DR. WALKER

Pericardial Effusion

What is a pericardial effusion?

A pericardial effusion is having too much fluid inside the saclike structure around the heart called the pericardium. This pericardial sac consists of 2 thin fibrous layer which contains approximately 3 tablespoons of fluid between the 2 layers. The purpose of this fluid is to decrease friction from the underlying beating heart. When excess fluid accumulates it is often secondary to inflammation. Other conditions however, could result in some fluid around the heart to include bleeding or malignancy.

What are symptoms of pericardium effusion?

A pericardial effusion may go unnoticed for some time, because the fluid can develop slowly over time. Chest pain however is a commonly presenting sign.

Other symptoms include:

Fever.
Chest pain/fullness.
Lightheadedness or dizziness.
Shortness of breath.
Chest pain that sometimes get worse with deep inhalation or bending forward. With larger pericardial effusion, symptoms could include trouble swallowing or hoarseness.

What are some causes of pericardial effusion?

Infection. Prior to Covid, pericardial effusion was often secondary to viral or bacterial infections. Autoimmune disorders to include lupus, Sjogren’s syndrome, and rheumatoid arthritis. Cancer/malignancy to include breast cancer, lung cancer, and lymphoma. Other disorders include HIV and tuberculosis. Hormonal problems to include underactive thyroid/hypothyroidism.

Should I be concerned about a pericardial effusion?

Perhaps one of the most concerning problems that could develop with pericardial fusion is a condition called cardiac tamponade. This occurs when the fluid accumulation happens so quickly that it does not allow the pericardial sac itself to compensate by the stretching. As a result, the pressure increases around the heart, preventing the chambers from filling adequately with blood. This is a life-threatening condition that sometimes require a surgical intervention.

How do I know if I have pericardial effusion?

Ultrasound/echocardiogram. This test enables your provider to measure the amount of fluid between the two layers. Additionally, this test determines if the function of the heart itself has been reduced which could suggest early signs of tamponade.
Computed tomography/MRI. Generally, there is no appreciable/visible fluid collection in the pericardial sac on imaging. These tests could show abnormal fluid collection suggesting pericardial effusion.

How long will a pericardial effusion last?

Pericardial effusion secondary to infection or inflammation of unknown causes are often more difficult to manage and diagnose. Often the effusion is only a manifestation of the primary disease process or disorder. Slow growing effusions may last weeks or even years depending on the underlying cause and treatment options. Your provider, however, may have serial follow ups to monitor the size of the effusion and may offer therapeutic options when indicated. Remember that as the fluid collection grows, it could compress the heart, restricting blood return to the heart, which is a dangerous/life threatening condition.

Selfcare tips.

Pericardial fluid collection that occurs quickly is very concerning. Slower growing fluid collections are less dangerous, but still worrisome. As the fluid collection grows, your healthcare provider could suggest having an aspiration procedure in which some of the fluid inside the pericardial sac could be withdrawn/pulled off.
If the cause is known then antibiotics, or other therapeutic option may be suggested.
Sometimes anti-inflammatory medications to include nonsteroidal anti-inflammatory could be used to help reduce inflammation/pain.
Probiotic rich foods to include sauerkraut, cabbage, blueberries, and kefir. Probiotics boost innate immunity by improving natural killer cell activity. Also, they enhance gut and respiratory, immune responses by increasing IgA and IgG antibodies and modifying the host’s innate immunity.
Anti-inflammatory diet. Healthy fats to include coconuts oil, olive oil, and avocados.

Consider adding the following supplements.

Omega-3 fatty acids. Omega-3 fatty acids are part of a healthy diet that is associated with lower levels of inflammation. Your body cannot make omega-3 fatty acids—eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA)—these must be obtained in the diet.

Vitamin D3 for immune support.

Magnesium. Low magnesium is associated with higher levels of inflammation, and higher magnesium levels are associated with lower levels of inflammation. Restrict diets that are high in processed foods to include added sugars/ carbohydrates to include white rice, pasta, and white bread.