Question: Moderate Pericardial Effusion

[dong]

My husband had a mitral valve repair surgery 8 weeks ago. He had moderate pericardial effusion detected by a ECHO test 2 weeks ago and was prescribed methylprednisolone for 6 days from 24mg stepping down to 4mg. He had an ECHO again after 11 days, the fluid only decreased a little. He still had moderate pericardial effusion. So he will be on prednisolone starting with a 40mg dose and check again after 3 weeks. He felt a little pain and only feel shortness of breath when he walked fast. I noticed that pericardial effusion was pretty common after the surgery from this website. Some patients have it drained in the hospital. I am worried that if the heavy dose of predisolone doesn?t work, the pericardial effusion would last too long and become chronic. Since we had our surgery out of town, it was inconvenient to see our surgeon. What is your experience with pericardial effusion?

 

[WayneGM]

Mine was very fast....went from nothing to tamponade (CHF) in a matter of days so I had to get surgically drained. My Cardio said had it been caught sooner it might have been controlled by meds. Even after the drain, I had residule fluid for several weeks. Watch his weight. If he has significant gain over a day or two get him checked out rather than waiting for the 3 weeks.

 

[ctyguy]

I had it about 3 weeks post-op but it was considered mild to moderate. I was told to take Advil for a few days to help the inflammation and let the body absorb the extra fluids. Thats what I did and within 4 or 5 days the symptoms subsided. I wasn't given any perscriptions.

 

[Lynlw]

Justin had pericardial effusions after a few of his surgeries, some went away with mortrin or steroids and others needed to be tapped. I'm not quite sure what your question is but if it helps, after Justin's surgery when he was 18 months old, he was in and out of the hospital for MONTHS, (close to 6) with his but when it cleared up there were no long lasting problems. Lyn

 

[Lisa in Katy]

Is he on Warfarin? If not, he should take Advil or Motrin. If so, he should take Aleve. I took Prednisone for quite a while for pericarditis. That was before Vioxx or Aleve were available, so there weren't really any NSAIDs that were recommended with Warfarin. Finally, Vioxx was released and it worked better. Taking an NSAID is okay even with a steroid.

This is my opinion as a survivor of severe acute pericarditis and recurrent acute pericarditis. My doctor is very conservative and didn't want to cut a window unless absolutely necessary.

 

[dong]

Thanks a lot for all your replies. My husband didn't have that much symptom and no fever at all. When we saw the cardiologist 6 weeks post surgery, he was nervous and kept ask my husband to do deep breath and asked if it was hurt. It might be severe on the ECHO, that was why he prescribe steroid pack immediately (my husband is only on baby aspirin). Since the low dose of methylprednisolone didn?t work, my guess is probably the non-steroid anti-inflammation drug won?t work either, it that right?

Dong

 

[Lisa in Katy]

For me, Vioxx worked better than Prednisone. It decreased the inflammation and the pain. With the Prednisone, I was having to take Vicodin for the pain. Of course Vioxx isn't available anymore, but Aleve is similar. Some people take Colchicine, which is a gout drug, but is being used to treat pericarditis as well. Personally, if I had to do it again, I would say no to the Prednisone. It causes a lot of problems, including weight gain and extreme tiredness, and in my case, I don't think the benefits outweighed the risks. However, it remains the standard of care, so their must be a reason it is used. I just didn't see it.

It's weird (and lucky) that he doesn't have any symptoms. Most people with severe effusion feel like an elephant is standing on their chests when they lie down on their backs. It can also cause pain in the shoulder/collar bone area. I would also get very short of breath when I climbed a flight of stairs or walked very far.

 

[PairoDocs]

Sorry that you're going through this anxiety. Pericardial effusion is annoying, especially if it just sort of sits there affecting your heart's performance without either going away or getting worse. That's what's been happening with me, though lately the symptoms are a bit less. I sometimes feel that peculiar shifting around feeling in my chest when I abruptly lay down from standing, but nothing like a huge weight--sort of a PVC-like feeling except seldom any actual PVCs. I just notice my heart struggling a bit for a few pulses then the feeling lets up after about 10 seconds or less. In my case my effusion remains "mild" with 1-3 cm of fluid surrounding my heart. The most obvious affect is my right ventricle contracts weirdly in the echo--kind of a front to back sloshing motion rather than an even contraction, as well as making my post-surgical septum wiggle a bit more pronounced.

Since the muscles are thicker and stronger on my left ventricle, this fluid seems to have only modest affect on my ejection fraction--50% rather than the 60% that was originally present when my first echo was taken post surgically. Ventricular motion and shape seemed normal.

Aerobic capacity has increased significantly, though, since my first post on my pericardial effusion a month or so ago. No long distance running (never could do it anyway due to flat feet), but okay with chasing down feral chickens (and feral kids! http://valvereplacement.com/forums/images/smilies/smile.gif especially my daughter, 4, who is frequently my first morning 'pill' and evening 'pill') and carrying boxes of stuff out to the garage and garbage can (see Post Surgical Clutter posting...). Getting ready for major mowing, too. About 2/3 acre of lawn with a walk-behind mower, including under the fruit trees--lots of ducking. The weight gain during the worst of the effusion symptoms (205 lbs.) has been reversed to 195 lbs., though not to the 190 lbs. I first came home from the hospital with. Perhaps it's just a matter of time.

Haven't tried medication treatment for the effusion--my father takes steroids for his Crohn's Disease and has developed osteoperosis with a broken fibula and maybe some ribs, plus spinal degeneration--and I don't want to go that way. Too many pills already...

Chris

 

[danbrown]

Hello Dong. I am so sorry that your husband has experienced complications. I was disgnoised with moderate perioardial effusion this Tuesday after a chest xray and an echo. My surgeon and cardiologist both were emphatic that, because I had what appeared to be a fair amount of fluid in my pericardial sac, drugs would not remove it. Also, because most of the fluid was posterior to the heart the better procedure would be to go back into surgery and have a periocardial window cut (an incision right below my sternum in my case but could be between the ribs on the left side of the chest) and a drainage tube put in. All-in-all approx. 600cc of fluid was removed and I was released from the hospital today.


Do not let this go too long. It can quickly become dangerous.

I wish you well,