Pericarditis and pleurisy

I'm interested to know how people have been diagnosed with pericarditis or pleurisy. Did the doctors hear something when listening to your chest? Abnormal ECG or inflammation showing on an xray?

Any other tests done as routine?

Were your tests all normal and the doctor guessed at one of the above and treated accordingly?

I've been reading some posts from years ago and it seems like chest pain is another thing potentially difficult to diagnose? Unless it's so severe people end up in hospital....

I had severe chest pain a few weeks ago for a few days, feeling of extreme pressure (elephant sitting on chest) and severe pain breathing in which made me very breathless. Symptoms worse trying to move around. Painful around ribs trying to sleep. Also severe pain in centre of back.

It started a few days after "flu" type symptoms. And around 2 weeks after high abdo pain and swelling (more intensive pain than I usually get in that area.)

I was treated as urgent at my local surgery (but my own gp wasn't there) with anti inflammatory injections plus I'm on steroids anyway. The pain came and went for a couple of weeks after the severe onset but much more manageable.

Doctor didn't seem concerned listening to my chest, rapid pulse, ECG and blood pressure normal. I'm having an xray tmw anyway that the Rhuemy ordered a while back at my appointment. I listed chest pain and breathlessness as 2 of my symptoms.

When I saw my own gp the following week she suspected inflammation. Does inflammation show on an xray?

When I see my rheumy next I'll obviously explain about this more severe episode.

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  • This is from Univadis , a medical reference site. Hope it helps.

    Pericarditis is inflammation of the pericardium, often with fluid accumulation. Pericarditis may be caused by many disorders (eg, infection, MI, trauma, tumors, metabolic disorders) but is often idiopathic. Symptoms include chest pain or tightness, often worsened by deep breathing. Cardiac output may be greatly reduced. Diagnosis is based on symptoms, a friction rub, ECG changes, and evidence of pericardial fluid accumulation on x-ray or echocardiogram. Finding the cause requires further evaluation. Treatment depends on the cause, but general measures include analgesics, anti-inflammatory drugs, and sometimes surgery.

    Pericarditis is the most common pericardial disorder. Congenital pericardial disorders are rare.

  • I agree with all of the above. Sometimes you get ST segment saddling on an ecg but you can have a normal ecg and still have inflammation.

    Doctors tend to rule out pericarditis very easily but don't always consider inflammatory serositis, which is harder to diagnose because bloods, ecg, chest X-ray can all come back normal. An echo can be normal and show no fluid (pericardial effusion) but you can still have pericarditis. Echos can also show "hot spots" of inflammation.

    I am battling pericarditis/serositis at the moment and have very similar symptoms to you. I've been admitted to hospital with it every year for three years. My symptoms are always the same but the clinical findings are often different. Either way the treatment for me is rest, anti-inflammatory meds, steroids and very strong painkillers. Surgery is very rare and carries very high risks and is only used in extreme cases. Rest is the key. Nip it in the bud if it is all caused by inflammation.

    Either way, it's good that you are being investigated as chest pain shouldn't be ignored.

  • Is it seasonal with you? It sounds horrendous. Get well soon too.

  • Thanks for your replies. I get the chest pain and breathlessness but not as severe as this time intermittently throughout the year but I think the last time it was bad (but again, not as bad as this time) was last April last year, so same as this year.

    We get sudden severe weather changes where I live and inflammation in other parts of my body such as arthritis and my IBD flare up with weather changes and extreme weather, humidity etc.

    So, like my gp I have been wondering that this was inflammation flaring.

  • I'm not sure that it's seasonal...rather every time I reduce my steroids to 15mg or below.

  • Thanks for your detailed response and sorry that you are suffering with it.

    I was told to rest up which I did (no choice anyway for that and other normal reasons!) The antinflammatory/ pain killer injection and continued meds at home did lesson the pain after a day or so from that unbearable acute type pain to more manageable.

    Happy tulip an you explain what the difference is between "inflammatory serositis" and pleurisy, pericarditis? You say they don't always look for inflammatory serositis... Everything I've read about serositis refers to the abdomen, lungs and heart being pleurisy, pericarditis and I can't remember the abdo name right now!!

    BTW. I was reading some older posts last night and someone mentioned that an MRI can pick up inflammation that xrays and ECG etc miss.

    Well, I will ask my Rhuemy what she thinks anyway.

  • My understanding is that serositis definitely occurs in the abdomen...basically, serositis can occur anywhere serous tissues occur.

    Pleurisy is basically serositis of the pleura. So far I haven't turned up a specific name for gastro serositis...so I'll be v interested if someone has...unless it's a version of local peritonitis

    During the many months I've been reading research papers, studies & reviews of the gastroenterological manifestations of my overlapping immune dysfunction & connective tissue disorders, the medics writing these pieces simply call serositis in the abdomen: serositis. Of course, serositis in this region can overlap with other stuff

    Here is a link that has helped me understand;

    en.m.wikipedia.org/wiki/Ser...

    I am prone to serosal inflammation (pleurisy particularly) and we suspect serositis of the abdomen too. My early onset crohns husband has had serositis of both the abdomen & pleurisy

    In my case, pleurisy was treated with NSAIDs + antibiotics because my medics hadn't recognised my underlying systemic lupus , sjogrens etc.

    more recently, the theory is that the serousal inflammation involved in the past 18 months of my persistent abdominal Visceral Hypersensitivity + Pelvic pain + slow transit dysmotility, flare has damped down in response to combined therapy daily meds (all my daily lupus meds with my daily therapeutic pred dose increased for a few weeks i+ my 3 Part gastro treatment plan + immunology's daily antibiotics)

    Many thanks for this grrrreat discussion

    I hope things improve for you...please keep us posted

    πŸ€πŸ˜˜πŸ€πŸ˜˜ coco

  • Morning.

    Just been for my chest xray, only had to wait 5 mins!

    I haven't come across gastro serositis but i remembered the name for serositis of the abdomen- peritonitis and I posted a few weeks about this aswell when I had the more severe high abdo pain and swelling. Serositis is much easier to remember though for all of them!!

    So, now I wait for all my results and followup with rheumy, hope it won't be long.

    Is your Sjogren's secondary to your SLE?

    My neurologist suspects Sjogren's and the rheumy has SLE at the top of the list for my systemic symptoms but a mountain of more bloods still ruling out loads of things including obscure infectious diseases etc, things I've never heard of such as coxiella/ Q- fever for example!!! (which actually makes an interesting read by the way!)

    So, an interesting follow up appointment ahead of me.

    Hope you aren't suffering too much today Coco.

    X

  • Thanks dear! πŸ‘ Am more or less "OK" πŸ˜‰

    Yes: my sjogrens is secondary to SLE

    Perotonitis is a special condition in its own right: can be due to inflammatory process, but can also be due to infection within the peritoneum (the serous membrane lining of the abdominal cavity). E.g. my crohns husband nearly died from fecal peritonitis due to crohns ulceration creating a hole in his bowel leaking contents into the peritoneum. But there is such a thing as localised peritonitis inflammation without infection due to spillage of various abdominal substances etc...this link covers everything including peritonitis (scroll to the bottom for that bit):

    en.m.wikipedia.org/wiki/Per...

    Seems to me, you & your medics are doing a really good job of figuring out your mix of underlying issues...am so glad you're keeping us posted...courage!

    πŸ€πŸ˜˜πŸ€πŸ˜˜πŸ€πŸ˜˜

  • Peritonitis tends to refer more to an infection of the peritoneal cavity, like when you have a ruptured appendix or a perforated intestine and the contents of your bowel leak into the peritoneal cavity. IV antibiotics are needed as this can be a life threatening situation leading to sepsis and will require surgery.

    The term abdominal serositis is used more for inflammation of the lining of any part of the gut or abdominal cavity but without the presence of infection. However, antibiotic cover should be considered if a patient is on immune suppressant meds or has an auto inmmune condition that puts them at risk of infection.

    Every patient is different!

    That's my understanding of the terms anyway. I may be wrong.

  • You are quite correct. My Consultant Cardiologist explained to me that pericarditis can be missed on an ECG if it's subtle and on an ECHO but it will always show on a cardiac MRI. However, this is a much more costly investigation so you can see why it doesn't get done as much. Generally on a chest X-ray or echo they are looking for a pleural effusion which is a collection of fluid around the heart.

    As for the inflammatory serositis question. In my experience the medical teams have listened to my symptoms and have been blinkered into looking for pericarditis or something cardiac in nature. (I'm talking about the medical teams in the Emergency Dept). They seem so set on bloods, ECGs etc that they have failed to consider the "Lupus piece of the puzzle." Meaning that they aren't thinking that the patient in front of them has an inflammatory disease, therefore they can get inflammation everywhere and anywhere. All my incidence of pericarditis have included pleurisy as well. So both lungs and heart were affected AND my muscles in my chest wall so I had a good bout of costochondritis too. It was only when my Rheumatology Consultant aka Wonderwoman saw me that she explained the full extent of my condition. She was quite frankly appalled that I had been told to go home and rest and take extra painkillers. I saw her in clinic and 30mins later I was been hooked up to 1g IV methylpred! Some 3 months after I initially got pericarditis.

    The same thing happened last September. I got abdominal serositis. The surgical team recognised that my abdomen was inflammed but didn't stop to think that my Lupus needed to be got under control in order to reduce the swelling. πŸ€¦β€β™€οΈ

    So, in trying to answer your question my understanding has been that thoracic inflammatory serositis involves inflammation of all the lining of the organs in your chest cavity. Whereas pericarditis is limited only to the pericardium.

    Either way, it's blooming painful and completely exhausting which is why it's taken me a while to reply. I was too shattered yesterday, sorry.

  • Thanks for replying esp when you are struggling with this right now!

    So if I'm understanding correctly from what you are saying... the investigations I had when I presented to them with quite severe acute symptoms they would have been primarily looking for signs of infection/ fluid / acute heart problems needing immediate attention rather than thinking this could be inflammatory related to an underlying disorder that needed treatment despite me telling them straight away I was currently under investigation for connective tissue disease by the auto immune rheumatologist at the hospital? (My GP wasn't there that day.)

    So, from what you say I should defo explain what happened to my rheumatologist at my revision app.

    I did see my own gp the week after having the ECG etc and after asking me loads of questions she did say it was probably inflammation flared by current weather conditions but didn't elaborate... Time issues etc.

    Thanks Happytulip, I think I'm beginning to understand the complexities of this a little better (if I am understanding you correctly) and can ask better informed questions now.

    I hope your condition improves. I'm still getting alot of chest pressure, a little pain and breathlessness on and off and ofcourse fatigue which is never ending anway but my chest doesn't feel like it was yet prior to the episode that resulted in my husband taking me to the surgery double quick!

    Best wishes.

    X

  • That's very helpful, happytulip. I've had persistent tachycardia, plus fluctuating chest pain for months now. At its worst, I was sent into A&E by my GP. I've had a couple of echocardiograms too, as well as numerous ECGs. Each time, I'm told that no abnormalities are detectable. I've been treated with Beta blockers, which has lowered my BP - yet the tachycardia and chest pain persist.

    I've raised pericarditis as a possibility, but been told that this would show on echocardiogram. I have another cardiology review next month, so I will definitely switch to asking about serositis!

    Thanks X

  • My experience with Pericarditis

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