Athletics and Pericarditis

  Hello,
  I am 23 years old.  I just graduated from the University of Wisconsin in
  December of '97 and currently I am working as a test engineer at Motorola.  
  Since graduation I have gotten heavily involved in sports again.  Since
  that time I also have experienced multiple occurrances of pericardial
  effusion.
  History:  
  I had 1200cc of fluid removed from my pericardium in November of 1991.
  Since then I have had reoccurring fluid, usually about twice a year and
  probably never exceeding 200cc.  I have seen a few cardiologists in the
  past and one recently.  Some questions I have never have been answered
  clearly or to my satisfaction.  
  I have read a few of the columns that were posted in the past year and
  none of them have been like this.
  The past year I have been working out and doing a lot of cardiovascular
  exercises.  I ran the Chicago Triathlon in August and I will be running
  in a marathon this weekend.  This year I have experienced about 8 or 9
  episodes where fluid re-accumulated.  I correlate these re-occurances to
  the stress that I have been putting on my body, but all along I have been
  told that activity has nothing to do with it.  I am concerned for my
  health in the future.  When I do get these episodes of fluid I have to
  rest for a week or more to get rid of the feeling and return to regular
  activity.  If I don't the sensations get worse and I will have to rest
  longer eventually anyway.  Is there anything that I can do?  How do these
  re-occurances correspond to strenuous activity?  Is there any other advice
  you can give me? Is there anything I should know about my situation that
  I don't know already?  Will this continue for the rest of my life? As long
  as I am active?  What factors does this depend on?  
  When the fluid was extracted no known cause was determined, but it was
  assumed to be a viral infection.  It just seems to me like this issue of
  high stress activity and reoccurring pericarditis hasn't been looked into.
  If anyone can address the specific question of high stress activities and
  re-accumulation I would be very grateful. Thank you for your time and
  helpful suggestions.
  
                         Steve Scherer

[CCF Cardio MD - MTR]

Dear Steve, thank you for your question.  You mention an unusual condition - recurrent pericardial effusion.  Frequently, the cause of a pericardial effusion is not clearly established and you certainly could have had a viral infection that caused your initial effusion in 1991.  I can't think of a specific reason that you keep developing recurrent effusions though.  Stress and physical activity should have no impact on the reaccumulation of pericardial fluid.  I can't determine whether this condition will be a lifelong problem for you nor what factors are causing you to develop recurrent effusions.  It could be that you are having a chronic inflammatory process that is affecting your pericardium that causes fluid to accumulate on a periodic basis.  Chronic inflammation could be caused by the initial process that caused you to develop pericarditis and if present, could be treated with non-steroidal anti-inflammatory agents like ibuprofen or steroids.  I think you should speak with your cardiologist about the possibility of having a pericardial window performed.  A window procedure is a minor surgical procedure where an incision is made just below the ribcage and a small hole is made in the pericardium.  The tissue that is removed can be studied by a pathologist to help determine the cause of the reoccurring effusions.  The fluid will then drain through the "window" that is created into the pleural space and be reabsorbed.  Thus, fluid should not reaccumulate in the pericardial space.  Only your cardiologist could determine whether this is an appropriate procedure for you.  

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.   The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.