Can we rule out Pericarditis????

[Roger-D-Sago]

Posted by Roger D. Sago on August 08, 1999 at 12:35:58
I am writing, because I am somewhat frustrated at my level of care my sister has been receiving.
From when I can remember as a little boy, she was always taking allergy shots to deal with severe asthma, it seem she was in the hospital with oxygen more than I could count.  (She outgrew the asthma and allergy issues and stopped taking shots eventually.
At about the age of 12 she was diagnosed with WPW.  As she grew it became progressively worse, in 1988 she was informed that here WPW was becoming life threatening, and a heart attack ensured.   (She is a 38 Y/O).   She had open heart surgey to remove the offending "bundle", and remain symptomatic over the years.
About 1 to 1.5 years ago, she started have irregular rhythms again.  The pattern was always the same, she would start out by complianing of chest pain (non cardiac) and discomform up into the throat and general area.   The discomfort would grow worse over a period of 3 - 4 days.  At the height of the discomfort, she would begin having periods of Tachycardia.   The rhythm would race for a while, return to normal, race again, or just sometimes stay elevated (150 - 200) beats per minute.  The upper chambers were not in synch with the lower chambers.
Most beta-blockers have failed to work altogether, and in the case of WPW Conversion with electrical shock (Paddles)were required.  She always knows when it "converts" back to normal rhythm.
Her current doctor where she is treated thought the WPW had returned but the pattern on the EKG was non-indicative.   He had thought it was Pericarditis, but has since discounted this as he has heard no rub.
EKG, Echo and Thalum Stress tests done during a period of no symptoms were normal.  The special blood tests that can be done, "Sep" (?) was normal when taken (at 4:00 AM this morning).
Do you think, a CT or MRI be conclusive in helping to identiy the item as Pericarditis.  Could there be another possible medical condition causing the discomfort for several days prior to the onset of Tachycardia.  
Her current attending Physican seems to be worried about Blot Clots, when she has these episodes of Tachycardia, and have prescribed Heparin, which she refuses because of the Severe Migraines that one of the elements in this medication cause.
Her doctor has recommended life-long beta blockers, which she tried for several weeks that produced so much fatigue that she was incapable of functioning.
The symptoms and discomfort, leading up to the onset of the Tachycardia has to be indicative of some underlying problem.  If we could get the Physicans focused on identifying and treating this problem, we very well may have found a way to control the Tachycardia.  Instead, they treat the Tachycardia as it's life threatening at the time, refusing to focus on the onset symptoms.
I failed to mention that several years back (4) she was diagnosed with cervical cancer, and tumors on her ovaries, as such, a complete hysterectomy was performed.  
Any thoughts would you have on this matter would be greatly appreciated, and if you've since anything similar, I would certainly be grateful if you could share your insight.
Thank you for your time!
Posted by CCF CARDIO MD - CRC on August 09, 1999 at 11:30:49
Dear Roger,
This is really more of a management question and somewhat beyond the scope of the forum.  To address a few of your concerns - MRI is probably the best test to look for thickening of the myocardium associated with pericarditis; coumadin may be used for long-term anticoagulation instead of heparin; it is possible she has a "Return" of the WPW or another arrhythmia and an electrophysiologist is the best doctor to determine what the next step is.  The bottom line here would be to get a second opinion if she is unhappy with her current care.  All of her problems sound managable but it will take a bit of work to get everything squared away.
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.