Why does fluid accumulate?
Effusion occurs when the layers of the pericardium become inflamed, damaged, or when the body's fluid balance is imbalanced. The most common cause is acute pericarditis of a viral or unspecified nature; After it, a small amount of liquid often remains, which gradually disappears. In areas with a high prevalence of tuberculosis, it is important to exclude tuberculous pericarditis. Other causes are tumors and metastases, severe renal failure, hypothyroidism, autoimmune diseases, chest trauma, myocardial infarction and the consequences of heart surgery.
- Viral and idiopathic pericarditis
- Tuberculosis
- Oncological diseases
- Chronic renal failure and uremia
- Hypothyroidism
- Systemic lupus erythematosus and other autoimmune diseases
- Chest trauma, heart attack, heart surgery
Symptoms
Slowly accumulating effusion may not cause complaints for years, because the pericardium has time to stretch. If the fluid is associated with inflammation, there is a pressing or stabbing pain in the chest, which intensifies with inhalation and in a lying position and weakens when a person sits down and leans forward. A large effusion compresses neighboring structures: shortness of breath, dry cough, hiccups, and a feeling of fullness in the abdomen appear. With tamponade, the condition worsens quickly: shortness of breath increases, pressure drops, and the neck veins swell.
- Chest pain depending on body position and breathing
- Dyspnea on exertion and at rest
- Dry cough, hiccups, hoarseness
- Heartbeat
- Weakness, swelling
- Fever of an infectious nature
Diagnostics
The main method is echocardiography: it shows the amount of fluid, its distribution and, more importantly, the effect on the filling of the heart chambers. It is EchoCG that answers the question of whether there is a threat of tamponade. The ECG reveals typical changes in pericarditis and a decrease in voltage with large effusions. On a chest x-ray, the shadow of the heart is expanded and takes on a spherical shape. Next, the doctor looks for the cause: a general blood test, inflammation indicators, kidney and thyroid function, examination for tuberculosis, and if a tumor is suspected, a CT scan. If a puncture is performed, the fluid is sent for analysis.
- Echocardiography is the main method
- ECG
- Chest x-ray
- Complete blood count, CRP, creatinine, TSH
- Testing for tuberculosis
- CT chest according to indications
- Study of pericardial fluid during puncture
Cardiac tamponade
Tamponade occurs when the fluid pressure in the pericardium becomes comparable to the pressure in the chambers of the heart, and the ventricles cease to fill fully. Cardiac output falls, organs do not receive enough blood. The person becomes restless, pale and sweaty, breathes quickly, complains of severe weakness, blood pressure drops, pulse quickens, and the veins in the neck swell. This is an emergency situation: help consists of urgent removal of the fluid under ultrasound guidance. You cannot wait and watch in such a situation - call an ambulance at 103.
- Rapidly increasing shortness of breath
- Fall in blood pressure and tachycardia
- Swollen neck veins
- Pale, cold sweat, confusion
- Ultrasound-guided emergency pericardiocentesis
Treatment and observation
Tactics depend on the volume of fluid, symptoms and cause. Small asymptomatic effusion usually does not require intervention: observation with repeated echocardiography is prescribed and the underlying disease is treated. For inflammatory pericarditis, a course of anti-inflammatory therapy is used, selected by a doctor, and physical activity is limited during treatment. In case of large or growing effusion, as well as to clarify the nature of the fluid, a pericardial puncture is performed. In complex and recurrent cases, surgical drainage or window formation in the pericardium is performed.
- Observation and repeat echocardiography for small effusions
- Anti-inflammatory therapy for pericarditis
- Treatment of tuberculosis, hypothyroidism, renal failure
- Pericardiocentesis for large effusion or tamponade
- Surgical drainage for relapses
- Limiting exercise during the treatment period
