Pericardial effusion
Pericardial effusion is a condition characterized by an abnormal accumulation of fluid in the pericardial sac surrounding the heart. This sac, known as the pericardium, serves to protect the heart and contains a small amount of fluid under normal circumstances. When excess fluid builds up, it can exert pressure on the heart, hindering its ability to function properly. The condition can arise due to various factors, including infections, autoimmune diseases, trauma, and notably, advanced stages of cancer, particularly lung, breast, and esophageal cancers. Symptoms may mimic those of heart issues, such as chest pain, shortness of breath, and dizziness.
Diagnosis typically involves imaging techniques like X-rays to identify a characteristic "water-bottle" shape of the swollen pericardium, and fluid may be sampled for analysis via a procedure called pericardiocentesis. Treatment often focuses on symptom relief, particularly in cancer patients, as pericardial effusions frequently occur in advanced stages of the disease. Unfortunately, the prognosis for individuals with malignant pericardial effusions is generally poor, with a significant percentage facing a short lifespan post-diagnosis. Understanding the implications of this condition is essential for those affected and their caregivers.
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Subject Terms
Pericardial effusion
ALSO KNOWN AS: Dropsy of pericardium, malignant pericardial effusion, pericarditis, swollen heart, fluid around the heart
RELATED CONDITIONS: Any number of cancers that have spread throughout the body, including lung, breast, esophageal, pancreatic, and melanoma
DEFINITION: Pericardial effusion is an increase in fluid between the pericardium and the heart. The pericardium is a thin layer of tissue that forms the pericardial sac, a pouch that holds the heart and the ends of the major blood vessels. The pericardium keeps the heart confined to the chest cavity and prevents it from enlarging if blood flow to the heart increases. The sac typically contains a small amount of fluid. Too much fluid puts pressure on the heart and affects its normal functioning.
Risk factors: For cancer patients, the advanced stages of cancer pose the most significant risk. A less serious but still common risk is earlier radiation treatments to the chest, especially for lung cancer.
Etiology and the disease process: The causes of effusions in patients who do not have cancer are many, including infection, autoimmune disorders such as lupus, certain medications, uremia, and trauma near the heart. The cause of malignant pericardial effusion in cancer patients is cancer that develops in the pericardium or the heart muscle or cancer that has metastasized from almost anywhere else in the body, particularly the lungs, breasts, esophagus, colon, prostate, and even bone marrow (leukemia) and skin (melanoma). Radiation therapy for cancer that occurs near the heart can also cause pericardial effusion, as well as certain chemotherapeutic drugs, such as doxorubicin and cyclophosphamide.
Cancerous cells rub against the pericardium. This irritant causes fluid to build up, much like a blister forms under the skin. Some cancers produce little fluid but cause the pericardium to thicken and become rigid. Both conditions are serious.
An effusion can be chronic (present over time) or acute (occurring suddenly). If the fluid collects slowly over time, the pericardium may stretch enough to hold it. The patient usually feels no symptoms until a large amount of fluid accumulates. When fluid volume reaches a critical amount or accumulates rapidly, even a relatively small amount of fluid, a condition known as cardiac tamponade occurs. At this stage, the effusion surrounds and squeezes at the heart. This interferes with the heart’s ability to pump blood effectively. Cardiac tamponade is a medical emergency that can be fatal if not promptly treated.
Incidence: Because effusions develop from several different diseases or conditions, any patient with any of the many conditions that can produce an effusion may be stricken with one. Effusions affect both sexes, all age groups, and all racial and ethnic groups.
A significant percentage of patients with lung cancer has a pericardial effusion caused by the spread of their cancer at the time of their death. Lung cancer is the most common cause of malignant pericardial effusions, accounting for 33 to 50 percent of cases, followed by breast cancer (12 to 25 percent) and hematological malignancies such as leukemia, Hodgkin disease, and non-Hodgkin lymphoma (15 to 25 percent).
Symptoms: Symptoms of an effusion are similar to symptoms associated with heart problems and include chest pain, rapid heartbeat, shortness of breath, dizziness or fainting, difficulty in swallowing, cough, and low blood pressure.
Screening and diagnosis: Doctors find spotting an effusion relatively easy. X-rays and other imaging techniques reveal the swollen pericardial sac's characteristic “water-bottle” shape. Doctors may perform pericardiocentesis, a procedure that uses a needle to withdraw some of the excess fluid. They may then analyze the fluid to determine the cause of the effusion.
Treatment and therapy: Treatment for cancer patients generally involves relief of symptoms because pericardial effusions usually arise in the later stages of cancer, often in the last few weeks of life. Doctors use various noninvasive and surgical procedures to drain the fluid, thus relieving the patient. In addition, doctors may prescribe anti-inflammatory drugs. Pericardiocentesis may be used in emergency cases to drain fluid, and a combination of chemotherapy and immunotherapy medications may be given to the patient in an attempt to decrease the fluid volume. Advances in cardiac magnetic resonance imaging may also increase the effectiveness of these treatments.
Prognosis, prevention, and outcomes: There is no way to prevent an effusion in cancer patients. The prognosis for cancer patients with malignant pericardial effusion is poor. One study showed that of patients diagnosed with malignant pericardial effusions, 86 percent died within a year of diagnosis. About one-third died within the first month. Patients with malignant pericardial effusion generally have a lifespan of two to seven months following diagnosis.
Bibliography
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