chest pains possibly pericarditis

[BillCBeach]

My husband is 59 years old.  At 40 he had a mammary artery byass because of 70% blockage in the LAD.  He was not a candidate for ballon dilation because of the location of the blockage.  He has been fine all these years.

Last month he had chest pains and a catheterization showed  mammary bypass was still open, but blockage was found in 2 smaller left arteries, and 2 cypher stents were successfully implanted.  The problem is that his chest pains did not go away.  The cardiologist says the heart images show blood is flowing freely, but now believes my husband has an inflammation of the heart which he has called a type of  pericarditis.  No “rubbing” sound was heard when the doctor listened to his heart.  My husband was diagnosed with pericarditis after his heart surgery in 1985, but it finally cleared up.  We cannot remember if he was given any meds for it at that time.

Cardiologist now tried Celebrex, but after a week, no better, now trying Vioxx.  His pains are pretty constant, but sometimes worse than at other times. He describes it as pressure on the left side of his chest, sometimes around rib cage area, radiating toward sternum. A few times he has felt a fleeting sharp pain.

He really doesn’t have SOB, but the pain is worse when he expands his chest with a deep breath. It is relieved somewhat when he leans forward.  He feels better in the morning, worse by the end of the day, but walking does not make it worse.  

Do you think the diagnosis and treatment is correct, and does
he have to take medication indefinitely? Thank you very much! Pat

[CCF-M.D.-RCJ]

Pat,

Thanks for the post.  Sorry to read of your ordeal.

Unfortunately, I cannot render a useful opinion about whether or not the diagnosis of pericarditis is correct or not without seeing your husband.  It certainly is possible.  Some of the symptoms are suggestive of pericarditis: better with leaning forward, increasing with inspiration, and the constant nature of the pain.  On the other hand, the absence of a "rub" and the pressure-like nature argue for coronary artery disease.

An echo might help, as might a therapeutic trial of steroids or indomethacin or colchicine.  If these meds don't help, I would seriously re-evaluate the possibility of pericarditis.

Hope that helps.

[Emmaj]

I experienced pericarditis out of nowhere about 7 years after bypass surgery. It lasted about six months. I was treated with Indocin (Indomethicin), and it did help very much. You didn't mention this, but I think it is common for pericarditis to bother a person more when he or she is lying down. Best of luck to you and your husband!

[BillCBeach]

We appreciate the doctor's reponse and the latest comment.  It helps to hear from others who have had similar problems.  My husband's pain is not worse when he lies down.   He was some better today, but he is only 3 days on the switch of med to Vioxx, guess we have to give it more time.  If he is not better in a week we will definitely ask his doctor for echo.

The frustrating thing is his symptoms do not seem to exactly match any we have read for pericarditis.  Also, no one seems to have heard of doctor prescribing Celebrex or Vioxx for this. Of course we'd say no problem if it worked.  How long did you have to take Indocin?  Thanks again for your comments.

[Emmaj]

I took Indocin for about six months ... it is a while ago now, and it's hard to remember. Have you done a search on "pericarditis" in the archives here? I remember reading some interesting posts about pericarditis but that was back aways too.
Sorry I can't be of more help!

[BillCBeach]

O.K. I tried to comment again and it didn't go, so hope this isn't posted twice:  Yes, we read this web archives for pericarditis, and searched the internet also to the "Nth" degree! :) ha!  

At least  we found this forum and kind people like you.   Thanks for your reply that you took your meds about 6 months. Glad you are fine now.