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Fluid Around the Heart - Causes, Symptoms, Diagnosis, Treatment

Updated on July 9, 2014

What does "Fluid Around the Heart" mean?

This means that there is an abnormal accumulation of fluid around the heart. Your heart is surrounded by a thin membrane sac that is double-layered and is called your pericardium. Normally between the two layers there are a few milliliters of fluid but if becomes more than that it is considered fluid around the heart. The medical terminology for this medical condition is pericardial effusion or pericarditis. In rare instances there may even be some blood in the fluid. Having this condition is not gender, race, or age specific. It can happen to anyone. When you have this excessive fluid you are putting extra pressure on your heart.

Symptoms

There is a possibility that a person can have significant fluid around the heart and have no symptoms. This is true if the fluid as slowly increased. If you do have any symptoms they may include:

  • Dyspnea, which is having difficulty breathing or shortness of breath
  • Orthopnea which is when lying down you have discomfort when breathing
  • Having chest pain that is usually on the left side of your chest behind the breastbone. It often feels better when you sit up instead of lying down and feels worse when you take a breath
  • Cough that is dry and chronic
  • Fever that is low grade
  • Heart rate that is rapid
  • Difficulty when swallowing
  • Nausea
  • Dizziness or fainting
  • Having a bluish tinge of your lips and skin
  • Pain that could radiate between your neck, shoulder, abdomen, chest, or back
  • In severe cases you may have carcinogenic shock.

Causes

When you have inflammation of the pericardium, referred to as pericarditis, it is normally a response to an injury, inflammatory disorder that has affected your pericardium, or disease. When you have fluid around the heart it is often a sign of the inflammatory response. Sometimes it just happens and the physician cannot determine the cause. Some of the other causes can include:

  • Surgery
  • Certain medications
  • Trauma or injury to the heart such as a wound that is near your heart
  • Chemotherapy and radiation if it is done near your heart
  • Lung cancer
  • Breast cancer
  • Congestive heart failure, which is when your body’s tissues are not receiving enough oxygen and blood because of the heart’s pumping action is reduced.
  • Diseases of your kidneys
  • Infections that are viral, parasitic, bacterial, or fungal
  • Autoimmune disorders like lupus or rheumatoid arthritis
  • Accumulation of blood within your pericardium or blockage of the flow of your pericardial fluid.
  • Having cancer of the kidney, stomach, esophagus, thyroid, cervix, larynx, leukemia, pancreas, etc and/or any cancer that has spread to your pericardium.
  • Idiopathic pericarditis, which is when there is an inflammation of your pericardium that is due to an unknown cause.
  • Dressler’s syndrome which is when you have inflammation of your pericardium following a heart attack or heart surgery.
  • Hypothyroidism which is when your thyroid is under active.

Diagnosis

To determine if you have fluid around the heart your physician will do a series of medical tests to look for fluid around the heart. They will identify what is causing it and what treatment you will need. You may also be referred to a cardiologist, who is a doctor that specializes in the heart and all heart problems. First the physician will listen to your heart with a stethoscope and if they hear a "friction rub", which is a scratchy high-pitched sound. Your heartbeat may sound distant or muffled if there is a large accumulation of fluid. The physician may also do an "echocardiogram" which uses sound waves to create images of your heart in real-time. This test may let the cardiologist see if one or more chambers of you heart have collapsed along with how well your heart is pumping.

Treatment

This is a medical condition that is left unchecked and untreated can lead to a complicated condition called tamponade, which is pressure on your heart muscles. This happens if the pericardial space fills up with fluid quicker than the pericardial sac can stretch out. If this happens one or more chambers of your heart can collapse resulting in an inadequate supply of oxygen to your body and poor circulation of the blood. This is why it is advisable to seek treatment early. The physician may also put you on a regimen of a low dose, or baby, aspirin each day.

You can treat fluid around the heart by:

  • Medications can be used to treat the inflammation of your pericardium if there is no immediate threat of deterioration of the condition. The physician may prescribe diuretics, other infection fighting antibiotics, over-the-counter non-steroidal anti-inflammatory medications, or other heart failure medications.
  • If you are at a risk for developing tamponade, they may do surgery to drain your pericardium sac.

Various surgical treatments

  • Open heart surgery especially if there is bleeding into your pericardium after recent heart surgery or other complicating factors. The surgeon will drain your pericardium and them if there is any related damage they will repair it. The surgeon may create a passage to allow the excess fluid to drain as necessary into your abdominal cavity where it will be absorbed.
  • Ultrasound-guided pericardiocentesis - this is a procedure that is commonly performed to drain or remove the excess fluid. It is an effective and safe procedure.
  • Video-assisted thoracoscopic surgery (VATS) - this procedure would be performed under general anesthesia. The surgeon will do a visual evaluation of your pericardium and then will drain and prevent this excess fluid from re-accumulating again.
  • Intrapericardial sclerosis - if you have his procedure you will have a solution injected into the space between the layers of your pericardium. This procedure will seal them together and is usually done for fluid around the heart that is caused by cancer.
  • Pericardiectomy - this is a surgical procedure for removal of partial or full pericardium but this surgery is only used in fluid buildup cases that are very complicated. Your heart can adequately function without a pericardium.

Having the correct course of treatment along with the right prevention will help you lead a good life.

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