Allan Klein, MD
Allan Klein, MD

Monday, January 23, 2017 | 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. answers your questions about pericarditis and other pericardial conditions.

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Diagnosis of Pericarditis and Recurrence

Alan2217: When determining whether a patient has a flare or recurrence of pericarditis, what specific criteria do you look for to make the determination? Would you treat for recurrence of pericarditis based upon symptoms (pericardial chest pain) in the absence of elevated inflammatory markers (ESR & hsCRP) or other clinically diagnostic data, particularly if the individual was on high dose NSAIDs and colchicine at the time of symptom recurrence? Could high dose NSAIDs and colchicine treatments potentially prevent spikes in the ESR & hsCRP that would typically be seen with pericarditis recurrences?

Allan_Klein,_MD: Typically to diagnose recurrence the clinical criteria is to have the initial episode of chest pain plus a new pericardial effusion, pericardial rub, EKG changes. The medicines that you are on can lower the inflammatory markers so it may not be reliable if you have symptoms. Suggest cardiac MRI to assess for inflammation. This will tell us whether to slow the tapering or to add another medicine.

Suejeand: I have been on prednisone for pericarditis since 2012. I have been on a slow taper and am finally at 5mg on M-W-Friday. Will my markers "be masked" and inaccurate due to the prednisone?

Allan_Klein,_MD: The markers could be suppressed and you will have to follow symptoms and/or more advanced testing such as an MRI.

karynwy: I am specifically wanting to know about treatment with steroids in pericarditis. I've read where treatment with steroids for viral pericarditis have a higher recurrent rate of p/c. My question is how do you KNOW for certain if the initial p/c episode is viral??? Before treating with steroids??

Allan_Klein,_MD: In general you want to avoid steroids as first line for viral pericarditis. Often NSAID and colchicine is started as first line. If it is a very advanced case, and steroids is given then it is a very slow taper.

karynwy: How do you KNOW for CERTAIN if an initial onset of pericarditis is viral? And shouldn't you NOT treat an initial episode with steroids (higher reoccurrence rate), because there isn't really a way to be sure it is NOT viral? And couldn't I just be someone who just has a naturally elevated sed rate? I looked at records from when I was 21 and my sed rate was elevated then as well... Or does that just indicate that I've had a problem for 28 years??!!

Allan_Klein,_MD: It is true that steroids NOT be the first line treatment. The elevated sed rate needs to be explained, suggesting you see a rheumatologist.

Charkell: Even if you have no clinical markers but are highly symptomatic and have suffered for over a year, would you be meet criteria for a pericardiectomy.

Allan_Klein,_MD: If you’re on medicines over several years and have side effects of the medicines, then surgery could be considered for intractable recurrent pericarditis.

CherylB: My daughter was diagnosed with pericarditis five months ago. At that time, there was evidence on the ECG, the 'rub' could be heard and she had excess fluid around the heart. She is still in considerable pain and on tapering prednisone (9mg), salazapyrin, targin and endone and panadol osteo. Even with these medications she continues to have considerable, debilitating pain most days. Our cardiologist is now questioning whether the pain is still pericarditis as the ECG is clear and cannot hear a 'rub'. She still has the fluid. Can she still have pericarditis without the rub and ECG changes?

Allan_Klein,_MD: Suggest your daughter see a pericardial specialist to sort out whether this is pericarditis, and if it is, to get her on the proper therapy - With the right tapering of medicine.

CherylB: Nineteen year old daughter with pericarditis (ongoing) - adding to my previous question after reading the chat (sorry new to this). She tried colchicine but was very ill so that's why she was put on colchicine. Why do you recommend a cardiac MRI? She is having another echo in a week or so to check for fluid as her heart rate is now sitting above 100 most of the time even at rest. Is this usual?

Allan_Klein,_MD: The MRI will predict how severe the disease is and prognosticate how long it will take to heal.

CherylB: Thank you. We are thinking of sending her information to you for a second opinion. She would not be able to fly for that length of time at the moment due to the pain, even driving (as a passenger or driver) for any length of time increases her pain. Is this normal?

Allan_Klein,_MD: It is hard to say without an evaluation - we would be happy to do a MyConsult for your daughter.

pericarditis101: How often should echo, MRI, and blood tests be taken for someone with active acute pericarditis?

Allan_Klein,_MD: The testing should be at the baseline and at 3 - 6 months; would not repeat MRI more than twice a year.


Recurrent Pericarditis

Brandia : 37-year-old, previously healthy female now struggling with recurrent idiopathic pericarditis since July (rheum w/u -) It took two months before I received a diagnosis-so when I did I was started on Colchicine and Ibuprofen. Two weeks later, I was emergently admitted and taken for a pericardial window/biopsy of my pericardium for constricted pericarditis. I was switched from Ibuprofen to Indomethacin with Colchicine. Six weeks later on this medication, my symptoms returned and the Indomethacin was stopped and prednisone started. This was two months ago. I was doing well until started weaning. Now my doctors want to start me either on Imuran or IVIG.
1) I was told I could exercise (now know that's false)-could this be causing the recurrence?
2) Should I continue to give the steroids a chance and not start the other immunosuppressants yet?
3) I’m still on Colchicine with Prednisone-should I be on a NSAID too?
4) How long is the wait list as a new patient to be seen at CC?
5) Can you ever exercise again?

Allan_Klein,_MD: If the pericarditis is active, do not exercise, keep heart rate less than 100, you should be on three medications. Add NSAID to colchicine and prednisone with very slow taper of prednisone. Next drug would probably be Imuran or anakinra. New patient could be seen within a week with one of my colleagues in the Pericarditis Center. You can definitely exercise again once the pericardium heals and you are off the medications. We see 100s of these cases a year.

Brandia : Which medication do you prefer to treat recurrent pericarditis, IVIG, Imuran or Kineret?

Allan_Klein,_MD: Usually if you are failing the traditional therapy we go to Imuran and then Kineret.

RMF: I am a 46-year-old female, who developed idiopathic pericarditis in August, 2016. Now I have recurrent pericarditis, with scar tissue around my heart, and a pericardial window. I am taking 17.5mg/day of Prednisone (started at 60mg/day in August), weaning off 2.5mg every four weeks because the initial plan to wean off 5mg/every two weeks was too fast and my symptoms returned. What I'm wondering about is...when I experience tension/stress, it manifests as pain in my shoulders and neck, a feeling similar to my initial pericarditis pain. Do you have any idea what is going on here? Maybe at least you could help me understand why pericarditis causes neck and shoulder pain?

Allan_Klein,_MD: Would recommend addition to prednisone slow taper, to be on colchicine and NSAID. The pain in the shoulders could be related to the pericarditis because the pericardium is enervated by the same nerve that enervates the shoulder. You should definitely see a pericardial specialist.

maryjanef: I am presently being treated for pericarditis (12/28/2016). It was diagnosed this December after a bout of chest pain (fifth round) that I first experienced last New Year’s Day 2016. I had a cardiac workup on January 1, 2016 that included everything but an echo and appeared from testing that it was not cardiac in nature. I diagnosed myself as having costocondritis (minus the sensitivity to chest pressure) and ibuprofen seemed to alleviate the problem. I had three similar, but much less severe, over the course of the year and did the ibuprofen and again arrested the pain in a three to four day period. This last time I had onset of chest pain, pericarditis was diagnosed (December 28, 2016) it was more severe with fluid evident around the heart. The cardiologist started me on four weeks of ibuprofen 3xday at 600mg and six months of colchicine. My question is ...if this had been appropriately diagnosed and treated a year ago at its beginning would there have been a chance of no reoccurrences and now that i am being treated for the correct disease is there still be a good chance it will not reoccur. Also one final question. Is it necessary to not allow me to go to the gym for three months...that in itself is difficult for me to imagine. I routinely work out at the gym five days a week and would miss the benefits this awards me. Thank you Doctor Klein.

Allan_Klein,_MD: If this is pericarditis with recurrence then the ibuprofen with colchicine is appropriate with very slow tapers. If the pericarditis is active whether by inflammatory markers or symptoms, or MRI, then working out to increase the heart rate is not a good thing. Eventually once it is healed you can resume your gym activities.


Chronic Persistent Pericarditis

leeds22: 52, idiopathic chronic persistent pericarditis since June 2012. 7mm effusion, ECG changes, fever, typical chest pain at diagnosis .Auto–inflammatory serositis with joint and bowel symptoms and negative auto-immune profile. Cardiac MRI Oct 2012-Normal. July 2015-thickening of pericardium in basal area mainly 4mm focally up to 6mm. No constrictive physiology. Numerous echos-some with, some without effusion. Current treatment methotrexate 10mg (2 years) hydroxychloroquine 400mg (1 ½ yrs.) - settled bowels, joints, low grade fever and flu-like symptoms .Colchicine 1500mcg daily (18/12) and eterocoxib 200MG daily (1 year) partially improved symptoms.6/12 ago steroid infusion caused heart failure and repeat effusion.) My rheumatologist is considering anakinra but inflammatory markers are, and always have been, normal. Would you consider anakinra with normal inflammatory markers and how do you monitor response. If not what other treatments would you consider.

Allan_Klein,_MD: The rheumatologist has to decide if this autoimmune or auto-inflammatory. If it is auto-inflammatory, then anakinra can be considered. Definitely a case like this needs a pericardial and a rheumatology specialist who specializes in pericardium. I would also recommend advanced imaging such as cardiac MRI to see if there is presence of inflammation before starting anakinra as a baseline.

DrNS2: I had an incidental diagnosis of chronic constrictive pericarditis four months ago following an acute episode presenting with severe central back pain, fever of 38.3 and palpitations. An Echo and MRI showed features of constriction, patchy foci of calcification and grade 3 diastolic dysfunction. Initial CRP and ESR were 154 and 48 which quickly came down to 7 and 11 within 48 hrs. and a month respectively. I was on Ibuprofen 400mg x3 for six weeks and am on Colchicine 500mcg x2 since diagnosis. Recent MRI and echo has shown normal heart functions and no features of constriction. It still shows calcification and in addition it has shown evidence of previous myocarditis. What would your differential given this history? Could TB present this way? How would you proceed with management of this case? Do I need to go through any further investigation with this new finding of myocarditis? In absence of features of constriction now, will my ds still be k/a chronic constrictive pericarditis?

Allan_Klein,_MD: There could be evidence of myopericarditis after the initial episode. Patchy foci of calcifications implies something more chronic. TB is in the differential for calcification. Your case is complex - you need to see a specialist. We would be happy to see you in our Pericardial Center.


Pericarditis Medication Regimen and Tapering

eamonaco: What is the most effective way to taper off of high levels of NSAIDs and Colchicine? Every time I try to taper, I have a flare up and more pain.

Allan_Klein,_MD: We taper every two - four weeks, for example ibuprofen 800 mg 3 x a day to twice a day every two - four weeks depending on the inflammatory markers and symptoms.

simpy1: My advance question: I will soon begin taking Kineret (Anakinra) for my incessant pericarditis. But I don't want to be 'trapped' taking another drug forever which results in a flare whenever I stop. Is Kineret a viable path to stopping all medication? (Even if it takes a very long time?)

Allan_Klein,_MD: Kineret is very promising because the pathways involving recurrent pericarditis deal with the inflammatory marker interleukin. It is true that stopping the drug could cause recurrence however, careful weaning may help prevent recurrences.

RMF: With regard to Brandia's question, do you recommend NSAID while weaning off prednisone, even if the symptoms are not present? And, what dosage of NSAID do you recommend?

Allan_Klein,_MD: In general to wean the prednisone we recommend ibuprofen or aspirin or naproxyn as an NSAID.

leeds22: If the MRI shows thickening but no active inflammation of the pericardium would this be seen as appropriate for anakinra treatment?

Allan_Klein,_MD: Anakinra would be more indicated if there is a failure on the traditional anti-inflammatories and the DMARDs (like Imuran).

pericarditis101: Hospitalized Dec. 29, 2016 with pneumonia and acute pericarditis. Finished pneumonia antibiotics. Pericarditis - told to take indomethacin 50mg 3 times a day for two weeks. And to continue colchicine 0.6 mg twice a day for four months... Took a blood test a week after stopping indo, and CRP was elevated at 7.6 and ESR at 28. Slow improvements during two weeks of taking indo. Ex: taking a deep breath easier. Once stopped, felt dull pain when taking a deep breath in the same place initial sharp chest pain that led to hospitalization. This hasn't improved during the week. Lying flat and sleeping has gradually improved both during indo intake and after. Q's:
Do you recommend that he go back on indomethacin? Also, for how long and when is it appropriate to stop?
I know that tapering is vital to for prednisone. Is this true for indomethacin? If tapering is appropriate, when should the tapering start and end?
How should pericarditis be monitored? Is looking at CRP and ESR enough?

Allan_Klein,_MD: I would suggest not weaning off medicines - you do not want to wean off too quickly - otherwise you will get recurrence.


Exercise and Pericarditis

leeds22: I note your advice about keeping heart rate below 100.To achieve this I would need to be on almost bed rest as small amounts of exercise causes my heart rate to go above 100.Do you ever recommend medication such as b-blockers to achieve this or do you advocate rest alone? Thank you

Allan_Klein,_MD: We often recommend a small dose of beta blocker to keep the heart rate less than 100.

simpy1: I see in a couple of answers above you say "Once it is healed you can resume exercise". - How do you know if it is really 'healed'?

Allan_Klein,_MD: By the inflammatory markers, echo, and MRI, and symptoms; and off medicines.


Constrictive Pericarditis

suizeq: My wife Susan, aged 68, was diagnosed with constrictive pericarditis in July of 2016. Can anything be safely done to reverse this? Please list risks versus rewards. Thank you, Bill.

Allan_Klein,_MD: It depends on the stage of the constrictive pericarditis. If the heart is calcified, and there is findings of heart failure, then surgery should be considered. If it is relatively recent, within six months to a year, and there is ongoing inflammation, then this can be treated medically with anti-inflammatory medications. It needs to be evaluated by a pericardial specialist. Patient may need advanced imaging with LV mechanics echo as well as MRI.

JKosan: What are the symptoms of constrictive pericarditis, and how they present related to physical activity or emotional stress? How is it differentially diagnosed from "normal pericarditis?"

Allan_Klein,_MD: Constrictive pericarditis is a thickened lining that compresses the heart. It causes symptoms of heart failure, leg swelling, and shortness of breath. This is the advanced stage of an earlier acute pericarditis. If there is constrictive pericarditis, you need to see a pericardial specialist.

Heather R.: How do you determine if constrictive pericarditis is severe enough to have a pericardiectomy? Is there any link between pericarditis and pneumonia, or being misdiagnosed with pneumonia when you really have pericarditis? If ibuprofen is prescribed after getting diagnosed with constrictive pericarditis, how long will it take to know if it is working? If ibuprofen temporarily relieves some of the constriction, what is the chances it will come back and why? Can previous surgery to your middle mediastinum cause constrictive pericarditis? Do you think constrictive pericarditis is hereditary? Does weather have any effect on constrictive pericarditis? Thank you!

Allan_Klein,_MD: It is severe enough if the heart failure symptoms are severe. Often we do a metabolic stress test to see the effect on oxygenation. Pneumonia or previous surgery can sometimes effect the pericardium and eventually lead to constriction. If the constriction is transient, within six months of the insult, then the medicines have to be tapered over a long period of time. It is not hereditary.


Pericarditis After Heart Surgery

madjake2000: I am very healthy 52-year-old male. Had successful robotic MVR surgery at Cleveland Clinic on 9/8/16. Four weeks later, had pericarditis like symptoms-pain in chest/shoulder, when inhale deeply, small effusion. Pain resolved in few days with aspirin and dose of steroid. Rested two weeks, returned to exercise.  Second episode on Nov 5, with fever. Resolved in few days with Indomethacin and started colchicine (no steroids taken since first attack). Rested two-three weeks, X-ray confirmed effusion was gone. Slowly returned to exercise over next several weeks, third episode Dec 22 with small effusion. Resolved with aspirin in few days. Echo and blood work on Jan 10 confirm effusions resolved and CRP and sed rate back to normal. Doctor now recommends min four-six weeks rest keeping heart rate below 100 bpm. I continue to take colchicine 2x daily and tapering aspiring. Any other advice? Would MRI be helpful? Thoughts on prognosis? I normally work out almost daily - swim, bike, weights, cardio.- anxious to get back at it.

Allan_Klein,_MD: Since you had the surgery here at Cleveland Clinic, we would be glad to see you . At this point, the exercise could be aggravating the pericarditis so I agree with your doctor to stay on the colchicine, follow markers. They may need to add an NSAID to the colchicine and very slow tapers. MRI may be a good idea to assess severity of inflammation and prognosis.

madjake2000: CCF robotic MV repair patient again. What is recommendation on tapering NSAID and colchicine? I am three-four week with no symptoms and taking 0.6mg colchicine 2x day and 325mg aspirin 2 day.

Allan_Klein,_MD: Every two - four weeks you can taper the aspirin, as long as no symptoms, markers are normal and MRI improving.

Allena89 : I have had shortness of breath and stabbing pains in my chest (when I inhale) ever since I had a minimally invasive single vessel heart bypass (LIMA/LAD) in 2009. I was only 42 years old in relatively good shape when I had my cardiac event. My EKG, ECG and MRI do not definitely indicate pericarditis, but no one can seem to pinpoint the source of my pain. I was prescribed colchicine and Celebrex but they do not help. I have very bad flare ups if I laugh too hard, yawn too hard, exert myself or become stressed. A medrol dose pack provides temporary relief that only lasts two-three days. My question is: do my symptoms sound like pericarditis to you, and what do you recommend I do to relieve the pain? It's going on eight years now dealing with this pain. I've retired on disability, and my physical activity is severely limited.

Allan_Klein,_MD: It would be unusual for this to be pericarditis if the colchicine and celebrex do not help. Have the inflammatory markers ever been elevated; or the MRI showing classic pericarditis? If not it may be worthwhile to see a rheumatologist or pain management specialist, especially since it has been eight years.

Allena89 : What's the difference between postpericardiotomy syndrome and pericarditis, if any?

Allan_Klein,_MD: Post-pericardiotomy syndrome or Dressler's syndrome can result from a previous open heart surgery or cardiology procedure. It can cause acute, recurrent pericarditis; or constrictive pericarditis. It is an increasing cause of pericarditis.

Allena89 : Sounds like I have classic Dressler's/PPS: I had a persistent fever for three weeks after my heart bypass, then the pains began about eight weeks later and haven't subsided since. You told me that I probably do not have pericarditis because I did not respond to the Celebrex and colchicine, but my symptoms say otherwise. My cardiac MRI doesn't show constrictive pericarditis, but I definitely have inflammation. My doctor said that he couldn't tell me exactly where unless they opened me back up. Shouldn't I try other meds since the colchicine and celebrex didn't help long term (they did work for about a week).

Allan_Klein,_MD: If it is Dresslers/PPS - then you may need steroids with very slow taper in addition to the colchicine and Celebrex. You need to have your diagnosis confirmed since it will be a long term treatment.


Radiation Induced Pericarditis

Jblightsey: Radiation Induced Pericarditis. Treated for Hodgkins in 2000 and had pericarditis about 10 days into radiation treatment which went away quickly. Now, as of Aug. 2016, pericarditis has returned and has been extremely bad. Chest pain radiating to shoulder, fever, shortness of breath, tightness. Had a "window biopsy" completed last month and the surgeon said she had to peel the section of pericardium off of my heart. It was very "fibrous"? I continue to have pain and shortness of breath. The surgery was intended to be diagnostic only. I have been on prednisone since Aug. along with colchicine. At this point, my doctors have told me that the focus now is pain management since any further surgery would make my heart "not happy". Am I now at the point where that is the focus, pain pills for the rest of my life, or a risky surgery that could end with a poor prognosis? Are heart transplants ever considered for radiation induced heart damage?

Allan_Klein,_MD: Radiation induced pericardial disease is very debilitating. However, would not give up hope. Would suggest a second opinion at Cleveland Clinic to see if there is any residual inflammation and decide the best approach.


Pericardial Effusion

GoIrish: A patient has a pacer implant. During the implant, a perforation of the atria wall occurs leading to a pericardial effusion. The pericardium fills with blood twice (first time it's emptied by catheter draining) and it takes a month for it to empty the second time with the patient being in continuous Afib during this period. Could there be permanent damage to the pericardium from this effusion and what are the symptoms of the damage?

Allan_Klein,_MD: The blood in the pericardium can irritate the pericardium. This has to be treated accordingly with anti-inflammatories to prevent recurrence or constrictive pericarditis.

Victoriarexer: Can a person still have an effusion with no pain? I had a bout of pericarditis in Aug. of 2016. I am no longer in pain, but as of my last echo (a month ago) there is still a slight amount of fluid. Is there anything I should be doing to get rid of this fluid?

Allan_Klein,_MD: You can have effusion but no pain. This needs to be followed over time.


Pericardial Cyst

Mooney1521: I had a total calcium score about two years ago and the score was 0. However, the report stated 4.3 cm cystic structure interpositioned between the right atrial margin and inferior vena cava. This may represent a pericardial cyst. Correlation with echocardiography may be considered. I went to Cardio in my area, had the echo done. I mentioned at that time I get a lot of neck pain. My chest sometimes feels like somebody is sitting on me. He stated everything was fine. That is how it was left. What would you recommend? Can anything be done and if so what are the options. I am a 48-year-old female. Any information I would really appreciate it. Thank you.

Allan_Klein,_MD: Most pericardial cysts are just followed with MRI or CT scans every one to two years. If the cysts are getting larger or compressing, there are minimally invasive surgical options. We would be glad to evaluate you.

BigPicture: Diagnosed with pericardial cyst in 2011 during routine chest x-ray. Have had two cardiac MRI's that have shown no changes (and have another cardiac MRI scheduled in several months).
1. Am I correct that as long as there are no symptoms there is no real need to do any regular follow-up?
2. If follow-up is required, which tests should be used and at what frequency?
3. Is a pericardial cyst a congenital condition?
Thank you.

Allan_Klein,_MD: If there is no change, a scan or CT/MRI every two - four years is probably sufficient. Often the cyst is congenital.


Pericardial Surgery

bethV28: Once you have a pericardectomy can you still have recurrent pericarditis symptoms?

Allan_Klein,_MD: It is possible, especially if the pericardiectomy was done for chest pain and not constrictive pericarditis.

kingsdalelobber: When I had my heart surgery in Nov. of 2011 They left my pericardium open effectively leaving me with no pericardium. I assume it shriveled up. I am 5'11" tall and weigh about 145 lbs. Since the surgery, my heart beat is very loud and I can also feel it much more than I did before surgery. I'm sure being thin doesn't help any. My problem is that I have heart rhythm problems such as pvc's and bigeminy which are exacerbated because I have no pericardium. Also if I have indigestion it triggers the rhythm problems until I can get the gas out. I take meds for the gas. I've tried every sleeping position known to man. Have any other patients complained about similar experience and have they offered anything that might help? Chet

Allan_Klein,_MD: I am not sure whether the symptoms are associated with leaving the pericardium open. Suggest you see an electrophysiologist (heart rhythm specialist) to assess the palpitations.

Suejeand: I have had two pericardial windows, both in 2012 (an open and a closed ) should I expect an abnormal echo cardiogram forever???

Allan_Klein,_MD: The fluid can completely resolve after the windows however sometimes it could come back. If more surgery is needed, sometimes we do a partial pericardiectomy.


Pericarditis and Other Medical Conditions

KaraCA: What is the relationship between lupus and pericarditis?

Allan_Klein,_MD: Lupus is an autoimmune disease who can manifest with pericarditis. It is quite common.

Victoriarexer: I am curious about the link between Lyme's disease and Pericarditis? It appears from what I have read that it is indeed one of the autoimmune illnesses that is linked to Pericarditis. Are you working with Lyme literate doctors who are on the forefront of treating Lyme's and if so do you have any recommendations?

Allan_Klein,_MD: We rarely ever see a case of Lyme pericarditis. If you have such a case, we would be happy for you to see one of our infectious disease physicians along with a pericarditis specialist.


Pericarditis and Marijuana

Jblightsey: Would marijuana help with the inflammation from chronic constrictive pericarditis when surgery for a pericardectomy is too dangerous due to radiation damage?

Allan_Klein,_MD: As far as I know, there is no data of the effect of marijuana on inflammation.


Pericarditis – General Questions

Victoriarexer: Hello, I am curious as to what percentage of people have a onetime acute case Pericarditis? Are most cases chronic?

Allan_Klein,_MD: You can look at our recent article on Complicated Pericarditis - www.onlinejacc.org/content/68/21/2311. Most cases of acute pericarditis do resolve with short term anti-inflammatories. But there is a certain percent that become complicated pericarditis.

trixiegirl: ER visit on 10/22. Still having rib and upper chest pain. Put on 2-35 aspirin per day but have ulcer (?) so can't take aspirin. Is three months later for pain normal. Is there anything I can do to relieve the discomfort?

Allan_Klein,_MD: We are not sure if this is pericarditis. What was the evidence of pericarditis?

trixiegirl: Previous question from trixiegirl. Diagnose at ER was pericarditis. Taking 10mg prednisone daily, as well as 6 tylenol and 50mg. tramadol for pain. Does pericarditis pain ever resolve itself and am I on the right meds to help with the rib and chest pain. Diagnosis was at local hospital on 10/22

Allan_Klein,_MD: It can get better on your medicine. We would recommend adding an NSAID or colchicine to allow you to taper off your prednisone.

CherylB: Are you aware of any pericarditis specialists in Sydney, Australia? We are having trouble finding someone who understands this condition when it doesn't resolve.

Allan_Klein,_MD: No - sorry - but we do see patients from Sydney in Cleveland.

SL2017: What is the significance of subepicardial delayed enhancement in the basal inferolateral wall? What would be the management of the pericardial thickening (resolved from max 5 mm to only 'mild') with foci of calcification without constrictive physiology, effusion and a normalized cardiac function (from previous diastolic dysfunction)? Would a surgery (window or total) be indicated in this case? Is there any role of pericardial box in absence of effusion? Example if TB is suspected Can TB selectively affect the pericardium and/or myocardium without any evidence of ds affection elsewhere? E.g. Interferon test -ve, absent systemic Sx (no wt loss, occasional history of night sweats). Note history of travel to India for a year. How does Myocarditis in the background of pericarditis affect prognosis? Can myocarditis recur? Would pregnancy be safe with myopericarditis (active ongoing inflammation but normal cardiac function and physiology)? Is it safe to breast feed on colchicine?

Allan_Klein,_MD: These are very specific questions and suggest an evaluation and time to discuss all of your concerns.

Heather R. : How can you tell if the heart has calcified?

Allan_Klein,_MD: That can be on chest X-ray or CT scan.

Reviewed: 01/17

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