Possible Pericarditis

Earlier this week I went to my EP on the first day the office opened to patients since the Covid lockdown.  My EKG revealed changes that concerned him, comparing it to the last EKG Feb 21, before discharge from the hospital.  I have an ICD and am paced in the atrium 99% due to SSS and paced in the ventricle 30%.  I had an ablation Feb 20 for atrial tachycardia and atrial flutter (over 110 areas ablated) and was doing fairly well, but it changed around March 23, texting my EP regarding extreme tiredness, swelling all over my body, and my arrhythmias had returned.  I did not tell him how sick I was......but as months went by and broader Covid symptoms were revealed, I was pretty sure I had Covid.  I had Covid testing over the last few weeks and both tests came back negative.  My labwork revealed inflammation and elevated white blood cell count, so the EP is suspecting pericarditis.  He has started me on oral med for pericarditis and I will see him in a couple of weeks, and I am sending Carelink transmissions 2x/week.  I had 75 atrial tach events ranging from 140s - 160s, sometimes lasting for up to 6 hours, since Monday's appt.  Can pericarditis spread to the ICD and leads?  I am looking for opinions regarding pericarditis.  He told me at the appt. several times I must let him know when I am sick with anything, no matter how minor I think it is.  He's an amazing EP and person, and I've been going to him for 21 years.  Any comments would be appreciated.  I'm pretty worried, as I am noticing my arrhythmias and the way I am feeling is worsening.   


Pericarditis or Myocarditis?

by crustyg - 2020-06-20 09:33:17

Pericarditis is an inflammation of the pericardium - the tough sack that encloses the heart.  Common causes (here) of pericarditis are partial myocardial perforation by a pacing lead, blood in the pericardium or a really big, full-thickness infarct (think LAD blockage - often leads to CHB).  I don't think this 'spreads' to PM or leads as the inflammation requires tissue - not the case with leads or PM.  A viral cause is often suspected but not often proven.  I don't think your symptoms fit well with pericarditis.

Myocarditis is an inflammation of the heart muscle, usually caused by an infection (bacterial or viral), or auto-immune damage post viral infection (Coxsackie B being the classic).  Often this results in a marked reduction of heart muscle efficiency (reduced %LVEF) which would fit with your tiredness and swelling and arrhythmias.  Not sure I understand why you didn't tell your doc how sick you were.  Myocarditis *may* be treatable (Lyme disease is the classic) or it may not, but it can be pretty serious.

I think your blood work would be similar for both: if it had happened to me I would be pushing hard for an Echo.

Hope you recover quickly Islandgirl

by Gemita - 2020-06-20 15:51:51

I cannot write with any personal experience about Pericarditis, although I do know that with many inflammatory conditions rest may help recovery.  You have had a lot of trauma with your recent ablation and your body has been stressed, so perhaps you need more time to fully recouperate

Recently speaking with my EP, he confirmed that an arrhythmia can quickly worsen with any infection and/or inflammatory condition.  I have been suffering for several months from a chronic upper chest/throat infection despite several courses of antibiotics.  Infection seemed to get better for a period and so did my arrhythmias.  Now it seems the infection is back and I have noticed a corresponding increase in my arrhythmias too so certainly this is no coincidence. 

The body is so complex and can quickly become distressed:  75 atrial tachycardia events in such a short time and at those heart rates must have been really difficult for you to cope with.  No wonder you were asking about your pacemaker leads or device becoming infected, so would I be wondering that too.  I would imagine pericarditis being an inflammatory condition, could not in itself cause any direct damage to your ICD or leads, but the “cause of the inflammation” could certainly trigger arrhythmias and other related health conditions. Have you had any dental work done recently ?  I recall my arrhythmias started at around the time I was having a lot of dental work done (root canal treatment). 

Funnily enough I believe I too had coronavirus early April (certainly from my symptoms) and we now know that coronavirus can cause whole body inflammation and many other distressing symptoms.  I really thought I would never get better.  I lost appetite, taste, had no physical/mental strength, had a high temperature, cough and felt like giving up completely.  And this went on for weeks and weeks.  I have not had any testing to rule it in or out but hope to get an antibody test at some time in the future.  What were your main symptoms Islandgirl ?  Does your EP think there might be a connection between your present inflammatory condition and Coronavirus I wonder ?

Take good care


Thanks for comments/suggestions

by islandgirl - 2020-06-20 16:25:54

Thank you both...... Worst symptoms lasted 2 weeks. Swelling greatly reduced a couple of weeks ago, dropping 7# overnight.  I still have swelling, but that is normal for my heart issues.  I had a low grade fever, chills for several days, vomiting for 3 days, extreme fatigue---sleeping 14 hrs/night and falling asleep sitting down, no energy, cough, had to prop myself up on the cough 2 nights as I couldn't breath lying down, thought my allergies were extra bad with runny nose a couple of days before I got symptoms, no appetite and would have a piece of toast or few bites of yoguret with meds, chest pain, extreme swelling started, and arrhythmias had worsened since ablation.  Covid did not cross my mind as I didn't meet the typical symptoms when I was sick, nor did I meet the criteria to get tested at that time, if they were even testing then.  I should have told the EP more of my symptoms, but didn't.....  The EP does think it could have been covid.  He said I tested way too late (which I knew I did), and he said the antibody tests are not completely accurate and they don't know how long the antibodies will be available.  I could have mistaken him saying pericarditis.  He discussed so many things and concerns.....  He started me on Mitigare and said he hopes he will see an improvement when I see him in 2 more weeks.  They are setting me up for an echo.  The medical assistant texted me late Friday afternoon and told me my EP was bringing my file home with him and he is concerned.  He downloaded my Carelink this morning (I have it set up so I get a text message when a report is received at Medtronic).  No coronary artery disease (squeaky clean), bp, nor cholesterol issues.  Serious electrical issues that keep creating new pathways (past 21 years), diastolic dysfuntion, cardiomyopathy and stiffening heart tissue, all unknown.  Thanks again for all of you help and suggestions.  This part is new to me!  Any help is appreciated.

Best of luck

by Pinkit94 - 2020-06-22 14:41:15

Pericarditis is not an infection, it's more like irritation. It usually happens after ep studies and ablations. I've had pericarditis after my ablations, my tips are: continue taking your medication and take it easy, there is not much anyone can do. Unfortunately, symptoms of pericarditis can linger for a few weeks, but it does get better. Best of luck to you!

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