Understanding the causes of fluid around the heart is important for maintaining cardiovascular wellness.
What is Pericardial Effusion?
Pericardial effusion refers to the accumulation of excess fluid within the pericardial sac, the protective, double-layered membrane surrounding the heart. The pericardium normally contains 15 to 50 milliliters of fluid, which acts as a lubricant and helps cushion the heart.
When too much fluid gathers, it can exert pressure on the heart. This can hinder the heart’s ability to fill with blood and pump effectively, potentially leading to reduced blood flow. A rapid or substantial buildup can severely impair heart function, potentially leading to cardiac tamponade.
Underlying Medical Conditions
Inflammatory processes, such as pericarditis, are a common cause, often triggered by viral infections. In such cases, the inflammation of the pericardium results in increased fluid production.
Autoimmune diseases also frequently contribute to pericardial effusion. Conditions like lupus and rheumatoid arthritis can cause the immune system to mistakenly attack healthy tissues, including the pericardium, leading to inflammation and fluid buildup. This systemic inflammation can result in the exudation of fluid into the pericardial space.
Kidney failure is another significant medical cause. When the kidneys are unable to filter waste products effectively, a condition known as uremia can develop, which can lead to inflammation of the pericardium and subsequent fluid accumulation. Certain cancers, particularly those that spread to the chest cavity like lung cancer, breast cancer, and lymphoma, can also cause pericardial effusion. This can occur through direct invasion of the pericardium, obstruction of lymphatic drainage, or metastatic spread.
Other Contributing Factors
Beyond chronic medical conditions, other factors, including acute events or external influences, can contribute to fluid buildup around the heart. Trauma to the chest, such as from an injury or medical procedures, can cause bleeding into the pericardial sac, leading to an effusion. This direct accumulation of blood can rapidly increase pressure around the heart.
Certain medications have been identified as potential causes of pericardial effusion. Some drugs, including hydralazine and procainamide, can induce an inflammatory response in the pericardium, resulting in fluid accumulation. Although rare, this side effect highlights the importance of considering medication history when investigating the cause of an effusion.
Radiation therapy, particularly for cancers located in the chest, can also damage the pericardium, leading to inflammation and fluid production. This effect can manifest acutely during or shortly after treatment, or it can develop months to years later, with the risk correlating with the radiation dose and the area of the heart exposed. Complications following heart surgery are another common reason for fluid accumulation. Post-cardiac surgery pericardial effusion is frequently observed due to inflammation or small bleeds in the surgical area, though it often resolves on its own.
Recognizing the Symptoms
Recognizing the symptoms of fluid around the heart is important for timely medical attention. Common symptoms include chest pain, which is often described as sharp, pleuritic, and may worsen when lying down or with deep breaths. This pain can sometimes be relieved by sitting up or leaning forward. The chest discomfort arises from the inflamed layers of the pericardium rubbing against each other or from the pressure exerted by the fluid.
Shortness of breath, or dyspnea, is another frequent symptom, occurring as the fluid restricts the heart’s ability to expand and pump blood efficiently. This reduced pumping action can lead to less oxygenated blood reaching the body’s tissues. Individuals might also experience palpitations, a sensation of the heart racing or skipping beats, as the heart attempts to compensate for its impaired function.
Fatigue and lightheadedness can also signal a pericardial effusion. These symptoms are a direct consequence of the heart’s diminished ability to pump an adequate supply of blood to the body, including the brain. In severe cases, the reduced blood flow can lead to feelings of faintness or even fainting.