Treatment for pericardial effusion will depend on how much fluid has accumulated, what's causing the effusion and whether you have or are likely to develop cardiac tamponade. Treating the 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 might 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)
- Corticosteroid, such as prednisone
If anti-inflammatory treatments don't correct the problem, if you have a large collection of fluid causing symptoms and making you more prone to tamponade, or if you have tamponade, your cardiologist will likely recommend one of the following procedures to drain fluids or prevent fluids from accumulating again.
Drain the fluid. Your doctor can enter the pericardial space with a needle and then use a small tube (catheter) to drain fluid — a procedure called pericardiocentesis.
The doctor will use imaging devices — either echocardiography or a type of X-ray technology called fluoroscopy — to guide the work. An ECG machine monitors your heart during the procedure. 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 might have surgery to drain the pericardium and repair 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.
- Open the layers. Balloon pericardiotomy is a rarely performed procedure in which a deflated balloon is inserted between the layers of the pericardium and inflated to stretch them.
- Remove the pericardium. The surgical removal of all or part of the pericardium (pericardiectomy) is usually reserved for treatment of recurring pericardial effusions despite catheter drainage.