Pericardial effusion ("fluid around the heart") is an abnormal accumulation of fluid in the
pericardial cavityThe pericardial cavity is a potential space between the parietal pericardium and visceral layer. It contains a supply of serous fluid. The serous fluid that is found in this space is known as the pericardial fluid....
. Because of the limited amount of space in the pericardial cavity,
fluidA fluid is a substance that continually deforms under an applied shear stress. All gases are fluids, but not all liquids are fluids. Fluids are a subset of the phases of matter and include liquids, gases, plasmas and, to some extent, plastic solids....
accumulation will lead to an increased intrapericardial pressure and this can negatively affect
heartThe heart is a muscular organ found in all vertebrates that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
function. When there is a pericardial effusion with enough pressure to adversely affect heart function, this is called
cardiac tamponadeCardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium . If the fluid significantly elevates the pressure on the heart it will prevent the heart's ventricles from filling properly. This in turn leads to a low stroke volume...
. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of
pericardial fluidSurrounding the heart is a sac known as the pericardium, which consists of two membranes. The outer layer being the fibrous parietal pericardium and the inner layer being the serous visceral pericardium. It is the serous visceral pericardium that secretes the pericardial fluid into the pericardial...
, or from a structural abnormality that allows fluid to enter the pericardial cavity.
Normal levels of pericardial fluid are from 15 to 50 mL.
It may be:
- transudative (congestive heart failure
Heart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs...
, myxoedema, nephrotic syndromeNephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine....
),
- exudative (tuberculosis
Tuberculosis is a common and often deadly infectious disease caused by mycobacteria...
, spread from empyemaPleural empyema is an accumulation of pus in the pleural cavity. Most pleural empyemas arise from an infection within the lung , often associated with parapneumonic effusions. There are three stages: exudative, fibrinopurulent and organizing. In the exudative stage, the pus accumulates...
)
- haemorrhagic (trauma, rupture of aneurysms, malignant effusion).
- malignant (due to fluid accumulation caused by metastasis)
- Pericarditis
Pericarditis is an inflammation of the pericardium .-Classification:Pericarditis can be classified according to the composition of the inflammatory exudate.Types include:* serous* purulent* fibrinous...
- Viral
The term viral is used to describe anything related to viruses.Viral may also mean:*See Virality,*Viral phenomenon, such as viral marketing and viral video.*Viral The term viral is used to describe anything related to viruses.Viral may also mean:*See Virality,*Viral phenomenon, such as viral...
infection(coxsackieCoxsackie may refer to:* Coxsackie , New York* Coxsackie , New York* Coxsackievirus -- any of a group of 23 Coxsackie A viruses and 6 Coxsackie B viruses....
virus)
- Infection
An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the...
- Inflammatory disorders, such as lupus
Systemic lupus erythematosus is a chronic autoimmune connective tissue disease that can affect any part of the body...
and post myocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart cells to die...
pericarditisPericarditis is an inflammation of the pericardium .-Classification:Pericarditis can be classified according to the composition of the inflammatory exudate.Types include:* serous* purulent* fibrinous...
(Dressler's syndrome)
- Cancer
Cancer is a class of diseases in which a group of cells display uncontrolled growth , invasion , and sometimes metastasis...
that has spread to the pericardium
- Trichinosis
Trichinosis, also called trichinellosis, or trichiniasis, is a parasitic disease caused by eating raw or undercooked pork and wild game infected with the larvae of a species of roundworm Trichinella spiralis, commonly called the trichina worm. There are eight Trichinella species; five species are...
- Kidney failure with excessive blood levels of urea nitrogen
Nitrogen is a chemical element that has the symbol N and atomic number 7 and atomic mass 14.00674 u. Elemental nitrogen is a colorless, odorless, tasteless and mostly inert diatomic gas at standard conditions, constituting 78% by volume of Earth's atmosphere.Many industrially important...
- Minoxidil
Minoxidil is a vasodilator medication known for its ability to slow or stop hair loss and promote hair regrowth...
- Heart surgery
Chest pain, pressure symptoms. A small effusion may have no symptoms.
Pericardial effusion is also present after a specific type of heart defect repair.
Pericardial effusion ("fluid around the heart") is an abnormal accumulation of fluid in the
pericardial cavityThe pericardial cavity is a potential space between the parietal pericardium and visceral layer. It contains a supply of serous fluid. The serous fluid that is found in this space is known as the pericardial fluid....
. Because of the limited amount of space in the pericardial cavity,
fluidA fluid is a substance that continually deforms under an applied shear stress. All gases are fluids, but not all liquids are fluids. Fluids are a subset of the phases of matter and include liquids, gases, plasmas and, to some extent, plastic solids....
accumulation will lead to an increased intrapericardial pressure and this can negatively affect
heartThe heart is a muscular organ found in all vertebrates that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
function. When there is a pericardial effusion with enough pressure to adversely affect heart function, this is called
cardiac tamponadeCardiac tamponade, also known as pericardial tamponade, is an emergency condition in which fluid accumulates in the pericardium . If the fluid significantly elevates the pressure on the heart it will prevent the heart's ventricles from filling properly. This in turn leads to a low stroke volume...
. Pericardial effusion usually results from a disturbed equilibrium between the production and re-absorption of
pericardial fluidSurrounding the heart is a sac known as the pericardium, which consists of two membranes. The outer layer being the fibrous parietal pericardium and the inner layer being the serous visceral pericardium. It is the serous visceral pericardium that secretes the pericardial fluid into the pericardial...
, or from a structural abnormality that allows fluid to enter the pericardial cavity.
Normal levels of pericardial fluid are from 15 to 50 mL.
Types
It may be:
- transudative (congestive heart failure
Heart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs...
, myxoedema, nephrotic syndromeNephrotic syndrome is a nonspecific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine....
),
- exudative (tuberculosis
Tuberculosis is a common and often deadly infectious disease caused by mycobacteria...
, spread from empyemaPleural empyema is an accumulation of pus in the pleural cavity. Most pleural empyemas arise from an infection within the lung , often associated with parapneumonic effusions. There are three stages: exudative, fibrinopurulent and organizing. In the exudative stage, the pus accumulates...
)
- haemorrhagic (trauma, rupture of aneurysms, malignant effusion).
- malignant (due to fluid accumulation caused by metastasis)
Causes
- Pericarditis
Pericarditis is an inflammation of the pericardium .-Classification:Pericarditis can be classified according to the composition of the inflammatory exudate.Types include:* serous* purulent* fibrinous...
- Viral
The term viral is used to describe anything related to viruses.Viral may also mean:*See Virality,*Viral phenomenon, such as viral marketing and viral video.*Viral The term viral is used to describe anything related to viruses.Viral may also mean:*See Virality,*Viral phenomenon, such as viral...
infection(coxsackieCoxsackie may refer to:* Coxsackie , New York* Coxsackie , New York* Coxsackievirus -- any of a group of 23 Coxsackie A viruses and 6 Coxsackie B viruses....
virus)
- Infection
An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply, usually at the expense of the host. The infecting organism, or pathogen, interferes with the normal functioning of the...
- Inflammatory disorders, such as lupus
Systemic lupus erythematosus is a chronic autoimmune connective tissue disease that can affect any part of the body...
and post myocardial infarctionMyocardial infarction or acute myocardial infarction , commonly known as a heart attack, is the interruption of blood supply to part of the heart, causing some heart cells to die...
pericarditisPericarditis is an inflammation of the pericardium .-Classification:Pericarditis can be classified according to the composition of the inflammatory exudate.Types include:* serous* purulent* fibrinous...
(Dressler's syndrome)
- Cancer
Cancer is a class of diseases in which a group of cells display uncontrolled growth , invasion , and sometimes metastasis...
that has spread to the pericardium
- Trichinosis
Trichinosis, also called trichinellosis, or trichiniasis, is a parasitic disease caused by eating raw or undercooked pork and wild game infected with the larvae of a species of roundworm Trichinella spiralis, commonly called the trichina worm. There are eight Trichinella species; five species are...
- Kidney failure with excessive blood levels of urea nitrogen
Nitrogen is a chemical element that has the symbol N and atomic number 7 and atomic mass 14.00674 u. Elemental nitrogen is a colorless, odorless, tasteless and mostly inert diatomic gas at standard conditions, constituting 78% by volume of Earth's atmosphere.Many industrially important...
- Minoxidil
Minoxidil is a vasodilator medication known for its ability to slow or stop hair loss and promote hair regrowth...
- Heart surgery
Symptoms
Chest pain, pressure symptoms. A small effusion may have no symptoms.
Pericardial effusion is also present after a specific type of heart defect repair. An Atrial Septal Defect Secundum, or ASD, when repaired will most likely produce a pericardial effusion due to one of the methods of repair. One repair method of an ASD is to take a piece of the pericardial tissue and use it as a patch for the hole in the atrial cavity.
The so-called "water-bottle heart" is a radiographic sign of pericardial effusion, in which the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle.
It can be associated with
Ewart's signEwart's sign is a set of findings on physical examination in people with large collections of fluid around their heart ....
.
Treatment
Treatment depends on the underlying cause and the severity of the heart impairment. Pericardial effusion due to a viral infection usually goes away within a few weeks without treatment. Some pericardial effusions remain small and never need treatment. If the pericardial effusion is due to a condition such as
lupusSystemic lupus erythematosus is a chronic autoimmune connective tissue disease that can affect any part of the body...
, treatment with anti-inflammatory medications may help. If the effusion is compromising heart function and causing cardiac tamponade, it will need to be drained, most commonly by a needle inserted through the chest wall and into the pericardial space. A drainage tube is often left in place for several days. In some cases, surgical drainage may be required by
pericardiocentesisIn medicine, pericardiocentesis is a procedure where fluid is aspirated from the pericardium .-Process:It is generally done under ultrasound guidance, to minimize complications...
, in which a needle, and sometimes a
catheterIn medicine a catheter is a tube that can be inserted into a body cavity, duct or vessel. Catheters thereby allow drainage, injection of fluids or access by surgical instruments. The process of inserting a catheter is catheterization. In most uses a catheter is a thin, flexible tube , although...
are used to drain excess fluid.
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