Reoccurring Pericarditis and Exercise

[pduckie]

Hi does anyone have experience with reoccurring pericarditis that seems to be related to endurance training, intense training or sport in general? Any advise on methods of reducing reoccurrence based on medication, lifestyle changes or nutrition would be greatly appreciated.

My story is:

I'm 41 now and have been a heavy exerciser (sounds negative ... maybe it after all this) since my twenties. Ive trained pretty much daily in many sports but mainly endurance and combat sports and was a competitive boxer that saw me training 2-3 times a day for a period. At the beginning of my 30's i developed intermittent Afib (atrial fibrillation) which started at once every 6 months and ended at 4 times a week when I solved the problem with an operation called an oblation. For 4 years after this, every thing went back to normal and I was running, doing Crossfit and cycling. 4 years ago I woke up the day after a long run with a pain in my chest. I thought at the time it was the beginning of a chest infection (I never usually get sick) but after days it developed into a crushing pain in my chest that made it hard to breath when I was lying down. I was on holiday in Ibiza and went to the local hospital where they did and x-ray, ECG but no Eco. They didn't know what it was and release me. After a day the pain slowly went away but then...Booom Afib came back. I had ongoing Afib for 2 weeks and at this stage I did not realise it was caused by what had been a bout of Pericarditis. At this stage i thought "f83K, Afib is back " but after 2 weeks it went and life went back to normal. A year later exactly the same thing happened, the day after training I woke with a slight pain and pressure in my chest, this increased into a crushing pain over a few days, I went to hospital but this time they did an ECO and diagnosed Pericarditis. After 3 days the inflammation and crushing pain reduced but the Afib returned for a couple of week. I was prescribed 600 mg (i think) Ibiprofine 3 x a day + colchicine for a month and no exercise. I took the medication and didn't train for 4 weeks and again life returned to normal.

Since then that has probably happened 3-4 times (say every 3 - 6 months). The day before it starts i've usually training hard (but I train hard a lot). Now when it happens I don-t take the Ibuprofen or colchicine because it seems to me the recovery time is the same without, it reoccurs anyway and it can't be good for you to take all that stuff.

The last time it happened was last Xmas and I was back in Australia to see my family (I live in Italy). I did a 4 hour trail run with my mate and this was more than double what i'm used to. The next day it came back exactly as above including the Afib that again came once the pain and inflammation disappeared (3 days later). After 2 weeks I was back to normal and started training again but started light. I had managed to stay free of this up until Thursday last week when it returned. This 6 months was a long stretch and I thought I had resolved the issue as I had realised that for maybe the last 10 years I had probably been chronically dehydrated. In the last 6 months and had begun drinking lots more water during and after training and was having great results in training and with other problems ( i used to always feel "cooked" and hot after training). On Wednesday it was super hot here and I smashed myself at Crossfit and guess what came knocking again Thursday morning... that little tingle / pressure in the chest :(. Since then the pressure in my chest grew and I knew it was back. The pressure and pain have gone now but this morning I got the usual Afib that happens when the pressure/pain in my chest goes. I do feel though that this time it was super mild and maybe that has something to do with the extra water and better nutrition that I had been benefiting from.

[Sunnie2day]

I was in my early 40s when my recurrent pericarditis 'adventure' began and I was 'lucky' enough to be living in the USA where it is not a rare condition and every ER (A&E) has a pericardial specialist on call and nearly all 'GP' surgeries have one on staff. At the time I was exceptionally fit, walking and swimming a combined 20 miles per day (training for annual Gulf Coast biathlon).

The second thing the pericardial specialist said to me was 'No more exertion until your acute flare is cleared'. The first thing was dietary and specific to what seemed to be making my acute flares worse (sodium/salt - please do not reduce yours until you've spoken with your medic).

The way he explained it to me was that during an acute flare, exertion (hard training) causes the heart to work harder which in turn increases the strain on an already strained pericardium and makes recovery longer and more difficult, also more prone to complications (cardiac tamponade) or relapse.

I know this is not good news to hear - and as everyone is different, only your medic can advise (but he/she is going to advise no exertion until cleared, so...) yes/no regarding 'pushing through' to keep up a training schedule.

Hopefully other athletic recurrent pericarditis patients will pop in with better news than mine. Ftr, I'm now in my 60s, recovering from an acute flare that took over 10 months to clear - I feel epic just getting four miles a day staggering up and down the wee goat track in front of my house (2mi am, 2mi pm).

[pduckie in reply to Sunnie2day]

Hi, thanks for the reply. Im going to check it out but im not sure here in Italy they have Pericarditis specialists. You're right though, its a good idea to get a specialists advise, especially when trying to understand the effects training has on the body when you have a flair up. I wouldn't want to put myself at more risk. The only advise ive had has been from cardiologists who spoke very generally about it.

My flair ups last usually 1-2 weeks. Im sorry you have a 10 month flair up, thats sounds like a nightmare. The flair up I just had seems to have gone now so im going to try training tomorrow. I guess Ill know in the next days if thats a good idea or not. Cross your fingers.

Thanks for spending the time to write to me.

[Sunnie2day in reply to pduckie]

Actually, Italy has a large number of cardiologists who specialise in pericardial disease and infection - give it a look using a search engine (in the old days, the local phone book would have been your best source but nowadays it's the Internet).

You can also find one checking with your GP, cardiologist, or local hospital with a medical clinic attached.

Pericarditis is not exactly endemic in Italy - but it is not as rare as it is here in the UK.

Please update as to your training trial go, and if you find a specialist.

[pduckie in reply to Sunnie2day]

Thanks for your response Sunnie2day. Good advise, i'm currently trying to find a cardiologist that specialises in Pericarditis near me.

Re training trial, well everything went ok. After the pain in chest + Afib came and went (2 days) and another 2 days rest, I did a crossfit class Monday (but i took it easy). I was very concerned it would return and was noticing every little sensation in my chest but it didn't. The next day I day a 45 min job at about 137 ave HR and yesterday i returned to normal training and did a 8.5-9/10 effort crossfit session that lasted 30 min (thats a long time for Crossfit). I was worried that today I would wake up with the familiar crushing sensation growing in my chest but no. It seems this relaps was very minor and I recovered very quickly.

As I said before I have been free of this for 6 months now and in that time I have made some big changes to how much water I drink. Its counter intuitive but the more I drink water, the less my body hold its and after hard training sessions I don't have this cooked feeling i've had for the last 10ish years. Ive got this feeling that its related some how. I can also see in face that my body is holding less inflammation.

[Sunnie2day in reply to pduckie]

Great to hear! Hopefully you'll find a pericardial specialist soon and that will be the topper for smooth sailing for years to come - my pericardial specialist kept me flare-free for nearly 15 years.

My troubles began after retiring home from the US to the UK and discovering pericardial specialists here are very few and very far between. In truth, I was 'winging it' from late 2010 to the acute flare March 2019 drove me to the GP who sent me on to the cardiologist. Still, following what the US specialist taught me kept me reasonably ok for all those years until I got a bit careless (didn't insist on prophylactic antibiotics with root canal treatment).

[Hidden]

Hi and sorry you’re going through this. Had my first & second episodes of Peri in Feb this yr, so am new at it, but have learned a lot from excellent Facebook groups (pericarditis and pericarditis uk).

1. Don’t assume that absence of pain means the issue is solved. Inflammation can remain without pain. Fluid can build without pain, & fluid may even reduce friction & pain. Usually it is several months before a Peri heart has healed, my guesstimate is 6m.

2. In UK & USA, first episode treatment is 3-6 months on colchicine, to control inflammation sufficiently and hopefully prevent recurrence of it. A month is not enough, especially if you went back to exercising!

3. Exertion is a real no-no. I know how hard it is to hear. I’m 52, was training for a multi-day desert trek & had to cancel it. Specialist advice is to keep Hr under 100. The heart has to beat 24/7, it can’t be ‘fully’ rested like other muscles, so it only gets a chance to heal if we give it plenty time without exertion. I’m doing this for 6months, only slow short walks to begin, & nothing like my normal 25km hikes.

4. Anti-inflammatory diet is a good idea, I’m trying this currently & feel better in many ways.

5. If you have recurrent Peri, which it sounds like you do, a specialist would hopefully consider you for second-line treatment. A drug called Kinaret is proving effective, but is expensive. I will try to post a good article you might be able to show your doctor, or it’s on the Facebook group.

6. Avoid steroids if you can, body becomes dependent & even slow weaning off seems to cause patients trouble.

7. Was your Peri viral or auto-immune? If no one told you, next time get blood tests to see, a viral panel and an autoimmune condition (eg lupus) panel. Might help see what was the trigger.

8. This isn’t scientific evidence, but I firmly believe hard training (hard for me, working towards & doing my 25k hikes) was one contributor to my Peri. Exercise itself causes inflammation, and I suspect may make the heart sack prone to inflammation at same time. So I’m trying to re-learn my body. It’s hard because the heart often lets us know the next day we overdid it, not at the time. But I’ve found it’s worth being more wary & always finishing with plenty left in the tank.

9. I don’t know any specialists in your country, but the admin of the Facebook group recently shared doctor names in Spain, so she may be able to find people.

10. If you’re really determined to exercise (please don’t!) then maybe consult an ‘exercise physiologist’ first - I had tele appointment with one in Australia, called Rebound Health. Medically trained enough to know what Peri is, and exercise focused enough to advise what is / is not a good idea to do. She stopped me doing too much, but still enabled me to do some.

It’s a tough road, many medics haven’t come across it, self education is really helping me. All the best

[pduckie in reply to Hidden]

Hey TealGreen,

Thanks for the detailed response and sorry for my delayed response. Works crazy and this relaps seems to have ended so Ive been complaisant.

Let me respond point by point:

1) You could be right. After having this many times im starting to develop a better understanding of how the inflation is going and when i recovering. Ive also had in the past blood tests close together to see how my CRP number was and i remember what it felt like when it was back to normal. Also, i'm sure i'm being somewhat naive due to a want to train.

2) Will defo speak to Peri specialist about this when i find one

3) The first few time I had it I followed all the advise, didn't train for months but it returned. Now Im experimenting and as happened this time, it seems so far, that when the crushing pain has gone, maybe its ok to train.. we will see. I should also note that only twice of the times i've had it (of the maybe 7 time total) it has been so bad that Ive gone to hospital to be seen. Every other time it's just been uncomfortable for 2-3 days, goes, then I get AFIB here and there for a few days to a week, then i'm back to normal. Maybe thats not acute..

4) Totally with you on this. I don't drink and eat clean anyway and as I've said, lots of water seems to be having a big effect on my inflammation and general well being. Turmeric also helps me a lot. Another thing is that, the night before this relapse I had the worlds largest Sorbet (500mls maybe )and that day I had training super hard. Maybe to combo of those 2 things played a role.

5-6) After years of docs and cardio's ive realised that most of the time, drugs should be the last resort. Most times rest can be the best solution. Im conviced now that unless my Pericardist is accute, I don't even need Iboprofine. Looking back it didn't increase recovery time and just destroyed my stomach and it reoccured anyway. I would consider colchicine though.

7) The general theory from the Cardio's ive seen here is that maybe its viral and I could have got a virus when the Abliation was done to solve my AFIB issue. Ill ask for panels next time.

8) Defo there is a relationship with my Peri and training.

Thanks again and ill let you know how it all going.

[Hidden in reply to pduckie]

You're well on top of everything & paying great attention to your body, I'm finding that's an endless journey !

I believe the same, that tablets are rarely the best option, especially long-term. Finding a cause & tackling that direct is best, if that can be done

Recognise that can be a bit hard with Peri. Also, it sounds like, with the number of times you've had it, that maybe you have chronic or recurrent peri.

So in case you try all non-meds routes & still have issues, there are 2 medications, used specifically for chronic or recurrent pericarditis, that I hear are quite effective - Kinaret and Anakinra.

Not sure if available in your country, I know it's rare in UK. They're hard to get even in the US, but as more countries do trials of them, maybe they will become more available. If I end up getting Peri chronically, I will try for these (because I'd do anything to avoid steroids (the other typical meds route), unless they are required in ICU to save my life !)

Yes please do update, all the best meanwhile.