chest trauma
- Complications of open-heart surgery
- Infection (bacterial, fungal or viral)
- Kidney failure
In some cases, doctors cannot determine the cause of pericardial effusion. This is called idiopathic pericarditis. Even if doctors cannot determine the cause of the pericardial effusion, they can still provide patients with a treatment plan.
03. Connection to Mesothelioma
The Connection Between Pericardial Effusion and Mesothelioma
Pericardial effusion is a common symptom of malignant pericardial mesothelioma. Pericardial mesothelioma develops in the lining of the heart after asbestos exposure. It is a rare form of the disease and makes up 1 – 2% of all mesothelioma cases.
As a result of asbestos exposure, fibers may embed in the pericardium and cause inflammation. Over time, tumors may form in the pericardium. Tumor growth causes the layers of tissue in the pericardium to become irritated. Irritation and inflammation may lead to fluid buildup.
Metastasis of any type of mesothelioma may also cause pericardial effusion. This occurs when mesothelioma spreads to the pericardium from another part of the body.
In some cases, patients may be diagnosed with pericardial effusion before they are diagnosed with mesothelioma.
Due to limited data, it is unclear if early diagnosis of pericardial effusion benefits mesothelioma life expectancy. However, individuals with a history of asbestos exposure can monitor for related symptoms. Early diagnosis may provide pericardial mesothelioma patients access to a wider array of treatment options.
04. Signs & Symptoms
What Are the Signs & Symptoms of Pericardial Effusion?
Some patients may not present with any symptoms of pericardial effusion. In these instances, the excess fluid may build up slowly over time. For other patients, pericardial effusion may cause a variety of symptoms. Pericardial effusion symptoms may vary based on the underlying cause of effusion.
Signs of Pericardial Effusion May Include:
- Chest pain
- Difficulty swallowing
- Dyspnea (shortness of breath)
- Enlargement of the neck veins
- Feeling of fullness in the abdomen or chest
- Increased heart rate and/or breathing rate
- Orthopnea (inability to breathe easily unless sitting up or standing)
- Swelling of the legs or abdomen
Patients with severe pericardial effusions may experience other symptoms. Cardiac tamponade is one of the most serious complications of pericardial effusion. It occurs when fluid causes severe compression of the heart muscle.
This complication results in poor blood flow and a lack of oxygen to the body. Patients may experience blue lips and skin, shock and changes in mental status as a result. Cardiac tamponade is a medical emergency and requires urgent treatment.
05. Pericardial Effusion Diagnosis
Diagnosing Pericardial Effusion
To diagnose pericardial effusion, doctors will perform a physical exam and listen to a patient’s heart. If a patient exhibits any pericardial effusion symptoms, doctors will perform additional testing to confirm the diagnosis.
If a patient is experiencing little to no symptoms, pericardial effusion may be diagnosed accidentally. Doctors report accidental diagnoses when a patient is undergoing tests for other reasons.
Physicians typically diagnose pericardial effusion using one or more of the following tests:
- Chest X-ray: A chest X-ray may show excess fluid in the pericardium and enlargement of the heart.
- CT Scan: A CT scan can detect pericardial effusions. However, these are not commonly used to diagnose the condition.
- Echocardiogram: An echocardiogram allows doctors to see how much fluid has collected in the space between the pericardial layers.
- Electrocardiogram: An electrocardiogram, also called an ECG or EKG, records electrical signals from the heart. Doctors may use an EKG to look for patterns that suggest cardiac tamponade.
If pericardial effusion is diagnosed, doctors may perform additional testing to determine the cause of the effusion. Additional diagnostic tests may include a fluid biopsy or a blood test. For patients whose pericardial effusion is caused by mesothelioma, doctors will need to take a biopsy to definitively diagnose the cancer.
06. Common Treatments
Common Pericardial Effusion Treatments
There are treatments available for individuals diagnosed with pericardial effusion. In some mild cases, treatment is not necessary. Doctors may continue to monitor patients with repeated echocardiograms.
For more severe cases, doctors may recommend several treatment options. Treatment may relieve symptoms and prolong survival in some cases.
The type of treatment a patient receives may depend on:
- The amount of fluid in the pericardial sac
- The underlying cause of effusion
- The likelihood of developing cardiac tamponade
Pericardial effusion caused by mesothelioma may be treated through surgery. These procedures help relieve pressure around the heart. Two common treatments are pericardiocentesis and pericardiectomy.
Pericardiocentesis Drains Excess Fluid
Pericardiocentesis is a minimally invasive procedure that removes the excess fluid from the pericardium. The procedure involves using a needle and a small catheter to access the pericardial cavity and drain the fluid.
A pericardiocentesis may also be performed as part of a more invasive surgery.
Some patients who undergo a pericardiocentesis may experience a recurrence of pericardial effusion. Patients with frequent pericardial effusions may be eligible for a pericardiectomy to prevent fluid buildup.
- Patient: 71-year-old woman
- Symptoms: Dizziness, difficulty breathing and weight loss
- Diagnosis: She was first diagnosed with pericardial effusion and later with cardiac tamponade. After more testing, the patient was diagnosed with pericardial mesothelioma.
- Treatment: Doctors initially treated the patient with an emergency pericardiocentesis. She later underwent 7 cycles of palliative chemotherapy (pemetrexed and cisplatin) to treat her mesothelioma.
- Outcome: According to the last follow-up in the 2017 case report, the patient survived at least 20 months after diagnosis.
Pericardiectomy May Prevent Pericardial Effusion Recurrence
A pericardiectomy is a surgical removal of all, or part of, the pericardium. This procedure is also known as pericardial stripping. The two types of pericardiectomy are:
- A partial pericardiectomy, which removes a diseased portion of the heart lining
- A total pericardiectomy, which removes nearly all of the lining
A pericardiectomy should not cause further complications as long as the patient’s lungs and diaphragm are intact.
Removal of the pericardium helps patients with severe or repeated cases of pericardial effusion. The procedure prevents pericardial effusion from occurring in the future.
Treating the Underlying Cause of Pericardial Effusion
Doctors may also treat the underlying cause of pericardial effusion to alleviate symptoms. For instance, pericardial mesothelioma patients may undergo cancer treatment to minimize symptoms of pericardial effusion.
If a patient has another form of metastasized mesothelioma, they may also continue their cancer treatment plan to alleviate pericardial effusion. A mesothelioma doctor can recommend a unique treatment plan for a patient’s diagnosis.
Through early detection and treatment of pericardial effusions, and the underlying cause, patients may improve quality of life.