Pericardial Effusions: The Causes, Symptoms, and Treatment of Fluid Around the Heart
Key takeaways:
A pericardial effusion is the medical term for fluid around the heart. There are many different causes for the condition, including inflammation, heart attack, cancer, and a condition called pericarditis.
The symptoms of a pericardial effusion include chest pain, shortness of breath, leg swelling, and fatigue. This condition is usually diagnosed with an echocardiogram.
Many pericardial effusions are not life-threatening. But a pericardial effusion may become life-threatening if the fluid starts affecting the heart’s ability to pump blood. A pericardial effusion may also be a sign of a serious underlying condition.
Many people don’t know that the heart muscle is actually surrounded by a thin sac, called the pericardium. A pericardial effusion is a condition in which fluid builds up inside that sac and surrounds the heart muscle. So it’s almost like the heart is sitting inside a water balloon.
A pericardial effusion is not really a disease itself. Instead, it’s usually a complication of another medical condition. Though, in some cases, a pericardial effusion can be more serious than the underlying condition that caused it.
What causes a pericardial effusion?
Many different medical conditions can cause a pericardial effusion, a collection of fluid around the heart. Some of these conditions involve the heart and nearby blood vessels. Others affect the entire body and not the heart specifically.
ED treatment on your terms
Build a personalized treatment plan and get erectile meds delivered discreetly. Subscriptions start at just $18/mo.
GoodRx is NOT insurance. Cancel anytime. GoodRx Health information and resources are reviewed by our editorial staff with medical and healthcare policy and pricing experience. See our editorial policy for more detail. We also provide access to services offered by GoodRx and our partners when we think these services might be useful to our visitors. We may receive compensation when a user decides to leverage these services, but making them available does not influence the medical content our editorial staff provides.
Some examples of conditions that can cause a pericardial effusion are:
Pericarditis: This is a condition in which the pericardium gets inflamed. It is often caused by viral infections or autoimmune diseases. The inflammation results in the abnormal buildup of fluid inside the pericardium
Heart attack: When the blood supply to the heart is blocked off, the heart muscle gets damaged and heart cells can die. This also leads to inflammation that can result in excess fluid.
Heart failure: If the heart isn’t able to pump blood forward well enough, fluid can build up behind the heart. This extra fluid can collect in many different parts of the body, like the lungs, legs, and around the heart.
Aortic dissection: This is a serious condition in which the walls of the aorta (a large artery in the chest and abdomen) start to tear. This can cause blood — not fluid — to collect around the heart.
Trauma: Any injury to the heart could cause bleeding into the pericardial sac. This could happen from a penetrating injury or a severe blunt injury to the chest.
Kidney failure: When the kidneys are not functioning at 100%, fluid and toxins can build up in the body. Like heart failure, this can lead to extra fluid around the heart, too.
Cancers: Different cancers can cause a pericardial effusion for a couple of different reasons. Increased inflammation in the body and cancer spreading to the pericardium are two possible causes.
Autoimmune conditions: These conditions, like lupus and rheumatoid arthritis, also cause inflammation throughout the body.
In some cases, the exact cause of a person’s pericardial effusion isn’t able to be determined, even after a lot of testing.
What are symptoms of a pericardial effusion?
With pericardial effusions, the symptoms can vary based on:
The way the fluid irritates the heart
If the pericardial effusion is big enough to affect the heart’s ability to pump
The underlying cause of the effusion
Common symptoms of a pericardial effusion include:
Chest pain, which can often be worse when lying flat
Shortness of breath, which can also be worse when lying flat
Swelling of the legs
Fatigue
Inability to tolerate even light exercise, like walking
Dizziness or lightheadedness
Read more like this
Explore these related articles, suggested for readers like you.
Sometimes, if the fluid builds up slowly over time, people may not notice any symptoms from the pericardial effusion. This is because the body has had time to adjust to the fluid.
How is a pericardial effusion diagnosed?
The best way to diagnose a pericardial effusion is with an echocardiogram. This is an ultrasound of the heart. With this test, providers can measure the amount of fluid and observe how much it is affecting heart function.
Other studies can find pericardial effusions, as well. Your provider might see some signs of a pericardial effusion on an electrocardiogram (ECG). These signs can also show up on chest X-rays, CT scans, and MRIs.
How is a pericardial effusion treated?
The treatment for a pericardial effusion depends on how big it is, the symptoms, and what is causing it. For mild cases, sometimes no treatment is needed. In this case, your healthcare provider would simply monitor your condition. And the effusion would eventually resolve on its own.
If the effusion is caused by pericarditis, there are some medications that can help with the inflammation and associated pain. They include:
Ibuprofen (Advil, Motrin)
In serious cases, a procedure called a pericardiocentesis may be needed, especially if the fluid is significantly affecting heart function. During this procedure, a specialist inserts a drain inside the pericardium to remove the fluid around the heart. The provider can also send the fluid for testing, if the cause of the pericardial effusion is not clear.
In rare cases, it may be necessary to have a part of the pericardium removed surgically. This can drain any existing fluid, and also prevent fluid from building up again. But most people don’t need either of these procedures to treat a pericardial effusion.
When is a pericardial effusion life-threatening?
Most of the time, a pericardial effusion is not an emergency. But there are some cases when it is life-threatening. This can happen if the fluid builds up quickly or the collection of fluid is large, which can lead to a condition called cardiac tamponade. This is when the heart may be under too much pressure to pump effectively and an emergency procedure (as described above) is necessary.
While most pericardial effusions are not life-threatening on their own, they may be a sign of a serious underlying condition. This is why it is important to identify what is causing an effusion, in addition to treating it.
The bottom line
A pericardial effusion is not a disease itself, but rather a result of another condition. There is a wide variety of underlying conditions that can cause pericardial effusions, ranging from something as simple as a mild virus to something more serious, like a heart attack.
Treatment for a pericardial effusion can vary from case to case. The good news is that most pericardial effusions are not life-threatening. They usually resolve on their own or with treatment for the underlying cause.
Why trust our experts?
References
American Heart Association. (2024). Treatment of pericarditis.
MedlinePlus. (2022). Cardiac tamponade.
Willner, D. A., et al. (2023). Pericardial effusion. StatPearls.
