Water Around the Heart (Pericardial Effusion)

Introduction

Pericardial effusion, commonly referred to as “water around the heart,” is a condition in which excess fluid accumulates in the pericardial sac, the membrane surrounding the heart. This can have significant effects on heart function, depending on the amount and cause of the fluid buildup.

Causes

Pericardial effusion can result from various medical conditions, including: - Infections (viral, bacterial, or fungal pericarditis) - Inflammatory diseases (such as rheumatoid arthritis or lupus) - Cancer (metastatic tumors affecting the heart) - Heart conditions (heart attack or heart surgery complications) - Kidney failure (severe cases can cause fluid retention, including around the heart) - Hypothyroidism (low thyroid levels can lead to fluid accumulation) - Trauma or injury to the heart

Symptoms

Symptoms depend on the severity of the effusion and whether it compresses the heart (cardiac tamponade). Mild effusions may have no symptoms, but larger ones can cause: - Chest pain or pressure - Shortness of breath - Fatigue - Dizziness or fainting - Swelling in the legs or abdomen - Rapid heartbeat

Diagnosis

To diagnose pericardial effusion, doctors use: - Echocardiography (Heart Ultrasound) – the primary imaging tool to see fluid around the heart - Electrocardiogram (ECG) – to check for electrical heart activity changes - Chest X-ray – may show an enlarged heart silhouette if effusion is large - CT or MRI scan – used in complex cases to evaluate the heart and surrounding structures - Pericardiocentesis & Fluid Analysis – extracting and testing the fluid to determine the underlying cause

Treatment

Treatment depends on the cause and severity: - Small, asymptomatic effusions – may only require monitoring - Medication (if caused by inflammation or infection): - Anti-inflammatory drugs (NSAIDs, Colchicine, Steroids in some cases) - Antibiotics for bacterial infections - Pericardiocentesis – a procedure to drain excess fluid if it causes significant symptoms or tamponade - Surgical options: - Pericardial window (creating a small opening to drain fluid permanently) - Pericardiectomy (removal of part or all of the pericardium in chronic cases)

Potential Complication: Cardiac Tamponade

If too much fluid compresses the heart and prevents proper filling of its chambers, it can cause a life-threatening emergency known as cardiac tamponade, requiring immediate drainage of the fluid.

Conclusion

Pericardial effusion can be harmless in some cases but life-threatening in others. Early diagnosis and treatment are crucial, particularly if symptoms such as chest pain or shortness of breath develop.

Source recommendations

1. American Heart Association Guidelines on Pericardial Diseases

1. https://www.ahajournals.org/doi/10.1161/circulationaha.105.561514
2. https://www.sciencedirect.com/science/article/abs/pii/S1936878X24001608
3. https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis
4. https://www.jacc.org/doi/10.1016/j.jacc.2019.11.021
5. https://professional.heart.org/en/guidelines-statements

2. European Society of Cardiology Guidelines for the Diagnosis and Management of Pericardial Diseases

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Pericardial-Diseases-Guidelines-on-the-Diagnosis-and-Management-of
2. https://academic.oup.com/eurheartj/article/36/42/2921/2293375
3. https://pubmed.ncbi.nlm.nih.gov/26320112/
4. https://www.escardio.org/Working-groups/Working-Group-on-Myocardial-and-Pericardial-Diseases/Publications/Paper-of-the-Month/2015-esc-guidelines-on-the-diagnosis-and-management-of-pericardial-diseases
5. https://pubmed.ncbi.nlm.nih.gov/15120056/