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Pericardial Effusion

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  • Pericardial Effusion

    I had an ultrasound last Thursday (4 1/2 weeks post-op from aortic root and aortic valve replacement surgery). The tech identified fluid around my heart. I met with my cardiologist early Friday am and he described it as a 'moderate amount of fluid.' His advice was to come back in a week for another ultrasound to be sure the fluid isn't increasing and I'm not at risk for cardiac tamponade. He said the fluid is normally absorbed by the body without intervention in about 80% of patients. The other 20% need it drained. Any thoughts? Just curious to hear from you all about this.

    I feel pretty good, no pains that seem suspicious. However, since the ultrasound I am especially sleepy and have returned to taking long naps each afternoon. I also have a mild achey headache that won't go away.

    One final question: What is the difference between pericardial effusion (what I have) and pericarditis?


  • #2
    Not going to be the most detailed explanation, but I will do my best. Pericarditis is when the "sack" that holds the heart gets irritated and inflamed. Pericardial effusion starts with Pericarditis. Both usually take care of themselves as you stated above. Hopefully you won't need to have yours drained.
    Mitral Valve Repair 12/9/05 with Dr. Laks at UCLA.


    • #3
      How is your breathing?

      If your breathing gets worse, you should have it drained. The fluid can get to the point where it puts pressure on the heart, so that it cannot fully pump. Be aware that it can cause you to go into afib. If you do not know about it already, search the forums for it. The fluid (blood) around the heart irritates not only the heart but also the sac. Many times it does get absorbed into the body.


      • #4
        I have had pericarditis and pericardial effusion

        since mid-January. I have been on high doses of anti-iflammatoreis 'round the clock with no real resolution so I am starting steroids tomorrow. I think my effusion is also moderate and without meds I am in pain, but the body generally reabsorbs the fluid...

        mitral repair 11/30/05


        • #5

          Thanks for the info. This was helpful. My breathing is good, however, when I walked the neighborhood this morning I did feel much more out of breath than normal. Also, last night while resting I took my pulse and it was at 100 which seemed rather high. Other than these things, I don't feel anything different. I'll keep you posted.


          • #6
            Hi Michelle, I had my aortic vavle replaced last septmenber and 2 weeks after I had to get fluid drained from around my heart, according to my cardiologist I had an enormous amount, so much so that he couldn't believe I was up walking around, anyway, I'm just writing this to let you know it's not that bad a procedure if it comes to that with you. They gave me some pretty good drugs which I appreciated. With me they drained the fluid and kept a tube in to keep any fluid buildup to just drain out right away. I was in the hospital for 3 days, they wanted to keep an good eye on it in case the fluid kept building up. Hope this helps, let us know if you have any other questions regarding the procedure.



            • #7
              cause of pericarditis?

              I'm still struggling with pericarditis almost 4 months after surgery (10-20-05). There was little pain the first time in early November but by December it was so painful that it was worse than my recovery the 4 days after surgery. This has continued until last weekend when I went to Hospital emergency. Yesterday I saw the surgeon and today see a cardilogist. Though fluid was at 11 mm in December it is minor now though the pain continues. If the pericardium thickens then they'll have to remove it. I start a Medrol dose pack soon.

              No one seems to know the cause of the pericarditis: viral, bacterial, fungi or some medication so they keep throwing anti inflammatories at it and it works for awhile then as soon as I stop or cut back it all comes back. I've been told it can last for 6 months for some people. Removing the pericardium is a high risk procedure and I don't know the long term consequences. I sure hope it doesn't come to that. So pericarditis can be much worse than the original operation - in my case, an AVR.


              • #8
                Hey Bob,
                I'm suffering the effects of pericardial constriction and have spent some time researching removal of the pericardium.
                I would have removal done as a last resort.
                I'm learning to live with what's going on, and I'm hoping that I will be able to forestall removal until I eventually need my bovine valve replaced (looks like we have the same model valve).
                I'm taking it one day at a time.
                Let us know how this progresses.


                • #9
                  pericardial constriction

                  Mary, you are at a much later stage of this process - sorry to hear that. I'm trying to avoid getting there. Perhaps, auto immune diseases makes it worse though my celiac disease is technically not an auto immune disease but an immune enteropathy. Is there ever a case of rejection with valves? I thought it had to be live tissue to cause rejection e.g. heart replacement.

                  Mary, how long did it take before you got to constriction? Why couldn't they prevent it?

                  Thank you,


                  • #10
                    Originally posted by windsurfer
                    Mary, how long did it take before you got to constriction? Why couldn't they prevent it?
                    Thank you,
                    Pericardial constriction is garnering more attention due to the greater number of open heart surgeries being performed. In my situation, it's a reaction (scarring) to the trauma it has undergone. Tobagotwo said it best when he likened it to "your heart wearing a strait jacket." The ventricle can't completely empty with each beat, so the blood backs up.

                    I received the diagnosis after my first echo was read at 10 weeks. On the echo, the pericardium was "echodense" and I had a "septal knock". The septal knock is the confirming symptom. I also developed a nagging cough and my jugular vein was distended from fluid retention. The cardiolgist started me on a mild diuretic, and I lost 7 pounds in two days.

                    I don't know if it's preventable. It's possible that the pericardium was sewn too tight after surgery. Bouts of pericarditis can cause it, but I never had that. I do pay attention when a member posts that they're having ongoing problems with excess fluid around the heart. My guess is constriction is more prevelant than we hear about; it's just not diagnosed early. I give my cardiologist credit for diagnosing it quickly.

                    Right now I'm following my own plan of action for dealing with it. There's not alot of information in that area, so I feel like I'm trail blazing my own path. I've learned that it's critical to keep the fluid retention down. With the fluid off, I can swim and jog. When I'm retaining it, I do very little to avoid taxing the heart. My "plan" also includes weight reduction. I believe that the less weight I'm carrying around, the easier it will be on the heart. I've lost 10 pounds and would like to lose 10 more.

                    If I can wait until I have my next replacement, they'll remove the pericardium when they replace the valve. I'm trying to buy myself time until we reach that point.;) ;)


                    • #11

                      I am confused. Many of you are mentioning the risks of 'removing the pericardium'. My cardiologist said the treatment for my effusion, if I need a treatment, would be draining the fluid with a needle. These *are* two different procedures, right?

                      Also, my second ultrasound to check on my fluid level is tomorrow. Since my last ultrasound my energy level has tanked. I haven't gone for my afternoon walk in a week and my naps are getting ridiculously long. I feel thoroughly fatigued during the daytime and have a little more energy around dinner time. It feels like when I was on the narcotics, just groggy and no fun to be around. I did some google searches and it looks like fatigue can be an effect of pericardial effusion. I'm anxious to see what the ultrasound shows tomorrow.


                      • #12

                        Michelle, Bob and Mary
                        If you ever need information on the removal of the pericardium I have had it done. It is the last resort so hopefully you will never need to know more. I did have pericarditis after all three heart surgeries and it was treated each time with an anti-inflammatory med called Indocin. It did help.


                        • #13
                          Hi, Michelle,
                          I had a terrible pericardial effusion, which almost went into tamponade, shortly after my surgery eight years ago. I was rehospitalized, and the pericardium and lungs were drained of a substantial amount of fluid. I took a short round of prednisone after the procedure and eventually recovered. Some of my symptoms were a great difficulty lying on my back (very uncomfortable), a puffy look in my face, a cough, and basically no energy.
                          You asked if removing the pericardium and draining it are the same things? No. A pericardectomy (Is that the right word, Mary?) is the actual removal of the covering, much more serious than just draining it with a needle.

                          Keep us informed as to how you progress.
                          mitral valve replacement - June 1997
                          Methodist Heart Institute, Methodist Hospital
                          Indianapolis, IN


                          • #14
                            steroids to stop it

                            I saw the cardiologist since my last post about pericarditis. They want to limit the inflammation so I guess the pain is a good thing since it let's us know that it is happening. I'll be starting a steroid which is a powerful anti inflammatory - it is called Medrol dose pack - Methylprednisolone a synthetic corticosteroid. I take 6 pills the first day, 5 the next and so on for 6 days. Then you wait for awhile and when the inflammation returns you do it again with a more powerful steroid for a longer time. Between steroids I'll take Ibuprofen.

                            Avoiding pericarditis will help prevent damaging the pericardium. Otherwise it will eventually thicken and harden like Mary and the others said and become a stiff strait-jacket preventing the heart from pumping so it has to be removed as Kathleen did.

                            An echo is a fast way to confirm pericardial effusion but a CT scan picks up even more detail - in my case showed the fluid around the lungs such as possible left pleural and or right pleural fluid and thickening that may come with pericarditis. I'm hoping that by getting it under control I will avoid constrictive pericarditis.

                            I asked if the problem was damage to the pericardium either from surgery or how it was closed up or when the wires on the heart were pulled out before I left the hospital. Apparently, that isn't the issue since it is quite common after surgery and the pericardium is not closed up as it somehow knows how to close itself.

                            I my case, the worst pericarditis started 10 weeks after surgery so I thought it was unrelated - but not so. Sometimes there is a delayed reaction even months and years later. But whenever it happens, the pain lets you know it's happening, allowing you to get the necessary anti-inflammatories to control it.

                            Thank you,


                            • #15
                              Effusion Update

                              Today is Sunday and I have just returned from a 3 day hospital stay to have my effusion drained with a pericardial window. On Thursday morning, I had my echo and soon thereafter got a call from my cardio saying the effusion needs to be drained because it hadn't decrease and there was stranding in the fluid (beginnings of clots). So I was admitted that afternoon to the hospital. The cardiac effusion team did an echo on me in the cath lab and identified a 'very large' effusion on the posterior (back) side of my heart. The location made the drainage a little tricky and they decided it would be safest to drain it with a surgical procedure called a 'window.' So they shot me with vitamin K, withheld my warfarin, and I was sent to the OR on Friday morning for surgery. My surgeon drained 800 CCs from my Things went well and now I'm home. My challenge now is to get my INR level back up to therapeutic range. They have me on lovinox and warfarin until I'm therapeutic again, which, I've been told, increases the risk of another effusion. Ugh.

                              I'm glad this hurdle is behind me and I'm very hopeful it won't come back.

                              Thanks for all your advice and support!