Persistent Pericarditis

[Matt B]

3 months ago I went to a doctor complaining of headaches and back pain. I was sent to a cardiologist who heart a "rub" in my chest, did an EKG and an echo, and diagnosed me with "acute benign viral pericarditis". I went on 6 Aleves a day and was able to work from bed for the next three weeks.

Then suddenly it got much worse. I began to get sharp stabbing chest pains and thought I was having a heart attack. I went to the emergency room and had a chest x-ray and enzyme blood test. This doctor concurred that I had pericarditis and gave me painkillers and a 6-day steroid dose.

I went back to my cardiologist who did another echo and put me on a 25-day steroid taper (from 40mg down to 5mg). I felt marginally better with this, but was still confined to bedrest. When the drugs were finished, the pains came right back and my cardiologist put me on a stronger dose of steroids (80mg taper in 20 days).

Again the pain has returned and I am now going BACK to the cardiologist for more tests.

In between I have spoken with a rheumatologist and several cardiologists, all of whom confirm the initial diagnosis. I do not have swollen joints, rashes, ulcers, weight gain, abdominal distension, or anything else. What I DO have is headaches, a fast heart rate, and constant back/shoulder/arm numbness/pain. It's been three months now with little to no relief. I haven't slept lying down in all that time.

My question: what can this be? Can pericarditis last THIS LONG and is there anything else that can be done to treat it, other than surgery? Is is just a matter of keeping the inflammation down until it passes? I'm scared and confused and it's been a long time.

Thank you,
Matt Brown

[Cleveland Clinic, MD]

Dear Matt,

Recurrent pericarditis occurs in about 20% of acute pericarditis cases.  The treatment for recurrent pericarditis is first nonsteroidals and then steroids for those who fail to respond.  Surgical pericardiectomy (striping of the pericardium) is reserved for those patients who have persistent recurrent pericarditis accompanied by severe chest pain despite agressive medical therapy.   There is some data that colchicine 1mg/day may be effective in preventing recurrent episodes but large scale trials have not been done.  I would recommend giving medical therapy a good trial first and then proceed to surgery only if necessary.

[Matt B]

Thanks for the information.

The only thing I would add is that this is not a recurrent case. I've had the SAME case for 3 months. Many web sites tell me that pericarditis can last as long as 3 months, and if that's the case, I can be patient. I'm just trying to figure out if that IS the case, or if this could possibly be something else causing the pericarditis. But the doctors tell me this is not a recurrence.

Thank you,
Matt

[emma]

Hi Mat, I was diagnosed with pericarditis about 9 years after I had heart surgery.  It lasted about six months, and I took indocin for that time (and actually a few months longer).  I don't think I was in as much pain as you are.  I was only bothered with pain while I was lying down, as I remember.  I think I heard at the time that six months was about the longest  that it lasted. Good luck - emma

[WJS]

If you don't have a problem taking Antibiotics, I suggest a good strong round of Zythromax.

The clamydia (chlamydia) pneumonia bacteria may be responsible for chronic inflamation (inflammation) in the coronary arteries.  Perhaps it may also play a role in pericarditis.

The way I see it, it's a low risk treatment, and may help.

Bill S.

[Matt B]

First off, thanks to everyone for helping and responding.

My siutation is unusual in that I've had no other infections along with the pericarditis. It does not, and has never hurt to breath deeply. But the doctors know it's pericarditis because they can hear the characteristic "rub" sound in my chest.

If I knew that it could, in fact, last for many months, I could handle the pain. It's the not knowing that's so upsetting!

If anyone else out there has experienced a long bout of pericarditis (especially of the idiopathic variety), please tell me about it. (e.g., how long did it last, what did you experience, how did you care for it, etc.)

Thanks to those who wrote and thanks in advance to anyone with anything to add!

Matt B

[emma]

Hi Matt,

My pericarditis wasn't associated with any infections. I believe it would be considered recurrent, as I had had heart surgery - the initial trigger. It wasn't viral in origin, but an autoimmune response (or so I was told) related to having had my pericardium cut. I do know absolutely that it lasted longer than the usual bout of pericarditis. And I had bad pain with breathing while lying down, but that was the extent of it - no headaches or stabbing pain in my back. I wasn't confined to bed. My cardiologist sent me to see a dr. at Mass. General in Boston; I felt I had good care. At six months it wrapped up and went away, and fortunately I haven't experienced more trouble with it. Don't lose hope! I know I'm not a lot to go on, but I did get 100% better after 6 months. emma

[jj]

Hi Matt, I have had chronic pericarditis for 16 months continuously. I have been followed very closely by an internal medicine doctor this past 16 months due to chronic/consistent mid-sternal pain that worsens as I lay on either side, lean forward, climb stairs, and even walk any distance. My pain tends to become more intense as I exhale or hold my breath. At the beginning, I saw my physician about every 4-6 weeks. I was initially diagnosed with coastal chondritis due to my history of rheumatoid arthritis. I have had multiple test this past year and finally saw a Cardioligist the 22nd of December (13 months into the pain). He made a diagnosis of pericarditis and plueritis. The plueritis was much different and this could possibly be something you are experiencing. Mine feels like I am being stung by wasps inside my rib cage and occurs even to my spine. I move a certain way and wham, the pain strikes. Headaches have occured on occassion due to not getting the proper amount rest. I have been taking the dosages of Prednisone that you have been taking along with 2000mg of Relefan per day. I have taken an anti-depressant at intervals to get me through the emotional roller-caoster which they have helped me rest through the night. Just the past few days, I have felt better than I have the past 16 months. I'm a 43 year old female and really knew very little about this. I will say that the physicians that I have spoken to say that surgery should not be considered unless the calcifications that occur as a result of the irritation causes restrictions to the heart or lungs and prevents them from functioning properly. Some of the signs and symptoms to tell your phsyician about would be: rapid heart rate, distended neck veins, and swelling/edema in your feet and hands. I have also been told that the next step would be to try Colchicine. I have also been told there is no cure and no prevention. So, this tells me, we need to do all we can to pay close attention to our bodies warning signs and see our physicians regularly.
I am hopeful that you are on the road to recovery and feeling better. You're in my prayers and I trust that God's perfect will is shining through you in this situation.
JJG

[little debbie]

hi matt
I've  just  been  reading  about  your  persistent  pericarditis.
I'm  sparing  you  the  details, but  my  husband  had  pericarditis....it  went  untreated  because  he  wasn't  the  type  to  go  to  a  doctor (he  ignored the  symptoms, pushed  himself  to  the  limit  and  kept  pushing). He  is  paying  now.  I  urge  you  to  go  to  the  BEST  cardiologist  you  can  find  and  do  what  you  gotta  do  to  get  rid  of  it.
Just  like  any  other  illness.....it  can  lead  to  much  worse  stuff.

[geoff]

Hey Matt
I hope this gets better for you. 36 months ago I was diagnosed with Acute pericarditis. We went through all the anti-nflamatory drugs. (Arthrotec, prednisone, cholchicine) they all helped for a bit. Presently I am diagnosed as having Chronic Constrictive Pericarditis. Not is the pericardium scarred and calcified but now the valves of the Heart are being restricted. As far as I have found out the ONLY treatment is surgery. However the surgery is really brutal. Mostly you live with it. If you learn anything more about this I'd love to know.

[JohnDoe]

Hi Geoff

How was your constrictive pericarditis diagnosed?  What are your symptoms?
I'm not yet diagnosed but I fear due to my symptoms I may have the same thing.  The doctor heard a pericardial "rub", and lately I have increasing abdominal distension, shortness of breath, orthostatic hypotension, palpitations.  I have nonsustained ventricular tachycardia also.  From what I can determine early surgery is the best hope but the thought of having such a surgery scares the hell out of me.


Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn, USA.

BACKGROUND: The clinical spectrum of constrictive pericarditis (CP) has been affected by a change in incidence of etiological factors. We sought to determine the impact of these changes on the outcome of pericardiectomy. METHODS AND RESULTS: The contemporary spectrum of CP in 135 patients (76% male) evaluated at the Mayo Clinic from 1985 to 1995 was compared with that of a historic cohort. Notable trends were an increasing frequency of CP due to cardiac surgery and mediastinal radiation and presentation in older patients (median age, 61 versus 45 years). Perioperative mortality decreased (6% versus 14%, P = 0.011), but late survival was inferior to that of an age- and sex-matched US population (57+/-8% at 10 years). The long-term outcome was predicted independently by 3 variables in stepwise logistic regression analyses: (1) age, (2) NYHA class, and most powerfully, (3) a postradiation cause. Of 90 late survivors in whom functional class could be determined, functional status had improved markedly (2.6+/-0.7 at baseline versus 1.5+/-0.8 at latest follow-up [P<0.0001]), with 83% being free of clinical symptoms. CONCLUSIONS: The evolving profile of CP, with increasingly older patients and those with radiation-induced disease in the past decade, significantly affects postoperative prognosis. Long-term results of pericardiectomy are disappointing for some patient groups, especially those with radiation-induced CP. By contrast, surgery alleviates or improves symptoms in the majority of late survivors.

PMID: 10500037

[little debbie]

my husband had  surgery in August  to  strip away  the  calcification on  his  heart. The  surgery  went  well,
however , they  were unable to  get only  part of  the stuff
off.He  had  surgery in  Birmingham, AL. He  was out of  hospital in 5  days!
The  down side is  that  he  is  no  better. He  has  class
3 0r 4 congestive  heart  failure. There  was  already  too  much  damage  done.
As you  know, every  case is  different. So  learn  all  you  can  about  YOUR situation  before making a  decision.
Contact me if I  can be of  ANY  help.
***@****

[dav]

I was just reading you comments on Pericarditis.  I have been experiencing an extremely sharp chest pain in my left side since January.  It is a constant pain and it concerns me that the pain has not gone away yet.  I was given Viox for 2 weeks but that did not help.  Today I go back to the doctor.  Three weeks ago he suspected that it was Pleuritis. I'm not sure how often it occurs in younger people. But the other night I went out to eat and had to stop because the pain became so sharp that it hurt for me to breathe. But this condition does concern me very much.  

[K0510]

A related discussion, persistent pericarditis was started.