Pericardial Effusion

The specialized heart doctors at UT Southwestern Medical Center expertly diagnose and treat people with pericardial effusion, an accumulation of fluid around the heart. 

Our experienced team offers leading-edge procedures to treat pericardial effusion – some of which can be performed with minimally invasive techniques.

Leading-Edge Treatments Take Pressure Off the Heart

Pericardial effusion (fluid around the heart) is an abnormal accumulation of fluid in the pericardial cavity, which is between the heart and the pericardium (the membrane sac that envelops the heart). 

A very small amount of pericardial fluid is normal, but a large pericardial effusion puts pressure on the heart and prevents it from functioning properly. Extreme fluid accumulation can cause a life-threatening condition called cardiac tamponade. 

UT Southwestern’s specialized thoracic surgeons offer leading-edge procedures to treat pericardial effusion – some of which can be performed with minimally invasive techniques. Working closely with UT Southwestern cardiologists and heart surgeons, our team delivers comprehensive care – all in one location and usually on the same day. 

UT Southwestern is also home to a dedicated Cardiac Rehabilitation program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.

Causes of Pericardial Effusion

There are many causes of pericardial effusion, such as:

• Autoimmune disorders, such as rheumatoid arthritis or lupus
  
• Cancer of the pericardium or heart
  
• Certain prescription drugs, such as hydralazine, a medication for high blood pressure; isoniazid, a tuberculosis drug; and phenytoin, a medication for epileptic seizures
  
• Chemotherapy drugs, such as doxorubicin and cyclophosphamide
  
• Blockage of the flow of pericardial fluids
  
• Inflammation of the pericardium (pericarditis) following heart surgery or a heart attack
  
• Radiation therapy for cancer if the heart was within the field of radiation
  
• Spread of cancer (metastasis), particularly lung cancer, breast cancer, melanoma, leukemia, non-Hodgkin lymphoma, or Hodgkin lymphoma
  
• Trauma or puncture wound near the heart
  
• Accumulation of blood in the pericardium after an injury or surgery
  
• Underactive thyroid (hypothyroidism)
  
• Viral, bacterial, fungal, or parasitic infections
  
• Waste products in the blood due to kidney failure (uremia)
  
• Heart attack
  
• Infection
  
• Rheumatic fever
  
• Sarcoidosis, inflammation of the body’s organs
  
• Whipple disease, a condition in which nutrients are not absorbed properly 

Symptoms of Pericardial Effusion

The volume of fluid and rate of accumulation determine the presence of symptoms with pericardial effusion. The condition doesn’t always cause symptoms, but when they are present, they can include:

• Anxiety
  
• Chest pain, pressure, or discomfort, relieved by sitting up or leaning forward and worsened by lying flat
  
• Feeling of abdominal fullness
  
• Confusion
  
• Cough
  
• Shortness of breath
  
• Fainting (syncope)
  
• Lightheadedness
  
• Heart palpitations
  
• Nausea
  
• Restlessness
  
• Swelling in the abdomen and legs
  

Pericardial Effusion Diagnosis

If we suspect that a patient has pericardial effusion, we will conduct a physical examination and order additional studies to confirm the diagnosis and determine appropriate treatment options. Common diagnostic tests for pericardial effusion include:

• Chest X-ray: To look for a “water bottle” appearance of the heart
  
• Computed tomography (CT) scan: To look for fluid accumulation around the heart
  
• Cardiac MRI: To look for fluid accumulation around the heart
  
• Echocardiography (echo or cardiac ultrasound): To estimate the amount of accumulated fluid – by looking for an echo-free space between layers of the pericardium – and determine its effect on heart function
  
• Electrocardiography (ECG or EKG): To test the heart’s electrical system and look for a low-voltage signal throughout
  
• Pericardiocentesis: To test for infections, tumor cells, and other pathogens using fluid drawn with a needle from around the heart
  
• Physical exam: To check for signs of hypotension (low blood pressure), elevated jugular vein pulse, widened pulse pressure, pulsus paradoxus, and a decrease in systolic blood pressure greater than 10 mmHg with inhalation; includes a stethoscope exam to listen for muffled heart sounds and pericardial friction    
  

Pericardial Effusion Treatments

Treatment for pericardial effusion depends on the amount of fluid that has accumulated and the cause of the disorder. A small amount of fluid around the heart might not require treatment or can be controlled with medications. However, for some patients, surgery is the most appropriate option. 

Common treatments include:

• Medications: Aspirin, nonsteroidal anti-inflammatory drugs, steroids, and/or antibiotics can reduce inflammation.
  
• Fluid draining: This minimally invasive procedure drains the accumulated fluid, helps identify the cause of the accumulation, and relieves the pressure on the heart. This pressure relief might be temporary, and another draining procedure might be necessary. In that case, a temporary catheter can be placed.
  
• Thoracoscopic pericardial window surgery: This minimally invasive, video-assisted thoracoscopic surgery (VATS) enables surgeons to see a wider area of the pericardium and the pleural region through two to four tiny incisions – and to create an opening (window) in the pericardium large enough for the fluid to drain internally and avoid collection in the pericardium.
  
• Pericardial window surgery (subxiphoid pericardiostomy): A four- to five-centimeter vertical linear incision is made at the highest point in the midline abdomen to open the pericardium and allow the fluid to drain internally or externally to relieve pressure on the heart. Very small drains that are placed to eliminate the fluid are removed in the outpatient clinic. This procedure can be performed in less than 30 minutes, and patients often can return home the next day.

Support Services

UT Southwestern’s cardiac rehabilitation specialists create customized plans that integrate proper nutrition, exercise, and, if necessary, nicotine cessation into patients’ lifestyles to improve their cardiovascular health.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving the outcomes of patients with cardiovascular disease.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.