Content provided by the Faculty of the Harvard Medical School

Ask the doctor: What causes fluid to build up around the heart and what can be done to treat it?

Ask the doctor

What causes fluid to build up around the heart and what can be done to treat it?

Q. My brother-in-law was told that he has some fluid around his heart. What does that mean, and how is it treated?

A. The heart is surrounded by a thin, two-layer sac called the pericardium. It looks a bit like a cellophane bag. The pericardium protects the heart, limits its motion, and prevents it from expanding too much when blood volume increases.

The medical term for a buildup of fluid inside this sac is pericardial effusion. It can be caused by infection, rheumatoid arthritis or lupus, a heart attack, heart or other surgery, trauma, kidney failure, malnutrition, an underactive thyroid, and many other conditions.

Pericardial effusion may be silent, cause pain, or hinder the heart's function, depending on the cause and severity of the buildup.

The management of pericardial effusion, too, depends on the underlying cause, how much fluid is present, and how quickly it is enlarging the pericardium. Treatment of the underlying disorder, such as an infection, heart failure, kidney failure, or malnutrition, generally reduces or eliminates the excess fluid. Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen are often prescribed to calm the inflammation and ease pain and other symptoms.

Rapid or excessive fluid buildup may require more drastic measures; otherwise, the pressure inside the pericardium could squeeze the heart. By preventing the ventricles from expanding fully, this pressure could limit the heart's output of blood. Drawing fluid out of the pericardium with a needle can temporarily relieve the pressure. Heart surgery may sometimes be necessary to drain fluid or to cut away scar tissue.

— Thomas Lee, M.D. Editor in Chief, Harvard Heart Letter

Last updated:	September 05, 2008