The human heart is a remarkable organ. It beats over 100,000 times a day, pumping blood and oxygen through a vast network of vessels that keep us alive. Scientists are constantly uncovering new insights into its function, and one of the more recent discoveries gaining attention is something called “fatty heart.”The idea that fat can accumulate around the heart is surprising to many. Most people are familiar with belly fat or the pinchable fat just under the skin. But the fact that fat can wrap itself around the heart, interfere with its rhythm, and silently raise the risk of life-threatening conditions is less widely known. Understanding what fatty heart is, how it develops, and what it means for long-term health is key to prevention and early intervention.What Is Fatty Heart?Everyone has some amount of fat around their heart. Known as pericardial fat, this tissue acts as a cushion, a source of energy, and even a thermal insulator. In healthy amounts, it supports the cardiovascular system. The problem begins when this fat becomes excessive.The fat that sits closest to the heart muscle is called epicardial adipose tissue (EAT). Researchers describe it as both protective and potentially harmful. In newborns and healthy adults, EAT provides energy reserves and shields the coronary arteries. But when too much accumulates, it transforms from a neutral tissue into a biologically active one, releasing inflammatory molecules that can contribute to atherosclerosis (plaque buildup), oxidative stress, and ultimately heart disease.Can You Have Fatty Heart If You’re Slim?A common misconception is that fatty heart only affects people with obesity. That isn’t true. Research shows even lean individuals can have dangerous levels of heart fat.A study published in the Journal of the American College of Cardiology found that about 10% of participants with a BMI under 25 still carried excess pericardial fat. The risk rose sharply with weight, 29% of those overweight and 55% of obese participants had high levels. Importantly, regardless of body size, the more fat wrapped around the heart, the higher the risk of heart failure.This means someone with a normal BMI can still silently harbor significant cardiovascular risk, which makes regular monitoring and lifestyle habits essential.What Is The Link Between Heart Fat and Heart Disease?The connection between fatty heart and cardiovascular disease is now well established. A systematic review published in Circulation: Cardiovascular Imaging examined 29 studies with more than 19,000 participants. It found that increased EAT—whether measured through ultrasound or CT scans—was strongly associated with major heart complications, including heart attacks, ischemic strokes, heart failure, and atrial fibrillation (Afib).Studies reveal that epicardial fat behaves differently than the fat under your skin. It is biologically active, releasing inflammatory substances and damaging the endothelium (the thin lining of blood vessels). It also generates reactive oxygen molecules, which, if not neutralized by antioxidants, contribute to oxidative stress—a process that damages cells and accelerates cardiovascular decline.According to a 2022 review in Nature Reviews Cardiology, nearly 2,000 studies over the past two decades have reinforced these findings. The verdict is clear: fatty heart is not just an incidental observation—it’s a critical risk factor.What Causes Fatty Heart?Dr. Anil Mishra, a cardiologist at BM Birla Heart Hospital, notes that fatty heart is often the outcome of modern lifestyles combined with underlying health conditions. “While most people are familiar with fatty liver disease, very few realize that fat can also accumulate around the heart. This silent but dangerous problem can increase the risk of heart failure, arrhythmia, and other life-threatening complications,” he explains.Some of the most significant causes include:Obesity – Excess body fat is a major driver, triggering inflammation and even fibrosis within the heart muscle. It also disrupts rhythm, frequently causing atrial fibrillation.Diabetes – Metabolic disturbances in type 2 diabetes accelerate fat deposition around the heart.High cholesterol – Elevated LDL cholesterol leads to fatty buildup in both arteries and heart tissue.Excess alcohol consumption – Heavy drinking harms both liver and heart, fueling fatty deposits.Sedentary lifestyle – Limited activity reduces calorie burning, allowing fat to settle around critical organs.Genetics – A family history of cardiovascular disease can predispose someone to this condition.Symptoms of Fatty Liver That Should Not Be IgnoredIn its early stages, fatty heart is often silent. Many people discover it only through imaging tests performed for other reasons. But as it advances, symptoms may appear, including:Persistent fatigue and weakness due to reduced pumping efficiency.Chest discomfort or heaviness as fat presses against heart structures.Shortness of breath, even with light exertion like walking upstairs.Irregular heartbeat or palpitations, sometimes due to atrial fibrillation.Swelling in legs or abdomen, a sign of poor circulation and fluid buildup.Difficulty breathing at night while lying flat.Dr. Mishra emphasizes that ignoring these warning signs can delay diagnosis. “If you notice unexplained fatigue, breathlessness, or palpitations, consult a doctor without delay. Early intervention can make all the difference,” he advises.How to Stay Protected?The good news is that fatty heart is not an inevitable condition, and like many cardiovascular risks, it can be reduced through consistent lifestyle choices and timely medical care. Staying physically active is one of the most effective ways to protect the heart, as regular exercise helps burn visceral fat, including epicardial fat. Activities such as walking, swimming, cycling, or strength training for at least 150 minutes a week can make a measurable difference. A heart-healthy diet is equally important—one that emphasizes whole grains, vegetables, fruits, lean proteins, and healthy fats like olive oil and nuts, while limiting processed foods, added sugars, and saturated fats. Managing chronic conditions such as high blood pressure, diabetes, and elevated cholesterol through medication and lifestyle adjustments is also essential to lower the risk. Limiting alcohol intake plays a role too, since heavy drinking promotes fat accumulation around both the liver and the heart, making moderation—or abstinence if advised—a key preventive step. Maintaining a healthy weight can further reduce the burden of fat around the heart; even modest weight loss has been shown to decrease epicardial fat levels. Finally, scheduling regular medical checkups is crucial, as imaging techniques like CT scans or echocardiography can detect excess heart fat early, well before noticeable symptoms begin. Together, these steps can significantly improve long-term heart health and reduce the risks associated with fatty heart.Fatty heart is a silent but serious condition that challenges the traditional way we think about fat and cardiovascular risk. It can strike lean or overweight individuals alike, and it is strongly tied to heart disease, arrhythmia, and failure.What this really means is that taking care of your heart requires more than watching the scale. It requires attention to lifestyle, awareness of symptoms, and proactive medical care. With exercise, a balanced diet, and timely screenings, you can protect your heart from this hidden risk and give it the resilience it needs to keep beating strong for years to come.