Re: Recurring pericarditis

Posted By CCF CARDIO MD - DLB on November 17, 1998 at 10:58:49:

In Reply to: Recurring pericarditis posted by Carol on November 17, 1998 at 09:53:01:






I had my mitral valve repaired in May of '97 for severe regurgitation. 7 months post-op I got pericarditis. I've had pericarditis 5 times since Jan. 98 (when I got it the first time). The first two times motrin worked. since then only prednisone works. We've tried a couple arthritis medicines but they didn't take away the symptoms. I have typical pericarditis symptoms (chest, neck, upperback, shoulder pain which subside somewhat when lying on one particular side or on my back; it hurts to breath; some fever, chills). But I also have pain or achiness in my legs and in my hips. The hips have been hurting since an ovary removal 3 weeks ago. My last echo was after after the third or fourth incident and was the same as the one right after the surgery which everyone was very pleased with. I'm having another echo which isn't scheduled yet. I'm working with a rheumatologist and a cardiologist. There is some talk of pericardium stripping. My situation seems to be uncommon. Do you have any suggestions? What do you think of the pericardium stripping idea? Are there different ways to do that and what would it accomplish? I don't have fluid build-up to my knowledge. Other facts that may be relevant: the prednisone may have contributed to osteoporosis (I am only on 10 mg. but for a short while was on 60 mg. then weaned down over 5 mos.; small ulcer from the motrin therapy - for a couple weeks I tried to control with only motrin - worked for awhile then flaired back up; history of endocarditis - about 6 years ago - bacteria was the type you find in the mouth, xxx veridans, about 6 years ago. Thanks for your help!
Dear Carol
Difficult situation. The pericardiectomy, or pericardial stripping, is delicate surgery. It involves removing the sac around the heart; scar tissue from the previous surgery would make it tricky to remove. While pericardiectomy has been used for patients with recurrent pericarditis, it is not always followed by relief of symptoms. Therefore, you could go through major surgery and still not be cured. If the echo suggests that the pericardium is constricting your heart and causing symptoms such as shortness of breath, then a pericardiectomy would be more strongly indicated. Before trying surgery just for recurrent pericarditis, it may be reasonable to try a medication called colchicine. Ask your rheumatologist and cardiologist. If they are not familiar with the medicine, we would be happy to see you here at the Cleveland Clinic. Good luck.
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.