Fluid Around the Heart

Our heart is surrounded by a double-layered thin membrane called the pericardium. Under normal circumstances, a few milliliters of fluid can be found between the pericardium and the heart muscles. Pericardial effusion occurs when there is an abnormal accumulation of fluid around the heart. In rare instances, even blood is found in the excess fluid.


Possible Causes
Excess buildup of fluid around the human heart is not age and/or gender specific. Following are the health conditions that can lead to fluid around the heart.

• Surgery
• Certain medications
• Injury or trauma to the heart
• Radiation and chemotherapy
• Breast cancer and lung cancer
• Congestive heart failure or kidney diseases
• Viral, bacterial, fungal or parasitic infections
• Autoimmune disorders such as rheumatoid arthritis or lupus
• Blockage of flow of pericardial fluid or accumulation of blood within the pericardium
• Cancer of the thyroid, kidney, cervix, stomach, larynx, esophagus, pancreas, leukemia, etc., and/or cancer that has spread to the pericardium

Associated Symptoms
Patients with pericardial effusion may or may not show any symptoms. If the fluid accumulates slowly, the patient may not experience any signs or symptoms, but if it accumulates pretty fast, one or more of the following symptoms are observed.

• Low-grade fever
• Chronic dry cough
• Shortness of breath
• Difficulty in swallowing
• Fainting, dizziness, or nausea
• Cardiogenic shock in severe cases
• Bluish color tinge of the skin and lips
• Sharp chest pain along with a feeling of tightness
• Pain radiating between the chest, neck, shoulder, back, or abdomen

Diagnostic Tests
The first step towards diagnosing this problem is a general medical examination by a doctor. The doctor listens to the heartbeat of the patient by the help of a stethoscope. An abnormal high-pitched sound can be heard by the doctor if the heart is surrounded by fluid. The sound appears to be coming from a distance, if too much fluid is present around the heart. Following this checkup, the patient is prescribed certain tests for further examination.

• X-ray: A chest X-ray is the first test that helps in identifying this problem. An enlarged outline of the heart is observed if it is surrounded by fluid.
• ECG: An electrocardiogram or ECG is used to study altered patterns of electrical signals which travel through the heart. Patterns produced because of pressure on the heart due to fluid buildup help in diagnosis of this medical condition.
• Echocardiogram: This is the most common diagnostic test used to detect pericardial effusion. Through this test, the doctor is able to study real-time images of the heart. A heart surrounded by fluid has altered space between the layers of pericardium, decreased heart function, and may have collapsed heart chambers.
• Blood Tests: On confirmation of the medical condition in a patient, the doctor may call for blood tests to figure out the underlying cause for this problem.
• Other Diagnostic Tests: Tests like computerized tomography and magnetic resonance imaging can also detect this condition. However, these tests are usually not used for the diagnosis of this problem.

Treatment Options
Unchecked and untreated fluid around the heart can lead to a complicated condition called 'tamponade'. Due to the pressure created by pericardial effusion, the heart chambers that pump blood fail to perform, and one or more chambers may partially collapse, resulting in poor blood circulation and an inadequate supply of oxygen to the body. Hence, it is advisable to seek early medical intervention and treatment.

If there is no immediate threat of deterioration of the condition, medications to treat inflammation of the pericardium may be used. These include non-steroidal anti-inflammatory drugs (NSAIDs) like indomethacin or ibuprofen, steroids, diuretics, other heart failure medications, and /or infection fighting antibiotics. If one is at risk of developing tamponade, then surgery for draining the pericardium may become an unavoidable option. Various types of surgical treatments include:

• Ultrasound-guided pericardiocentesis: Commonly performed, this is a safe and effective medical procedure used to remove or drain excess fluid from the pericardium.
• Video-assisted thoracoscopic surgery (VATS): This procedure is performed under general anesthesia, where visual evaluation of the pericardium can be conducted. This procedure drains and prevents re-accumulation of excess fluid.
• Intrapericardial sclerosis: In this procedure, a solution is injected into the space between the layers of the pericardium for sealing them together. This procedure is usually used for pericardial effusion caused by cancer.
• Pericardiectomy: This procedure involves surgical removal of full or partial pericardium. However, this surgery is only performed in very complicated cases of fluid buildup.

These were the details about pericardial effusion or fluid around the heart. The right course of treatment, along with adequate prevention, as advised by a medical practitioner, will help one lead a life of good health and minimal health-related complications.