Too Much Fluid In The Pericardium: Diagnosis And Treatment

Too much fluid in the pericardium is a condition that involves the accumulation of fluid around the heart. Sometimes it  is related to a disease. Other times, specific monitoring and evaluation is needed to determine its cause. In some cases, it is not possible to identify a cause.

It can even become chronic without causing serious problems. However, it is very important to get treatment.

Treatment focuses on solving problems that cause too much fluid in the pericardium and managing its symptoms. However, if the cause is unknown, the clinical management is the same as for peritonitis.

What is too much fluid in the pericardium?

Too much fluid in the pericardium is an abnormal accumulation of fluid. The pericardium consists of two layers: a serous layer and a fibrous layer. The space between the two layers is the pericardium. Usually, it contains up to 50 ml of serous fluid. When there is inflammation or an infectious process, the production of fluid increases and too much fluid occurs.

This can also manifest itself due to decreased reuptake of the fluid. This generally occurs due to increased systemic venous pressure. The increase in pressure typically occurs over time due to heart failure or high blood pressure in the pulmonary circulation.

Diagnosis

The clinical presentation of too much fluid in the pericardium depends on the rate at which the fluid accumulates. Typical symptoms are  shortness of breath and chest pain. Nausea, dysphagia, hoarseness and hiccups  are also common symptoms.

When a medical professional suspects too much fluid in the pericardium, they  may request one of the following tests:

• Echocardiogram. This allows doctors to detect the magnitude of the fluid and evaluate the function of the heart.
• Electrocardiogram. This test can detect any blocking patterns.
• X-ray of the chest. This allows medical professionals to determine the magnitude of the accumulation of fluid.

The most commonly used test for diagnosis is echocardiogram. However, computed tomography (CT) and magnetic resonance imaging (MRI)  offer a broader view. However, due to availability and cost, medical professionals do not use these as often.

In each case, echocardiographic evaluation allows to determine five important variables: size, duration, spread, composition, and hemodynamic effects. They use these to  determine the cause of too much fluid in the pericardium to decide the appropriate form of treatment.

Treatment of too much fluid in the pericardium

Overall, the treatment of fluid accumulation in the pericardium depends directly on several causes. This includes the amount of fluid accumulated, the presence of cardiac tamponade and the cause. In general, the problem disappears as soon as doctors can treat the cause.

The first step in dealing with the accumulation of fluid in the pericardium is to evaluate its size. Physicians must also define its hemodynamic significance and decide on possible associated diseases. there is an underlying disease in about 60% of cases. 

If there is no tamponade or significant risk of it occurring, most doctors indicate rest and an anti-inflammatory treatment. They also often prescribe colchicine and corticosteroids.

If there is a risk of tamponade or a high risk that the condition will develop, then doctors should perform a drainage of the fluid using a needle. When it is not possible to do so or the procedure fails, then drainage using an open operation is the next step. This should include a biopsy and the development of a window into the heart.

Monitoring and forecasting

In general, idiopathic accumulation of fluid in the pericardium and peritonitis have a good prognosis. The risk of complications is therefore very low. Cases of idiopathic accumulation of fluid in the pericardium have a probability of 30% to 35% to develop into cardiac tamponade.

In the other cases of too much fluid in the pericardium, the prognosis depends primarily on the cause that produces it and its size. In about a third of cases, those larger than 10mm get worse and develop into a tamponade.

However, it is recommended to monitor moderate idiopathic fluid accumulation with an echocardiogram every six months. If it is severe, the patient should be evaluated every three months. In case of non-idiopathic accumulations of fluid, the monitoring will depend on the disease which caused the accumulation of fluid.