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Pericardial Effusion

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Diagnosis of Pericardial Effusion

Because pericardial effusions often cause no symptoms, they are frequently discovered after routine tests are abnormal. Various tests can suggest the possibility of a pericardial effusion:

Physical examination: A doctor may occasionally hear abnormal sounds over the heart that suggest pericarditis. However, doctors cannot reliably detect pericardial effusions by examination.

Electrocardiogram (ECG): Electrodes placed over the chest produce a tracing of the heart's electrical activity. Certain patterns on ECG can suggest a pericardial effusion or pericarditis is present.

Chest X-ray film: The heart's silhouette on a chest X-ray film may be enlarged, suggesting a pericardial effusion could be present.

If a pericardial effusion is suspected, the best test to make the diagnosis is an echocardiogram (ultrasound of the heart). The excess fluid around the heart is usually seen easily on an echocardiogram, confirming the diagnosis of pericardial effusion.

Once a pericardial effusion is identified, a doctor assesses its size and severity. In most cases, the pericardial effusion is small and causes no serious problems. In contrast, large pericardial effusions can compress the heart and impair its ability to pump blood. This condition, called cardiac tamponade, is a potentially life-threatening result of a pericardial effusion.

To try to identify the cause of a pericardial effusion, a doctor may recommend taking a sample of the pericardial fluid. In this procedure, called pericardiocentesis, a doctor inserts a needle through the chest and into the pericardial effusion, and withdraws pericardial fluid.

Treatment of Pericardial Effusion

The treatment of a pericardial effusion depends on its severity and its cause. Small pericardial effusions without symptoms and due to known causes (for example, kidney failure) require no special treatment.

For pericardial effusions due to pericarditis, treating the pericarditis also treats the pericardial effusion. Treatments for pericardial effusions due to pericarditis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Aleve, and Indocin
  • Corticosteroids, such as prednisone and Solu-Medrol
  • Colchicine

If severe infection or heart impairment (cardiac tamponade) is present, the pericardial effusion must be drained urgently. Drainage of pericardial effusions is done in two ways:

Pericardiocentesis: A doctor inserts a needle through the chest into the pericardial effusion. A catheter is advanced into the fluid, and the pericardial effusion is suctioned out.

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