Having fluid around the heart is a serious condition that impairs the ability of the heart to function properly. Also known as pericardial effusion, it can be due to a disease, an infection, an injury or a complication from surgery. Certain medications and chemotherapy can also cause fluid to accumulate around the heart. Fortunately, this condition can be successfully treated and it is therefore important to recognize and treat it early to avoid serious complications.

Symptoms of Fluid Around the Heart

Pericardial effusion is often caused by pericarditis or inflammation of the outer membrane lining the heart. Chest pain is the most prominent symptom. It usually worsens when breathing deeply and is relieved by leaning forward. Other symptoms include:

• Fatigue
• Fever
• Shortness of breath
• Muscle aches
• Nausea and vomiting
• Diarrhea (associated with viral illness)

Fluid around the heart that is not related to pericarditis often does not cause symptoms. However, some may have serious symptoms like cool and clammy skin, palpitations, shortness of breath, light-headedness, and fainting. This may be life-threatening and is considered a medical emergency.

When to See a Doctor

You must immediately call 911 if you experience chest pain lasting more than a few minutes, difficulty breathing, painful breathing, or unexplained fainting spells. Call your doctor when you feel shortness of breath, fatigue and other symptoms of pericardial effusion.

Is Fluid Around the Heart Dangerous?

The cause and nature of the condition determines the severity of your condition. If it is caused by infection, for example, which can be easily treated with medications, then it is not very serious. However, if it is massive and caused by cancer, you will need more aggressive treatment because your condition may be life-threatening.

The danger of rapid fluid accumulation around the heart is that it can cause severe compression of your heart (a condition called cardiac tamponade) that will impair its ability to pump blood to the rest of the body, which is life-threatening.

What Cause Fluid Around the Heart?

The heart is enclosed in a sac that normally contains a small amount of fluid. This helps the heart to function normally. However, when excess fluids are produced due to inflammation of the sac or other reasons like trauma or heart failure, and drainage is impaired, then fluids accumulate around the heart, causing pericardial effusion.

The most common cause of fluid accumulation around the heart is inflammation of the sac or lining surrounding the heart. However, in many cases, the cause may not be found. Possible causes include:

• An autoimmune reaction like lupus or rheumatoid disease
• Certain drugs
• Kidney disease
• Pregnancy

Less commonly, a bloody type of fluid can form around the heart which may be due to a leakage from the heart or from the blood vessels connected to the heart. Cancer of the lining of the heart or from elsewhere that spreads to the heart can also cause pericardial effusion.

Diagnosis of Fluid Around the Heart

If your doctor suspects pericardial effusion from your medical history, he will listen to your heart sounds which may reveal grating noises caused by a pericardial friction rub. However, this may not appear in all cases.

Other conditions can cause similar symptoms to pericarditis. Therefore, tests may be needed to clarify the diagnosis and to rule out other causes of chest pain:

• A chest X-ray
• An electrocardiogram or ECG
• An echocardiogram
• An MRI or magnetic resonance imaging scan or CT (computed tomography) scan
• Fluid aspiration with a needle and syringe

How to Treat Fluid Around the Heart

1. Take Medications

If your condition is stable and not life-threatening, medications may be all you need such as:

• Aspirin
• NSAIDs or Nonsteroidal anti-inflammatory drugs like ibuprofen or indomethacin
• Colchicine
• A corticosteroid like prednisone

2. Drain the Fluid

If necessary, your doctor may use a needle and a small tube/catheter to drain fluid around the heart, a procedure called pericardiocentesis. This is usually done under the guidance of imaging devices like echocardiography or fluoroscopy. Monitoring of the heart during the procedure is carried out with ECG. The catheter is usually left in place to slowly drain the sac for a few days to relieve pressure around the heart and help prevent fluid build-up.

3. Undergo Open-Heart Surgery

Sometimes, surgery may be indicated, especially when there is bleeding around the heart due to a damaged structure. Drainage of fluids to the abdomen may also be used as an option.

4. Seal the Layers Together

To prevent fluid from accumulating in the sac, a simple procedure called intrapericardial sclerosis may be done. This involves injecting a solution into the space between the two layers of the sac which results in sealing the two layers together. Sclerosis is usually done if you have recurrent pericardial effusion or if your effusion is caused by cancer.

5. Remove the Pericardium

The heart can adequately function even without the sac or pericardium. The pericardium may be removed surgically (a procedure called pericardiectomy). This is usually reserved for the treatment of recurrent pericardial effusion in spite of catheter drainage.