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Understanding Pericarditis

Monday, January 13, 2014 - Noon

Description

Pericarditis is an inflammation of the pericardium, which is a thin, two-layered, fluid-filled sac that covers the outer surface of the heart Pericarditis develops suddenly and may last up to several months. Sometimes excess fluid develops in the space between the pericardial layers and causes a pericardial effusion, a potentially life threatening condition. Dr. Klein and Dr. Johnston answer your questions about pericarditis and other pericardial conditions.

More Information


Pericarditis – Symptoms

eileena: How do you tell if you have pericarditis? As I get older I notice my feet and hands are colder; I occasionally have tingling in my arms and legs. Is this normal or a sign of a more serious condition? What are the signs to look for?

Allan_Klein,_MD: The signs of pericarditis include:

  • Sharp chest pain when you take a breath
  • Trouble lying flat and need to sit forward
  • Often the doctor will hear a rubbing sound when he listens to the heart
  • On echo there is often a new or worsening pericardial effusion
  • EKG shows abnormality.

Your symptoms do not suggest pericarditis and you should see your primary care doctor for possible vascular issues or neuropathy.

arjunpandya15: Initial symptoms of Pericarditis seem mild and rather similar to normal and everyday problems. Do you think an earlier diagnosis would lead to drastic improvement in treatment and recovery? If so, how do you recommend a person with low risk of heart problems to identify a problem such as inflammation of the pericardium, when the symptoms are so ordinary?

Allan_Klein,_MD: We mentioned the symptoms of pericarditis earlier (see above). People with pericarditis usually have specific features.

okie17: Why is pericarditis so difficult to diagnose? I had symptoms for three weeks: dry cough, soreness in chest, extreme anxiety and unable to sleep lying down. Unable to continue to function, I was taken to the ER where it was determined I had pericarditis. Thank you.

Allan_Klein,_MD: Pericarditis has specific criteria as mentioned earlier - however it does appear similar to someone with pneumonia. Often pain with breathing; fluid around heart; rubbing sound when listening to the chest; and EKGs are often abnormal. In addition, the inflammatory markers are elevated. Often ER physicians use that as a diagnosis but there is not that strong evidence.

MAM: With the onset of pericarditis I also have hypertension and periodic symptoms of CHF which are new. (My BP was always low - normal). Normal for this disease?

Allan_Klein,_MD: Your heart failure can mean that the pericarditis is changing to a constrictive picture. The blood pressure can be related to the NSAIDs (nonsteroidal antiinflammatory drugs) or steroids if you are taking them.


Pericarditis Causes

Pericarditis Patient: I am a 55 year old female who has had pericarditis with a moderate pericardial effusion for the past nine months. I am being treated with 550 mg. of naproxen sodium twice per day and .6 mg colchicine twice per day. My symptoms resolve and then recur periodically, and I can't find a pattern. I have not been hospitalized, but many days I just generally don't feel very well. My cardiologist says my condition is "stable", and he does not want to start steroids. He has referred me to a rheumatologist, endocrinologist and thoracic surgeon, all of whom can't find an underlying cause. I have Graves Disease which was treated with radioactive iodine five years ago, and within the past year I have roller coaster-ed from being hypothyroid to hyperthyroid, but all physicians don't believe this is the cause of the pericarditis. What are my treatment options? What are the pros and cons of steroids in my case?

Allan_Klein,_MD: Hypothyroidism can cause pericardial effusion. It is important to monitor TSH.

kfkatcher: Any links between pericarditis and menopause?

Allan_Klein,_MD: I am not aware of any.


Pericarditis – Course of Treatment

RI_Heart: 1) What is the length of the typical course of triple therapy for pericarditis? 2) What are the best markers that indicate therapy is working and meds can be adjusted? 3) What is the success rate for medical treatment of viral pericarditis? 4) How many courses of triple therapy are done before surgery is indicated?

Allan_Klein,_MD: 1) For a usual case, they are on the medicine three - six months with a very slow taper of the prednisone. 2) Best markers - At Cleveland Clinic, we get a baseline testing of CRP and SED rate and often an imaging test such as MRI and three - four months later we check for improvement and resolution. It is possible as patients taper down the dose of prednisone to about 10 mg - it is possible to have a relapse. At this point we don't recommend increasing prednisone up to 40 mg but stay at the dose they previously tapered from. 3) Majority of people do get better from viral pericarditis - however there are some resistant cases that we have to add a fourth medication such as imuran. For intractable cases we may need to do a pericardiectomy.

Douglas_Johnston,_MD: 4) That is not an easy question to answer, the decision for surgery in someone with relapsing pericarditis is a challenging one and should be a joint decision between the surgeon, cardiologist and the patient.

sjkatcher: Since pericarditis is a disease of inflammation, are there other collateral therapies that can decrease the incidence of recurrence, such as diet, physical therapy, chiropractic or any alternative therapies?

Allan_Klein,_MD: Those are all good things but they will not necessarily help pericarditis.


Incessant Recurrent Pericarditis

BETHELMOM: My daughter was hospitalized with pericarditis in August 2010. At that time she was put on steroids to clear the fluid as there was not enough to drain. It is now January, 2014. and she is still on the steroids as the pain and fluid return when she decreases. She started with 20 MG. At one point they had to increase to 40MG as pain returned and 20MG did not work. Currently, every time she gets down to 5MG after two weeks the pain and fluid return. PLEASE tell us what needs to be done to get her off these horrible drugs. Her doctors are at a loss.

Allan_Klein,_MD: She has a common problem of starting steroids early with pericarditis. She has incessant recurrent pericarditis. I would recommend adding colchicine 0.6 twice a day and ibuprofen 800 three times a day to current regimen and very slowly taper the prednisone and all three medicines. At that point if that does not work, she may need to see a rheumatologist and add a 4th agent.

Douglas_Johnston,_MD: In some cases when the steroids cannot be tapered we perform pericardiectomy - which is removal of the pericardial sac.

BETHELMOM: My daughter wanted me to ask you about pregnancy after being on steroids for almost two years. Does she need to wait? Will it affect baby? Can she get pregnant?

Allan_Klein,_MD: You will want to be off all medications when getting pregnant - she should consult her cardiologist and OB.

lifeguard1: I have been suffering from persistent pericarditis since just after my bypass surgery in 2002. In an attempt to reduce the inflammation and/or fluid buildup the doctors tried several drugs, colchicine and prednisone were the two that I recall today. Prednisone wound up being the most effective and I have been taking 2 mg daily of prednisone for the past 12 years. Every time I try to eliminate or even cut back my dosage my symptoms reappear requiring me to start a new regimen of prednisone (usually 40 mg) and slowly wean myself back to 2mg per day. I would like to stop the prednisone entirely but every time I stop my symptoms return within a few days, (difficulty breathing, severe neck pain, muscle pain and headaches). On the bright side, I am told that 2mg of prednisone daily is not that bad, on the not so bright side there are side effects (thin skin and who knows what other long term problems) that I would like to do without. Thank You!

Allan_Klein,_MD: I would suggest as a similar case, to get off prednisone while adding an NSAID and colchicine - such as a previous question (see above). We would be happy to see you here. Prednisone tapering has to be very slow - a mg each month while on the other meds.


Recurrent Pericarditis – Medication Tapering

MRkosch: I have been dx with Acute Recurring Pericarditis after having Pneumonia. Each hospital visit (second stay in four weeks) was given iv Prednisone and Toradol, plus oral Colchicine and 400 mg ibuprofen per day. After 24 hours I was symptom free. I stayed four days each due to labs - Sed Rate was at one point >140 and is now 37. CRP was at one point 22.4 and is now 2.7. I went home on tapering dose of prednisone (one week of 30 mg per day) (one week of 20 mg per day) (one week of 10 mg per day) 400 mg ibuprofen per day and .6 colcrys two times a day for 21 days. 325 aspirin per day. Two weeks after each hospital release I have return of extreme chest and shoulder pain and pressure. I was surprised that the day after the last bloodwork with the low numbers that I had a new episode pain, etc. I spent the next two days in acute pain. I managed by increasing prednisone to 40 mg. per day and 800 mg ibuprofen every four hours. Any advice to not stay on this rollercoaster of pain?

Allan_Klein,_MD: You have a case of recurrent pericarditis after pneumonia. Looking at the management I see that the steroids are decreased too quickly. I would recommend tapering very slowly prednisone 5 mg every two weeks while staying on 800 mg ibuprofen three times a day and colchicine two times a day. I know every time your steroids are stopped you get a recurrence - and that is because the steroids are stopped too soon. We call that a yo-yo effect.

SMig: I was diagnosed and had a pericardial window performed five mos. ago. I’ve had five recurrences and milder flare-ups. I'm on Indocin, Colcrys, Diltiazam (had A-Fib after surgery), Pantoprazol. Last blood test showed very good inflammation markers. Tried reducing Indocin by half after feeling well for a month but some symptoms came back again. Haven't resumed activity (tennis) for five months. Should I be on Prednisone? I get irregular/strong heart beats when I try a glass of wine/coffee or when stressed. Is it possible to get symptoms back when inflammatory makers are low/normal? What else should I be trying?

Allan_Klein,_MD: You should go slower on the tapering of the medication - Indocin. Often I change the Indocin to ibuprofen (which has a lower dose range)- such as 800 mg three times a day - to twice a day - to once a day over several weeks. Prednisone would be reserved for if the inflammation comes back, while taking colchicine and ibuprofen. Often we use an MRI and other imaging techniques to assess the degree of inflammation around the heart.

MAM: I am a 55 year old female diagnosed with pericarditis/effusion/borderline tamponade in July 2013. I have Samter's Triad and have been desensitized to aspirin and prior to the onset of the pericarditis had been taking 650mg of aspirin bid for 15 years. How could I develop pericarditis while on this high dose of aspirin? And why is it taking so long to recover? I'm currently on 400 mg Ibuprofen and 325mg aspirin AM and PM as well as 600 mg Ibuprofen at mid-day (I have to stay on that amount of aspirin to maintain my desensitization status) I had to take prednisone in August due to an asthma exacerbation (this eliminated the effusion) and it's been very hard to get off of it - I'm decreasing milligram by milligram every two weeks or so - now at 4 mg daily. If I'm more than an hour late taking my NSAIDs I have symptoms of pericarditis. My activity level is normal but I don't feel completely well. Thank you!

Allan_Klein,_MD: You have a difficult case with Samter's Triad - we can suggest adding colchicine 0.6 mg twice a day. It is good that you are tapering very slowly - if you need to go back on prednisone we usually start at 40 mg and taper slowly. We would be happy to see you here at our Pericardial center.

nikonl820: I will not be available for the chat on Jan 13, but I do have a question. Two years ago, I had pneumonia and pericarditis effusion. I was on prednisone for approx. two years to help control my sed rate. It is now leveled off at 30-35. My PCP put me on colchicine because of being diagnosed with Dressler Syndrome. I have a concern with this prescription because of the side effects outlined with this prescription. Please provide me with information regarding this situation. Thank you in advance, and I apologize for not being available.

Allan_Klein,_MD: It has been a long time on prednisone, and being on the colchicine and a NSAID such as ibuprofen, would allow you to taper the prednisone slowly.

Domnica: During the last seven years I had three colon surgeries, a complete hysterectomy due to Fallopian tube cancer, diabetes and five chemo sessions. Presently I'm cancer free. In December 2012, I was diagnosed with pericarditis. 2013 was a yo-yo of painful attacks of pericarditis. My daily medication is: 8 mg Methylprednisolone, 1.2mg Colchicine, 400mg Plaquenil. Is there any other treatment?

Allan_Klein,_MD: If the kidney function is good, you can consider a small dose of NSAID such as ibuprofen and then you can wean the prednisone.

sdp: Hello, I just finished my 7th or 8th course of 50mg of Indomethacin three times a day for my four yr. battle of recurring pericarditis. My primary care doctor recommends I now take a baby aspirin, 81mg 1x a day. Four days in, I feel okay, do you think this is good to control the inflammation or should I go back to my cardiologist?

Allan_Klein,_MD: Go back to your cardiologist and suggest adding colchicine to your regimen to allow you to taper off the indomethacin. This medication long term is not a good idea.

kfkatcher: I am managing my third occurrence of viral pericarditis since onset in early October. Currently taking 0.6 mg Colcrys, 30 mg Prednisone and 600 mg Ibuprofen since 12/26, along with 25 mcg Synthroid, 15 mg Lansoprazole, 4000 IU Vitamin D and a multivitamin daily. I have significantly reduced pain in the past several days, and am looking for a strategy to wean off meds. Is a 5 mg reduction in Prednisone week upon week the right approach? Also, can you comment on the role of physical activity (positive or negative) in the recuperative process?

Allan_Klein,_MD: Prednisone taper is too fast. Using the markers of inflammation - I would recommend a very slow 2.5 - 5 mg every two week taper. If there is a recurrence, you should go back to the previous dose of prednisone. Physical activity is recommended such as walking but during inflammation it is not the best to increase the heart rate too much such as the treadmill or elliptical - you want the process to heal and then start your activities again. We would be happy to see you.

happydak: I am a 64 year old woman who was treated with surgery, chemo and radiation therapy 2-1/2 years ago in 2011 for breast cancer. Within days of finishing radiation treatments, I developed pericarditis and was hospitalized. My pericardial symptoms are now under good control - if I take Colcrys (colchicine) .6mg twice a day. If I try to back off on the medication and take it less often (it is very expensive- about $330 per month), the chest pains return within three - four days. I have no other problems like swollen ankles or blood pressure issues related to pericarditis. I never had a pericardial rub, and my stress test was OK (can't recall the numbers.) I exercise regularly without pain as long as I am on the full dose of Colcrys. Colcrys does give me GERD, so I'm also taking Protonix twice a day. Will I have this need for Colcrys for the rest of my life? Or will the pericarditis eventually go away? I'd like to get off this medication. Thank you for any insight into this condition.

Allan_Klein,_MD: It is important to check your inflammatory markers and if elevated you may need to be on NSAID with this. Eventually it will get better slowly. We would be happy to see you in our Pericardial center.

kkassaw: I wanted to ask about recurrence and/or permanent complications. Once the pericardium is scarred from the initial infection are symptoms continual unless lessened by a prescription regiment?

Allan_Klein,_MD: Roughly 1/3 cases of acute pericarditis become recurrent. With each recurrent episode there is some inflammation and some scarring. It would be important to treat recurrent episode with a regimen of anti-inflammatories to prevent scarring.


Constrictive Pericarditis

CaliBuffy: I had effusive constrictive pericarditis in July 2012. Is it normal to still feel tightness in my chest when taking a deep breath? I am a very active 66 year old woman, otherwise in great health. I have been taking colcrys 0.6 mg since August 2012 and have been advised to continue until January 2015, which will be two years after a normal SED rate.

Allan_Klein,_MD: It is not normal to feel the tightness and I would be concerned that there are still features of mild constriction present. You should have further evaluation with noninvasive testing such as echo and MRI. Also - you can follow SED rate and CRP.

kkassaw: Pericarditis was discovered during open heart procedure for un-roofing of a myocardial bridge in 2011. Scar tissue was scraped away to complete procedure. Continue to have issues with PAC's on a daily basis along with tightness in center back and chest. Elevated BNP was noted on two visits to ER for swelling in legs - no concerns noted by local doctor. Self-referred to cardiologist at St. Luke's in Houston. This doctor is concerned I may have constrictive pericarditis. Completed echo with protein injection. Could not get clear images of pericardium. Has requested I have a cardiac MRI. Is this the best indicator for constrictive pericarditis? What are my options if this is the diagnosis?

Allan_Klein,_MD: Constrictive pericarditis can often be determined clinically with elevated neck veins and swollen legs. MRI would be a good ancillary test to rule out constrictive pericarditis if the echo was sub-optimal.

an1000: 1) A cardiologist told me yesterday that he believes (from an echocardiogram, done because of previous pericardial effusion) that I may have developed constrictive pericarditis. He suggested doing more studies in three months. When I got home, I wondered, is there anything it would be better to do right away? I have an upcoming visit with my internist and perhaps if something would be better done now, it perhaps could be done then. 2) Is there anything I should be careful about? I had pericarditis starting Sept. 2012, diagnosed as viral, and it continued on and off for about four or five months. I had continuing pericardial effusion for much longer. I had pleural effusion and decreased lung volume. I just started feeling really better(healthier, fit) in November 2013, so I thought it was now all behind me. I had fairly high crp -- 88,45, the times it was measured (Sept 2012 in hospital, once as outpatient in October 2012.) I am 73, work full time, have been active. Thank you.

Allan_Klein,_MD: You should be evaluated sooner than three months. We would be happy to see you here - If you have inflammation, you should be treated with anti-inflammatories to hopefully decrease constriction and decrease inflammation. If inflammation does not go away then surgery may be indicated.

doctorimranjaved: What are the management options for patients with Tuberculosis chronic Constrictive Pericarditis who already have completed short course anti-tuberculosis therapy but cardiac function is still compromised?

Douglas_Johnston,_MD: If there is evidence of pericardial constriction as the reason for cardiac function being compromised, then pericardiectomy can be advised.

jhk: Re: chronic constrictive pericarditis: are there medications that have been implicated as causative agents? If so, which? Since the time course for the development of chronic constrictive pericarditis may be very long, I would imagine it could be difficult to identify such agents. I would also imagine that if ESR and crp are normal, current medications would not be implicated, especially if symptoms existed before starting the current medications. Am I off base here?

Allan_Klein,_MD: There are some medicines that can cause an effusion - hydralazine. But to implicate the medicine that is causing the constriction is remote but it could be possible.

raymore: I am diagnosed with constrictive pericarditis (at a "moderate level"). I have taken prednisone and - and am now off of it. Some degree of symptoms are now coming back. Is it likely that surgery is inevitable with constrictive pericarditis and how is the best time for it determined?

Allan_Klein,_MD: If there was a trial of prednisone to treat transient constriction and however if the symptoms are returning, despite the trial of prednisone then the patient should be evaluated for possible surgery if the symptoms or findings are significant enough. Prednisone allowed the patient to decrease the amount of inflammation but not necessarily cure the constriction.


Pericardial Effusion

Jebosley: My echocardiogram over the last several years continues to show mild pericardial effusion. I have rheumatoid arthritis, lupus, Sjorgens and severe pectus excavatum (that has been surgically repaired). One doctor said that can be normal to have mild pericardial effusion. Others say it is not and it is from autoimmune conditions. Several times a year I have flare ups with pericarditis- feels like a fist is being pressed on my heart, less painful when i sit up. Anti-inflammatories or steroids help the pain. Do you think it is normal to have a chronic mild pericardial effusion or not? If you have mild pericardial effusion does that mean you have pericarditis too? Or can they occur separately? Thank you!

Allan_Klein,_MD: It appears that you have a small pericardial effusion related to your autoimmune process -whether RA, SLE or Sjogrens. You most likely should be on medicine to treat the underlying condition and this may help treat the small pericardial effusion.

FAOWife: I have had pericardial effusion since August 2013. I’ve had one drain (opened chest to take sample of sac) because I went into tamponade and have been admitted two times for pain and pressure since then. I am 48, female in otherwise great health. Question: my levels are two and below of fluid with a strange mass in the sac (residual from the operation?) I still have continues pressure and shortness of breath. I'm on Colcryn and Indomethacin daily. Can I resume any kind of exercise program? I'm gaining weight! Also, my effusion is idiopathic.....any ideas of how long I could have this?

Douglas_Johnston,_MD: It is normally ok to exercise with pericardial effusion, however we would want to know what the residual mass is in the sac - perhaps an MRI would be helpful. We would also want to check your markers for inflammation - if you are very inflamed, then we would want to monitor the level of exercise.


Medication Questions

passau: My cardiologist prescribed Ibuprofen for my Pericarditis. The dosage is three times 400 mg daily for six months. However, it has side effects. I am unsteady on my feet and have a problem with constipation when taking them.

Allan_Klein,_MD: With the ibuprofen, you should be on a proton pump inhibitor for the stomach; it is also possible to lower the dose to once or twice a day - another drug would be colchicine as a substitute.

mysticmac: I have a history of pericarditis and am taking naproxin and xarelto. I am having a colonoscopy and was told to stop taking both meds for five days will this affect my pericarditis?

Allan_Klein,_MD: It is possible if the pericarditis is active, stopping the naproxin may cause a recurrence - but if the colonoscopy is needed - that would need to be done. You may consider going on colchicine during this time and you can stay on it during the colonoscopy. Talk to your cardiologist.

Domnica: Doctors gave me Ibuprofen at the beginning, but I became allergic to it. Is Acetaminophen a good substitution? Thank you.

Allan_Klein,_MD: Acetaminophen is not an anti-inflammatory - it is an analgesic. You can see an allergist to see if it is a true allergy or sensitivity or you may need to be on colchicine.


Surgery – Radiation Heart Disease

JAD: As a result of radiation 50 years ago I have developed restricted lung and constrictive heart disease (pericarditis). I am being treated with diuretics and low sodium diet, with my only other option -pericardiectomy. I am questioning the success due to the phrenic nerve was damaged with the surgery previous done 50 years ago and know the pericardiectomy would require scraping , cutting between the phrenic nerve and heart on the other side. What are the chances of that nerve being damaged and my breathing more impaired? Also, my age is a consideration -75 years. Thank You for any input you can give.

Douglas_Johnston,_MD: Radiation disease is one of the most difficult conditions to make a decision regarding pericardiectomy. One question would be the nature of the previous surgery and the degree of phrenic nerve injury. There are some tests that can be done to see if pericardiectomy would be beneficial such as right and left heart catheterization and MRI. You should choose a center with great experience with radiation heart disease.

Allan_Klein,_MD: We do see a lot of patients with radiation heart disease.


Surgery – Pericardial Window

jbz: I had pericarditis and had a pericardial window operation. Please tell me if the "window" eventually closes or if it will stay open. Just wondering if I ever get it again if the window is still there Thank you.

Douglas_Johnston,_MD: If the window is done underneath the breast bone - subxyphoid window - most of those will eventually close. It is possible to still get a recurrent effusion. If the window is done in the pleural space around the lung, it can stay open for a very long time.

spicka1: I (male, 47 years old 5'11" 280lbs) was diagnosed with pericarditis with effusion in early July of last year. In late July, I had VAT surgery where a pericardial window was opened and fluid drained. Subsequent recovery was slow, two steps forward, one back. I fully returned to my office job in early November. Would you have recommended Colchicine? During exercise when my heart rate gets high, I can feel a bit of discomfort in my chest, about where the window was cut. Is that simply continued healing of surgical scars? What are the chances of re-occurrence and what symptoms should I should I look out for? Occasionally when I am tired or have been exerting myself I can feel a slight vibration or rumble on the left side of my chest when I breathe. I can't hear an audible wheeze. Any thoughts what that is? The diagnosis was idiopathic but "probably viral". I traveled to china and the far east in March, do you think there may be a connection?

Douglas_Johnston,_MD: 1) Colchicine is related to inflammation at the time of surgery. That question could be better answered now by testing for inflammatory markers. 2) It is normal to have some tightness in the chest after surgery but that should resolve over the first few months. 3) In general, the symptoms should be similar to the symptoms you had before surgery. An echo would be helpful to see if you have residual fluid.

SMig: After surgery for the window, I experienced A-fib and continue to get strong flutters when my symptoms come back. It's been almost six months. Should this go away?

Douglas_Johnston,_MD: It depends whether the afib/flutter is related to the process in the pericardium or a separate process. An echo would help to figure out the current situation but that may be a difficult one to determine.

spicka1: I had a VAT pericardial window operation six months ago. My cardiologist says there is still a very small amount of effusion but nothing to worry about. Is that normal or should I expect all of the fluid to have drained?

Douglas_Johnston,_MD: It is common to have a small residual fluid after a window. The question would be if the fluid grows or shrinks with time. You should have a follow up echo in three - six months.


Surgery – Pericardiectomy

okie43: Dr. Johnston performed a pericardiectomy (redo) on me last October with excellent results allowing me to resume a normal, albeit limited lifestyle during convalescence. I am very thankful for what he was able to do. I am still taking diuretics (Torsemide 60mg/day). Is this common or will I be able to wean myself off the diuretics? Also, I am not gaining back any weight.

Douglas_Johnston,_MD: I am glad to hear you are doing very well. Many patients do need to stay on some dose of diuretic especially if there is some diastolic dysfunction of the heart muscle which is common after a previous heart surgery. However, many patients can taper to a very low dose. It may be time for a follow up visit. We would be happy to see you.

RI_Heart: When and how is the determination made for surgery?

Douglas_Johnston,_MD: There are two reasons to operate: 1) Pericardial constriction - where the heart is not able to fill with blood adequately - this is usually diagnosed with a combination of echo, MRI, and cardiac catheterization. 2) The second reason which is less common is for patients with severe recurrent pericarditis that is not well responsive to medications. These decisions are best made with an experienced pericardial surgeon and pericardial cardiologist; albeit a Center of Excellence for Pericardial Disease is important.

raymore: How do you determine on surgery "where to go in" - what are the entry options for a pericardiectomy?

Douglas_Johnston,_MD: Incision can be through bilateral thoracotomy - which is a horizontal incision on both sides of the chest; A clam shell incision which connects those two through the middle; or a sternotomy which is a vertical approach down the sternum.

garbo: How dangerous is a pericardiectomy? I had pericarditis treated with a pericardial window and steroids. The surgeon stated that surgery (pericardiectomy) may be in my future. However, currently I am pain free, just occasional palpations.

Douglas_Johnston,_MD: In patients who are otherwise healthy, pericardiectomy can be very safe. In the literature, the risk has been described as 5 - 10%. In our experience it is closer to 2% in patients who are otherwise healthy.

Douglas_Johnston,_MD: Complications include; Some patients have fluid around the lungs that can last for some while after surgery. Serious complications such as injury to phrenic nerve which can cause difficulty breathing are fortunately rare.


Surgery – Calcified Pericardium

Fran: Do your surgeons use the ultrasonic bone scalpel to remove the calcified pericardium?

Douglas_Johnston,_MD: No - we have not used that. In general, we found that separating the heart from the calcium and taking the calcified pericardium out as a large piece is an effective method.


Pneumothorax

nehasunny: Hi. I want to ask you if either the pneumothorax patients after pleurodesis after four years can travel in airline for a long journey.

Douglas_Johnston,_MD: In general as long as there is no longer a pneumothorax by chest x-ray patients are safe for air travel.

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