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Treatments and drugs
By Mayo Clinic staffTreatment 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 tamponade — impaired heart function due to pressure on the heart. Treating the underlying cause of pericardial effusion — such as pericarditis or uremia — often corrects the problem.
Anti-inflammatory medications
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:
- Aspirin
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin (Indocin) or ibuprofen (Advil, Motrin, others)
- Colchicine
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.
Invasive procedures
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.
- Pericardiocentesis. With this procedure, your doctor uses a needle to enter the pericardial space and then a small tube (catheter) to drain fluid from the pericardium. 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 reaccumulation of fluid.
- 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.
- Intrapericardial sclerosis. With this procedure, 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.
- Pericardiectomy. Pericardiectomy is the surgical removal of all or a portion of the pericardium. This rarely performed procedure is usually reserved for treatment of recurring pericardial effusions despite catheter drainage. The heart can function adequately without the pericardium.
- Little WC, et al. Pericardial disease. Circulation. 2006;113(12):1622-1632.
- Cardiopulmonary syndromes (PDQ®): Malignant pericardial effusion. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/supportivecare/cardiopulmonary/HealthProfessional. Accessed Nov. 1, 2008.
- Martin M, et al. Pericardial disease. In: Libby P, et al., eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/108738632-2/0/1549/0.html. Accessed Oct. 29, 2008.
- Khunnawat C, et al. Cardiovascular manifestations in human immunodeficiency virus-infected patients. American Journal of Cardiology. 2008;102(5):635-642.
- Maisch B, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary: The task force on the diagnosis and management of pericardial diseases of the European Society of Cardiology. European Heart Journal. 2004;25(7):587-610.
- Ristic AD, et al. Management of pericardial effusion: The role of echocardiography in establishing the indications and the selection of the approach for drainage. Herz. 2005;30(2):144-150.
