Treatment for pericardial effusion will depend on how much fluid has accumulated, what is causing the effusion, and whether pericardial effusion has caused or is likely to cause decreased heart function due to pressure on the heart (cardiac tamponade). Treating the underlying cause of pericardial effusion often corrects the problem.
Medications that reduce inflammation
If you don't have tamponade or there's no immediate threat of tamponade, your doctor may prescribe one of the following to treat inflammation of the pericardium that may be contributing to pericardial effusion:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) or ibuprofen (Advil, Motrin IB, others)
- Colchicine (Colcrys)
If you don't respond to medications or you have recurring pericardial effusion after a successful treatment, your doctor may prescribe a corticosteroid, such as prednisone.
If anti-inflammatory treatments don't correct the problem, if you have tamponade or if you're at risk of tamponade, your cardiologist will likely recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.
Aug. 01, 2013
- Drain the fluid. Your doctor can use a needle to enter the pericardial space and then a small tube (catheter) to drain fluid from the pericardium. This procedure is called pericardiocentesis. The doctor will use imaging devices — either echocardiography or a type of X-ray technology called fluoroscopy — to guide the work. Your heart is monitored during the procedure with an ECG machine. In most cases, the catheter will be left in place to drain the pericardial space for a few days to help prevent the fluid from building up again.
- Open heart surgery. If there's bleeding into the pericardium, especially due to recent heart surgery or other complicating factors, you may undergo surgery to drain the pericardium and repair any related damage. Occasionally, a surgeon may drain the pericardium and create a "passage" that allows it to drain as necessary into the abdominal cavity where the fluid can be absorbed.
- Seal the layers together. During a procedure called intrapericardial sclerosis, a solution is injected into the space between the two layers of the pericardium that essentially seals the layers together. This procedure is usually used if you have recurring pericardial effusion or if the effusion is caused by cancer.
- Remove the pericardium. Pericardiectomy is the surgical removal of all or a portion of the pericardium. This procedure is usually reserved for treatment of recurring pericardial effusions despite catheter drainage. The heart can function adequately without the pericardium.
- Hoit BD. Diagnosis and treatment of pericardial effusion. http://www.uptodate.com/home. Accessed June 10, 2013.
- Khandaker MH, et al. Pericardial disease: Diagnosis and management. Mayo Clinic Proceedings. 2010;85:572.
- Papadakis MA, et al. Current Medical Diagnosis & Treatment 2013. 52nd ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=1. Accessed June 10, 2013.
- Cardiopulmonary syndromes (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/supportivecare/cardiopulmonary/HealthProfessional. Accessed June 17, 2013.
- Sagrista-Sauleda J, et al. Diagnosis and management of pericardial effusion. World Journal of Cardiology. 2011;3:135.
- Fuster V, ed. et al. Hurst's The Heart. 13th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=5. Accessed June 10, 2013.
- Imazio M. Contemporary management of pericardial diseases. Current Opinion in Cardiology. 2012;27:308.