PERICARDIAL EFFUSION
PERICARDIAL EFFUSION
is a condition where fluid builds up around the heart.
The pericardium is the sac around the heart.
The pericardium helps to cushion and protect the heart.
There is usually nothing in the pericardial space, typically, except for a thin film of fluid.
The body naturally maintains a volume of about 50cc of pericardial fluid that lubricates the heart.
The pericardial fluid is usually thin like water (low viscosity) and has a yellowish color.
Cardiac tamponade is a life-threatening problem and emergency intervention is needed.
Typically, the blood pressure is low, urine output slows, and the patient experiences shortness of breath, lightheadedness, and/or chest pressure.
Cardiac tamponade can be treated with pericardiocentesis or pericardial window.
If the same amount of blood is going to move thru the valve, then the blood must move faster if moving thru a smaller opening.
An analogy is putting your finger over the end of a water hose. The reduction in space forces the water to move faster. As such, the water will also shoot farther.
When the blood moves faster thru the valve, the blood can produce an abnormal sound. The abnormal sound is a murmur.
The body cannot fix aortic stenosis. There is no known way to remove calcium from the leaflets and make them move better again.
There is no medication that can remove calcium from the leaflets.
There are no vitamins or supplements shown to halt or reverse the process, either.
Surgery to replace the stiff, stenotic leaflets is the only therapy which effectively eliminates the problem of the stiff leaflets and extra work for the heart to open them.
Not every patient with aortic stenosis needs an operation, of course.
Scientific studies have been done to help determine when an operation should be considered for patients with AS.
Often, aortic stenosis is first suspected because a murmur is heard. Generally, the worse the stenosis, the louder the murmur.
An echo cardiogram can make the diagnosis. An echo is a fancy ultrasound.
Measurements can be made via echo to determine how severe the stenosis is.
With severe stenosis, the heart may struggle to produce enough force to open the valve and get the proper amount of blood out.
These studies have shown that patients can live for a long time with some aortic stenosis.
However, once the patient begins to experience symptoms, there is a dramatic change and many patients will not survive for long.
In general, once patients have symptoms from severe AS, about 50% of patients will not be alive in 2 years.
The symptoms patient experience are shortness of breath, chest pain, and passing out.
Often, patients do not report shortness of breath but instead they cut out the activities which would cause them to feel short of breath.
Often patients assume they are feeling tired and run down because they are just getting older - which may be true! But it may also be that their heart is struggling.
Sometimes the heart will struggle so much that it becomes weak.
It is preferable to provide the patient with surgery prior to the heart becoming weak.
Though no patient wants heart surgery, one satisfying aspect of aortic valve replacement for AS is that patients can live for many years.
So whereas patients have a 50% chance of living for 2 years without surgery (once they have symptoms), patients can live many years after AVR and often a problem other than their heart is the ultimate cause of death.
When it comes to aortic valve replacement, there are several options.
FREQUENTLY ASKED QUESTIONS
Q: What causes aortic stenosis?
A: It is unclear exactly why some patients get AS and others do not. About 50% of patients have senile AS, which is age-related calcification of the valve leaflets. But it is not like the patients ate too much calcium or anything like that. The calcification is thought to be related in some way to inflammation. About 30-40% of cases of AS involve a bicuspid aortic valve, which is a valve with 2 leaflets instead of the normal 3. And about 10% of cases are from rheumatic fever, where scar tissue forms on the valve, narrowing it.
Q: How common is aortic stenosis?
A: AS is the most common heart valve disease in the US. It is estimated to affect roughly 2 million people!
Q: What happens if a person tries to ignore AS?
A: AS almost always worsens over time. As the valve becomes tighter and the heart works harder to pump the blood out, the person becomes increasingly tired and run down. If the person does not seek medical attention, the heart will struggle more and more and eventually become unable to provide enough blood to the body. Generally, a person does not "drop dead" from AS in this process but rather it is a slow, progressive process. Still, there are some patients who get worse quickly and frequent visits to the hospital can be common.
Q: My doctor says I have a murmur - should I be worried?
A: A murmur is the sound caused by abnormal blood flow. A murmur may or may not represent a problem that is unsafe. Often, a patient may have a murmur for many years and the patient requires no particular intervention. However, if you have been found to have a new murmur, this should be fully investigated by a specialist, usually a cardiologist.
Sometimes the fluid in the pericardial space builds up.
The pericardium is relatively inelastic, like a burlap sac.
The volume and shape of the sac are set and there is not a lot of slack in the sac; that is, the pericardium is only slightly larger than the heart, and the size of the pericardium is set.
So if fluid builds up in the pericardial space, it has nowhere to go.
And the fluid can build up with such pressure that the heart begins to struggle.
Typically, if the fluid builds up enough, the heart has difficulty filling, so that it cannot pump enough blood out - because there isn't quite enough blood inside it to pump out.
If the fluid builds up and the heart begins to struggle, the condition is called cardiac tamponade.