Signs and Symptoms of Fluid Around the Heart

 by Lori Newell

Excess fluid around the heart, known as a pericardial effusion, causes a variety of signs and symptoms that range from mild to severe.

A sac surrounds the heart and normally contains about 1.0 to 2.5 tablespoons of fluid in adults. This fluid-filled sac, called the pericardial sac, reduces friction between the beating heart and nearby structures in the chest. Pericardial effusion refers to increased fluid around the heart within the pericardial sac.

A pericardial effusion can develop for a variety of reasons including infection, autoimmune disease, a heart attack, cancer, radiation therapy, chest trauma, kidney failure and certain medications, among others. The signs and symptoms associated a pericardial effusion vary depending on the underlying cause, the volume of excess fluid, and how rapidly it accumulates.

Varied Signs and Symptoms

A pericardial effusion sometimes causes no symptoms, especially if the condition develops gradually. In these situations, the condition is usually detected because of signs noted during physical examination or testing.

At the opposite end of the spectrum is the rapid development of dramatic symptoms, often signaling an immediately life-threatening accumulation of fluid around the heart. In most people with a pericardial effusion, the signs and symptoms are between these two extremes.

In general, the signs and symptoms associated with a pericardial effusion tend to be more numerous and severe with larger amounts of fluid. However, rapid accumulation of lesser amounts of excess pericardial fluid can also cause severe signs and symptoms.

Heart and Circulatory Signs and Symptoms

Excess fluid around the heart can impair its function and the delivery of blood to the body organs and tissues. As fluid accumulates in the pericardial sac, pressure around the heart often increases. This pressure can make it more difficult for the heart to fill with blood.

As a consequence, less blood is pumped to the body with every heartbeat. A variety of heart and circulatory signs and symptoms can develop in this situation, including:

  • Rapid heart rate
  • Low blood pressure
  • Cool hands and feet
  • Swelling of hands and feet
  • Prominent, distended neck veins
  • Dizziness, lightheadedness or fainting
  • Anxiety, restlessness and/or confusion (due to decreased brain blood flow)

These signs and symptoms often do not develop until the fluid buildup around the heart reaches a critical level. However, abnormalities in heart and circulatory function can be detected in advance of circulatory symptom development with tests such as an electrocardiogram (EKG) and an ultrasound of the heart (echocardiogram). These tests help identify people at greatest risk for potential heart failure associated with a pericardial effusion.

Inflammatory Signs and Symptoms

Inflammation of the pericardium, known as pericarditis, is a leading cause of excess fluid around the heart. This condition often develops suddenly and leads to specific inflammatory signs and symptoms. The most common symptom is pain in the left chest or behind the breastbone that worsens when you inhale deeply, cough or move your upper body in certain ways.

Lying down typically increases the pain, and sitting up or leaning forward usually reduces the pain. The pain might radiate to the back, shoulder or neck. Other inflammatory signs and symptoms may include:

  • Fever, with or without chills
  • General sense of feeling unwell
  • Reduced energy level
  • Abnormal heart sound called a friction rub

Respiratory Signs and Symptoms

The heart and lungs work together and sit in close proximity within the chest. For these reasons, excess fluid around the heart often causes respiratory signs and symptoms, which vary from mild to severe, including:

  • Shortness of breath
  • Reduced exercise tolerance
  • Rapid breathing rate
  • Dry cough
  • Decreased breath sounds and/or crackling sounds in the left lung when listened to with a stethoscope

Other Symptoms

A sizable collection of fluid around the heart can cause other symptoms, primarily to due to the expanding pericardial sac pressing on nearby structures or a backup of blood in the venous circulation. Examples include:

  • Hoarseness
  • Frequent and/or persistent hiccups
  • Difficult or painful swallowing
  • Nausea, vomiting and/or diarrhea
  • Abdominal bloating

Warnings and Precautions

A pericardial effusion can be a relatively mild condition that causes few, if any symptoms. But some pericardial effusions are potentially life threatening and might culminate in heart failure and shock if not treated promptly.

If you experience any signs or symptoms that might be caused by excess fluid around the heart, contact your doctor immediately. Seek emergency medical care if you experience any warning signs or symptoms that might signal serious heart or circulatory impairment, including:

  • Shortness of breath
  • Chest pain
  • Cold, clammy skin
  • Dizziness, lightheadedness or fainting
  • Mental confusion
  • Rapid heart and/or breathing rate

Reviewed and revised by: Tina M. St. John, M.D.


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