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Does Pericarditis Cause Chest Pain?
Question: I have been diagnosed with pericarditis after ongoing radiation treatments for breast cancer. It has been 2 1/2 months. My latest echo this week shows that the fluid is no longer in my chest wall but I am still experiencing pain shooting from the left of my chest region and shoulder down my left arm. The pain started out extreme and then got better after steroids. Then it came back and they were able to see the fluid in my echo. Now the pressure is gone but if I do anything besides bed rest (and I’ve been resting A Lot) it comes back. Ibuprofen doesn’t seem to help much and I can’t continue the steroids as I am on a clinical trial. Is it normal to have this much pain after 2 1/2 months? And how long can this take to heal given that my radiation is over and I know that the effects can last a while. I am having to be out in Long Term Disability and take Percocet at times when the pain is bad. Obviously I don’t want to have to continue that Medicine and am afraid they will eventually want me off if it. I just want to be back to normal. Any advice? I am also on colchicine once daily.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and would like to explain that chest pain is a normal finding in patients experiencing pericarditis.
This pain can get stronger when the pericardial fluid diminishes or even is totally absorbed, as in such case the pericardial layers (inner and outer) come to closer contact with each other stimulating nerve endings and producing pain.
It is true that steroids appear quite efficient at improving pericarditis symptomatology much faster than the other drugs classes (non-steroidal anti-inflammatory drugs, colchicine), but at the same time, they are accused of showing a higher rate of pericarditis relapses.
Probably what remains the most acceptable choice is your actual combination (ibuprofen and colchicine) with possible dose optimization (mainly Ibuprofen which can be increased up to 2000 mg/day) and close monitoring for potential adverse effects.
Generally, clinical symptomatology of pericarditis subsides in a variable period of time, ranging from weeks to a few months.
The fact that your clinical symptomatology persists beyond 2 months, means that your pericarditis tends to turn into a chronic inflammation and in such case, it is important to investigate possible signs of pericardial constriction.
Chest radiation is an important cause of constrictive pericarditis which may lead to serious physical disabling.
In such a case, it is recommended that besides checking for increased inflammatory response by means of inflammation tests:
- complete blood count with differential leukocytes count,
- PCR,
- ESR
periodic cardiac ultrasounds and in case of suspicion a cardiac CT would help to detect such a complication.
Short rounds of steroids may be required, but I would discourage from using prolonged periods of Percocet as it may lead to addiction (besides other potential adverse effects).
You should discuss with your attending cardiologist on the above-mentioned issues.
Hope I have answered your query.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and would like to explain that chest pain is a normal finding in patients experiencing pericarditis.
This pain can get stronger when the pericardial fluid diminishes or even is totally absorbed, as in such case the pericardial layers (inner and outer) come to closer contact with each other stimulating nerve endings and producing pain.
It is true that steroids appear quite efficient at improving pericarditis symptomatology much faster than the other drugs classes (non-steroidal anti-inflammatory drugs, colchicine), but at the same time, they are accused of showing a higher rate of pericarditis relapses.
Probably what remains the most acceptable choice is your actual combination (ibuprofen and colchicine) with possible dose optimization (mainly Ibuprofen which can be increased up to 2000 mg/day) and close monitoring for potential adverse effects.
Generally, clinical symptomatology of pericarditis subsides in a variable period of time, ranging from weeks to a few months.
The fact that your clinical symptomatology persists beyond 2 months, means that your pericarditis tends to turn into a chronic inflammation and in such case, it is important to investigate possible signs of pericardial constriction.
Chest radiation is an important cause of constrictive pericarditis which may lead to serious physical disabling.
In such a case, it is recommended that besides checking for increased inflammatory response by means of inflammation tests:
- complete blood count with differential leukocytes count,
- PCR,
- ESR
periodic cardiac ultrasounds and in case of suspicion a cardiac CT would help to detect such a complication.
Short rounds of steroids may be required, but I would discourage from using prolonged periods of Percocet as it may lead to addiction (besides other potential adverse effects).
You should discuss with your attending cardiologist on the above-mentioned issues.
Hope I have answered your query.
Take care
Regards,
Dr Ilir Sharka, Cardiologist
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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