Danger of pericardial effusion, when the heart is 'submerged' in water

Have you ever heard of a condition in which the heart is submerged in water? Even though it sounds strange, this condition is in fact one of the problems that may occur in your heart. This heart health problem is referred to as a pericardial effusion. Check out the explanation in the following article.

What is a pericardial effusion?

Pericardial effusion is an excessive or abnormal build-up of fluid in the area around the heart. This condition is called pericardial effusion because it occurs in the space between the heart and the pericardium, the membrane that protects the heart.

Actually, the presence of pericardial fluid, as long as the amount is still small, the condition is still classified as normal. The reason is, this fluid can reduce friction between the layers of the pericardium that stick together every time the heart beats.

However, the buildup of fluid that exceeds normal limits can put pressure on the heart, preventing the organ from pumping blood normally. This means that the heart cannot function properly.

Normally the fluid in the pericardium layer is only about 15 to 50 milliliters (ml). Meanwhile, in pericardial effusion, the fluid in this layer can reach 100 ml or even 2 liters.

In some people, this pericardial effusion can take place quickly and is known as acute pericardial effusion. Meanwhile, in other conditions, the buildup of fluid takes place slowly and gradually, known as subacute pericardial effusion. This condition is only called chronic if it occurs more than once.

At a more severe level, this condition can cause cardiac tamponade, which is a heart disease that can be life threatening. If this is the case, you certainly need immediate medical care. Even so, if treated immediately, pericardial effusion will not get worse.

What are the symptoms of a pericardial effusion?

In fact, people who have a pericardial effusion often experience no symptoms or signs. Basically, when experiencing this condition, the pericardium will stretch to accommodate more fluid. When the fluid doesn't fill the stretched pericardial space, signs and symptoms usually don't appear.

Symptoms will occur when there is too much fluid in the pericardium, so that it presses various surrounding organs such as the lungs, stomach, and the nervous system around the chest.

The volume of fluid in the cavity between the heart and the pericardium determines the symptoms that may appear. This means that each person's symptoms are different, depending on how much fluid has built up. Some of the symptoms that may appear include:

The chest hurts, feels like pressure, and gets worse when you are lying down.
The stomach feels full.
Cough.
Hard to breathe.
Fainting.
Heart palpitations.
Nausea.
Swelling in the abdomen and legs

However, if the condition is severe, you may experience symptoms such as:

Headache.
Cold hands and feet.
Cold sweats.
The body experiences weakness.
Nausea and vomiting.
The skin becomes pale.
Irregular breathing.
Difficulty urinating.

What causes pericardial effusion? '

This condition can be caused by several things, including:

Autoimmune disorders, such as rheumatoid arthritis or lupus.
Pericardium cancer.
Use of certain drugs, such as drugs to lower blood pressure, tuberculosis drugs, anti-seizure drugs, chemotherapy drugs.
Blockage that blocks the flow of pericardial fluid.
Inflammation of the pericardium after heart surgery or heart attack.
Radiation therapy for cancer, especially if the heart is exposed to radiation.
Spread of other organ cancers (metastatic), such as lung cancer, breast cancer, melanoma, blood cancer, Hodgkin's lymphoma, and non-Hodgkin's lymphoma.
Trauma or a stab wound around the heart.
Buildup of blood in the pericardium after an injury or surgical procedure.
Hypothyroidism.
Infections caused by bacteria, viruses, fungi, or parasites.
Uremia.
Heart attack.
Rheumatic fever.
Sarcoidosis or inflammation of the body organs.
The body cannot absorb nutrients properly.

Is pericardial effusion dangerous?

The severity or seriousness depends on the health condition that caused the pericardial effusion to occur. If the cause that causes pericardial effusion occurs can be resolved, the patient will be free and recover from the pericardial effusion.

Pericardial effusions caused by certain health conditions, such as cancer, must be treated promptly because they will affect the cancer treatment being carried out.

If pericardial effusion is left untreated and gets worse, another health condition called cardiac tamponade.

Cardiac tamponade is a condition in which blood circulation does not work well and many tissues and organs do not get oxygen due to too much fluid pressing on the heart. Of course this is very dangerous, it can even cause death.

How to diagnose pericardial effusion?

According to UT Southwestern Medical Center, when a doctor or other medical professional suspects that a person has a pericardial effusion, the first thing that is done is a physical exam.

Only after that, the doctor or medical expert will perform several other tests to make a diagnosis in order to determine the right type of treatment. The following are some of the types of tests that are usually done to diagnose pericardial effusion:

1. Echocardiogram

This tool uses sound waves to form an image or photoreal-time from the patient's heart. This test helps the doctor determine the amount of fluid in the cavity between the pericardial membrane layers.

In addition, an echocardiogram can also show the doctor whether the heart is still pumping blood properly. This tool will also help doctors diagnose potential patients experiencing cardiac tamponade, or damage to one of the chambers of the heart.

There are two types of echocardiograms, namely:

Transthoric echocardiogram: a test that uses a sound transmitter placed over your heart.
Transoesophageal echocardiogram: A smaller sound transmitter found in a tube and placed in the digestive system that extends from the throat to the esophagus. Since the esophagus is close to the heart, a device placed in that location can provide a more detailed picture of the patient's heart.

2. Electrocardiogram

This device, also known as an EKG or ECG, records the electrical signals traveling through the heart. The cardiologist can see patterns that may indicate cardiac tamponade from using this device.

3. X-ray of the heart

This diagnosis is usually done to see if there is a lot of fluid in the pericardial membrane. An X-ray will show an enlarged heart, if there is excess fluid in or around it.

4. Imaging technology

Computerized topographyor what is commonly known as a CT scan andmagneting resonance imaging or MRI can help detect the presence of pericardial effusion in the area of the heart although these two tests or tests are rarely used for this purpose.

However, both of these examinations can make it easier for doctors if needed. Both of them can both indicate the presence of fluid in the pericardium cavity.

Then, how to treat pericardial effusion?

Treatment for pericardial effusion depends largely on the amount of fluid present in the heart cavity and pericardium, the main cause, and whether the condition has the potential to cause cardiac tamponade or not.

Usually, treatment will focus more on addressing the cause so that pericardial effusion can be handled properly. The following are possible treatments:

1. Use of drugs

Usually, the use of drugs aims to reduce inflammation. If your condition doesn't have the potential to cause cardiac tamponade, your doctor may prescribe anti-inflammatory drugs such as the following:

Aspirin.
Nonsteroidal anti-inflammatory drugs(NSAIDs) or pain relievers such as indometachin or ibuprofen.
Colchicine (Colcrys).
Corticosteroids such as prednisone.
Diuretic drugs and various other heart failure medications can be used to treat this condition if it is caused by heart failure.
Antibiotics can be used if the condition is caused by an infection.

In fact, if this condition occurs due to the patient's cancer, other possible treatments include chemotherapy, radiation therapy, and the use of drugs that are injected directly into the chest.

2. Medical and surgical procedures

There are also medical and surgical procedures that may be performed to treat pericardial effusion. This method of treatment can be chosen if treatment using anti-inflammatory drugs does not seem to help overcome this condition.

In addition, these methods are used if you have a potential for cardiac tamponade. Some of the possible medical and surgical procedures include:

a. Liquid removal

Your doctor may recommend that you remove fluids if you have a pericardial effusion. This procedure is performed by the doctor inserting a syringe accompanied by a small tube into the cavity of the pericardium to remove the fluid inside.

This procedure is known as pericardiosynthesis. In addition to using a syringe and catheter, the doctor also uses echocardiography or X-ray to see the movement of the catheter in the body so that it reaches its proper destination position. The catheter will be on the left side of the area where fluid will be removed for a few days to prevent fluid from building up again in the area.

b. Heart surgery surgery

The doctor may also perform heart surgery if there is bleeding in the pericardium, especially if it is due to previous heart surgery. This bleeding may also occur due to complications.

The goal of heart surgery is to remove fluids and repair damage to the heart organ. Usually, the surgeon will make a pathway through the heart to allow fluid to exit the pericardium into the abdominal area, where it can be properly absorbed.

c. Pericardium stretching procedure

Usually, this procedure is rarely performed. However, your doctor may perform this procedure by inserting a balloon between the layers of the pericardium to stretch the two adhered layers.

d. Removal of the pericardium

Surgical removal of the pericardium may be performed if pericardial effusion persists even after fluid removal has been performed. This method is called pericardiectomy.

Can this condition be prevented?

Prevention of pericardial effusion aims to reduce the risk of various causes that may cause this condition to occur. Generally, this condition can be prevented by maintaining a healthy heart, such as:

Limit alcohol consumption.
Eat heart-healthy foods.
Exercise regularly and maintain body weight.
Consult your doctor regularly, especially if you have health problems related to the heart.