Chronic diopathic pericarditis: medication

I have had idiopathic recurrent pericarditis about 2 years. Before that I was parfectly healty 48 female. My doctors tried "wait-and-see", anti-inflammatory drugs, Prednisone, colchicine, colchicine+anti-inflammatory medication. The last combination seems to work best, but I still get pain very easy. I have had EKG, echo several times, MRI and some laboratory tests. There is always some extra inflammation in the paricardial sac, why it's still there? I can't exhaust me, the pain becames back. I feel it also for example when I lay myself down. I have had pericrditis 4 times before and every time it went away "itself".

My cardiologist suggest surgery. In what cases docs do "only" pericardial "window" and when they take all pericardial sac away? Do the heart get easier bacterias etc. because the sac is away? Where does inflammation goes afterwards or stop the heart forming it altogether? The pericardial sac somekind softens heartbeat, after taking it away, will I feel my heartbeat lauder for the rest of my life?
I hope my medication helps me forward, I have taken the last combination about 5 months now. How soon doctors usually suggest somekind of surgery? And how safe those surgeries are?

[CCF-M.D.-MJM]

Hi TerryC,

I am sorry to hear about your condition.  It is equally frustrating for health care professionals and patients when we have to label something as idiopathic -- a big word meaning we don't know why.

Pericardial windows are usually reserved for pericardial effusion (fluid around the heart between the pericardium and the heart).  Removing the entire pericardial sac is done if there is concern for cardiac constriction.  The pattern of inflammation/no inflammation/repeat can lead to a stiffening of the pericardial sac, encasing the heart and not giving it the room it needs to do it's job.  It is truly a judgement call on which procedure they do.  If they do a window and it keeps coming back, you may eventually need a pericardial stripping as well.  Why not do it all at once?  The stripping is a much more involved process with a large incision and more post operative risk of infection, discomfort, bleeding, etc.

Do the heart get easier bacterias etc. because the sac is away?

It is not more at risk for infection because of the stripping itself (removal of pericardial sac), the increased risk is from the surgery.  Once you heal there is not a greater risk of infection.

Where does inflammation goes afterwards or stop the heart forming it altogether?

Hopefully after they remove the pericardium, you will not have recurrent problems.  the lining of your lungs (pleura) are similar tissue and may also be at risk in the future for inflammation.

The pericardial sac somekind softens heartbeat, after taking it away, will I feel my heartbeat lauder for the rest of my life?

We are not sure why the pericardial sac is there.  There are people born without a pericardial sac and they have no problems.  you should not have an increased awareness of your heart after surgery.

How soon doctors usually suggest somekind of surgery? And how safe those surgeries are?

When to recommend surgery is a judgement call made on a case by case basis.

Depending on your overall health, the procedure is relatively safe.  This is a question you will need to ask your surgeon when the time comes.

I hope this helps.  

Good luck.

[KAEB]

I had a pericadectomy done eight years ago for constrictive pericarditis, after two open heart surgeries.  The phrenic nerve was damaged during the surgery and I have paralysis of the diaphragm. One year later we had to go in and plicate the diaphragm to reinflate the lung and move some organs back where they belonged. My lung has remained inflated for seven years but of course the paralysis remains.
Kathy

[TerryC]

Thank You very much for your answers.

I didn't know that the inflammation/no inflammation/repeat can lead to a stiffening of the pericardial sac and that can be reason to take the sac away. Is this continuing inflammation often "transforming" as a constrictive pericarditis?

I am sorry to hear your situation KAEB. Did you mean that your phrenic nerve damaged during the pericardiectomy? How soon this operation was after your two open surgeries?

CCF-M.D. wrote that the prosedure (surgery) is relatively safe. Perhaps KAEB your case is different than mine. I don't have any other heart disease and my perikarditis in not (yet?) constrictive.

I suppose there are no any other medication for this disease, I have tried the best of them?

I guess that I am still a little confused with these case. Both answers gave me new facts and I must ask some questions next time I meet my cardiologist. Thank You!!