Will a pericardial window heal or is it permanent? Is there anything else that could be considered?

[Dora740]

In April I went to the ER due to severe chest pain radiating up my neck, shoulders and back.  I had been previously diagnosed with pleurisy for approximately 2 years and given numerous rounds of Levaquin and Decadron. I would go to ER and they would see a high WBC, fever and state I had a bacterial infection. Over 2 years my bouts became closer together. The decadron would relieve symptoms in hours but would recur in 2 months and towards the end my relief lasted for a few days. I went to TN to the ER. I was experiencing a pericardial tampanode. They moved me to Johnson City Medical Center. My BP was around 90/70 and experiencing tachycardia. The vascular surgeon conducted an open heart incision over my sternum and put in a pericardial window. They removed 400cc's of fluid and inserted chest tubes. The test that came back positive was for the Coxsackie Virus. The doctors feel that this may have not been the cause. I was discharged on NSAIDS. 2 days later I was in the hospital. CT scan also showed a slightly enlarged liver and spleen. Infectious disease wanted to do a liver biopsy and a bone marrow tap which most doctors were against. Neither done. My WBC would jump to 29,000 and then in hrs drop to 9,000 and I would run a mild fever. Did this for days. Bacterial cultures were done. Negative. HIV test completed. Negative. I went home for 2 days and it came back. They felt it was Post Cardiac Injury Syndrome. I was put on steroids. I started at 120mg. I have relapsed as Prednisone decreased. The first was at 2.5 mg and SED rate was high, C Protein factor was high and WBC count. Increased the Prednisone to 40mg. I was on 5mg for about 5 wks when the symptoms returned. It has been gradual onset. Pain in my left ribcage, my ribs felt bruised around to the floating rib, it would radiate up my side into my left shoulder. Pain is now in the center of my chest, under my left breast and in the mid of my back and up my neck. I am on 4mg. It's worse when I lay down

[Lee Kirksey, MD]

Im glad that you received temporary relief from the cardiac window to treat tamponade. I believe that your question is will it heal. The answer is yes. The window open the sac that lies around the heart, the pericardium to permit the fluid to leave and to relieve the pressure on the heart. Allowing it to perform better.

You have a complex, long standing problem and need to be seen at a large medical center/university that can look at all of your previous records and put the pieces together. This type of infection in the fluid around your heart is not normal as you know and may represent some immunocompromised state or infection elsewhere in your body. It sounds as if  your quality of like if poor right now. Gather your records and take a trip to get this figured out. This is not a simple problem that will be solved in the emergency dept or over the internet.

Good luck and God Bless