Recurring Pericarditis

[Michael__0__0]

Posted by Michael on May 05, 1999 at 13:40:16
Hi and thank you for taking the time to read and respond to my message.
A little background. I am a 39 year old male and in good shape. I have been diagnosed wiht idiopathic pericarditis, ie; no bacteria or virus found.  Two years ago, April 1997 I had emergency surgery to remove the fluid around the heart and a window cut in the heart lining to prevent future fluid build up.  Prior to the surgery I do recall chest pains a couple of times, which after a couple of days rest dissapeared.  I during that time I visited a hospital twice and was misdiagnosed.
Six weeks after the operation fluid built up in the lungs and the fluid was removed.  A year ago I had more chest pain.  It seems to move from the right side to the left side. The treatment was prednisone and naporsine and lots of blood tests.  After six months the prednisone dosage was 5mg and lowered to 1 mg.  3 days after stopping 1mg, in April 1999 I noticed discomfort and resumed 1 mg.  A month later I lowered to 1/2 mg and 6 days later went to 2mg without success.  I am and have always been under a Rheumatologist direction.  Now I am taking 7.5 mg and naporson and the pain has mostly disapeared. This is the third relapse. We plan to try antiinflammatory drugs without prednisone as a solution as soon as I am stable, probally in 4-6 weeks.
Questions:
1)  I was thinking of scheduling an appointment at John Hopkins, Balt. MD for a second opinion in the Rheumatology Department.  Is this the best place to go around Washington DC? and is this the correct department?
2) Should I expect to have this problem for life or will it perhaps dissapear over time.
3)  What are the long-term effects of 5mg-1mg predisone and naporson.
4) Are there other medications that may cure the problem ie: colchicine or methodrexate.
5)  I often get sinus infections at the same time I get flair up.  Any relationship.  I plan to see an aleregy doctor very soon.  What tests could be done by them that might help this situation.
Thank you in advance for your response.
Sincerely,
Michael
Posted by CCF CARDIO MD-APS on May 07, 1999 at 10:36:07
Dear Michael,
The increase in sinus infections could be due to the immunesuppression caused by your taking the steroids, otherwise I can think of no "relationship."  Long term side effects of steroids are many and this should be discussed with you NOW  by your rheumatologist since you already have been on them a long time.
John's Hopkins, YES, is the best place to go in DC for your second opinion, especially since they will know and have access to the latest, and greatest treatment modalities for your condition.
Recurrent pericarditis is fairly rare and thus many cardiologists, myself included, do not treat, and do not know of the most recent therapies.  A rheumatologist would have a better understanding of what therapies are left to try and which ones are "up and coming" or even experimental like the colchicine and methotrexate (which I have heard are being considered and in some cases used for such a condition.) I am sorry I could not be of more help, but I can say that sometimes recurrent pericarditis does just go away on it's own and that is why it is good for someone like you to always reevaluate and not think that your medications are "life-long."
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. Good luck.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call
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can be used to select the physician best suited to address your cardiac problem.