Pericardial Effusion (Fluid Around the Heart)

The protective sac around the heart

The heart sits inside a thin, two-layered sac called the pericardium, with a small amount of fluid between the layers so it can move smoothly. When inflammation, infection or another illness makes extra fluid collect, it is called a pericardial effusion. If fluid builds up slowly, the sac can stretch and even a large amount may cause few symptoms. If it builds up quickly or becomes very large, it presses on the heart so that it cannot fill properly. This dangerous situation is called cardiac tamponade.

Common causes

• Viral infection or inflammation of the pericardium (pericarditis)
• Tuberculosis, an important cause in India
• Kidney failure
• An underactive thyroid
• Cancer or its treatment
• After a heart attack, heart surgery or a heart procedure
• Autoimmune diseases such as lupus or rheumatoid arthritis

Diagnosis

An echocardiogram is the main test. It shows how much fluid there is and whether it is pressing on the heart. An ECG, chest X-ray and blood tests (blood counts, ESR or CRP, kidney and thyroid function) help find the cause. A CT or MRI scan is sometimes used.

How it is treated

Treatment depends on the cause and the amount of fluid. Small effusions are often watched with repeat echo while the cause is treated, for example with anti-inflammatory medicines for pericarditis or anti-TB treatment. If the fluid is large, pressing on the heart, or needs to be tested, it is drained with a thin needle under echo guidance. This procedure is called pericardiocentesis, and the fluid is sent to the lab to help find the cause. Fluid that keeps coming back may need a minor surgical procedure to create a drainage window.

Emergency signs

Increasing breathlessness, fainting, very low BP, cold and sweaty skin or confusion can mean tamponade, which needs urgent drainage. Call 108 and see the emergency page.

Diagnosis and treatment are decided only after examination by your doctor. This page is for understanding the condition.