Restrictive Pericardial Disease

[Launa__0]

  I have been in A-Fib/Flutter with rapid ventricular response for over 6 months.  I have been unsuccessful at 6 cardioversion attempts and arrhymic meds.  I was on Verapamil, now trying Dilacor XR, also on Coumadin.
  Yesterday I saw a new primary care physician who said, without re-checking a recent Echo, he noted a possible restrictive pericardial disease because he found, upon taking my b/p, a 15mmHg change with respiration.  The ER physician noted a small pericardial effusion, but did not speak of ventricular thickening.  IF it is Restrictive Pericardial Disease, what are the treatment modalities?  I have been considering a pacemaker but this was obviously to control the rvr.  Please email me with your thoughts.... thank you.
  Incidentally, I am 58 years, do not drink alcohol or caffeine and have not had a hx of high blood pressure.
  L Marlo

[CCF CARDIO MD APS]

_
Dear L.Marlo,
Firstly, the diagnosis of restrictive cardiac disease needs to be confirmed and fully elucidated as there are varying degrees and often there can be a mixture of restriction and constriction.
The tests most helpful in such a diagnosis are Transthoracic=/-Transesophageal echocardiogram (ultrasound of the heart) done with a concommitant respirometry AND cardiac catheterization whereby pressures
in each individual chamber are measured.  These tests will also allow for better investigation of the pericardium and heart muscle; this information provides important clues as to the possible etiologies.
Since restrictive and constrictive heart disease is a relatively rare diagnosis, it is best that it be investigated at a cardiology center that has much experience in the diagnosis and these centers are usually
only found at  large hospitals that act as tertiary referral centers like the
Cleveland Clinic.  If you would like an evaluation at the Cleveland Clinic simply call 1-800-CCF-CARE and ask for an appointment with one of the cardiologists at desk F15.
The 'new primary care physician' was very much on the ball so to speak in checking for some unusual cause of your difficult to control atrial fibrillation as this is often not the case (i.e. atrial fibrillation is often very responsible to medications and conversion, except in the case of patients with markedly abnormal hearts.)
As for the treatment of restrictive cardiomyopathy, it really depends on the cause as well as the global heart health (different for those with concomitant coronary artery disease.)
Good Luck and write back if you have any further questions. Information provided in the heart forum is intended for general medical informational purposes only, actual diagnosis and treatment can only be made by your physician(s).