Pericarditis

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Seaton

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May 13, 2015
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338
Location
London, UK
I’ve been in hospital for nearly four days. Went in last early Tuesday morning and finally sent home last Friday evening.

Just before the previous weekend to that, I’d had overnight chills and aches. Then an ache in my left shoulder/clavicle area that felt like I’d pulled a muscle. The pain seemed to increase when I tried to fully inhale. It was extremely difficult to lie comfortably in bed.

Over the weekend the pain spread into my chest and palpitations increased. My temperature was creeping up. Peaked at 38° Sunday.

Temperature stabilised next day but pain across my chest increased substantially and around the left clavicle area, especially when inhaling.

Things didn’t improve overnight, so I went to A&E at St Thomas’ first thing Tuesday morning after telephone advice from GP. By the time I arrived at the hospital it was becoming hard to walk far without difficulty breathing and pain.

Was triaged quickly at St Thomas’ as they were suspecting endocarditis (my CRP blood marker was high, my temperature was 38.3º and there was microscopic blood in my urine sample). They took full bloods and an extra two bottles to culture for endo. I had an X-ray and EKG.

I was put in a diagnostic ward to stay overnight, but at 10pm was transferred to a cardiac ward.

Next day a second blood culture was done.

Plus:
echocardiogram
CT scan
utrasound (of kidneys)
Lots of swabs and more bloods.

Over Wednesday and Thursday, pain worsened on exertion and inhaling. Pain eventually seemed to isolate around the heart away from shoulder. D-dimer test was elevated.

I was given paracetamol to lower temperature and ease pain. They were reluctant to give antibiotics so as not to mask blood culture results.

No vegetative growth could be seen on my valve anywhere via echocardiogram.

Eventually endocarditis was ruled-out (saw the infectious diseases team to confirm) and a diagnosis of pericarditis was given. My pericardium had been infected, probably by a virus. The bloods and swabs are being investigated to confirm.

Pericardial effusion was present on echo but no cardiac tamponade, which was good news.

My temperature stabilised and the disabling pain began to subside.

Discharged late Friday evening fatigued but relatively pain free, with a two week supply of twice daily colchicine and told to go back to GP or A&E if things deteriorate. Been told to take paracetamol as needed.

A final (third) endocarditis blood culture was taken before I was discharged as a precaution. They said this can take up to five days to grow any organisms if present. They’ll be in touch if anything materialises in the culture(s), but they weren’t expecting anything. The first culture came back negative.

All in all, a pretty thorough work-up from St Thomas’ and with their usual excellent care.

They’re booking me a follow-up Cardiology outpatient appointment with a repeat echo in 6 weeks.

First night home my bed was soaked with fever sweat by morning. But normal temperature next day. I’ve been quite heavily fatigued all weekend and breathless climbing stairs. Today some slight pain increase noticeable again on inhalation. But I’ll keep taking the meds and see how it goes!
 
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LoveMyBraveHeart

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Aug 6, 2019
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122
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USA
Best of luck to you @Seaton ! I'm glad you took the advice and went in to be seen. That does not sound comfortable, and I'm hoping you've seen the last of it. It's bringing back vivid ER memories of when Mathias was readmitted for tamponade. So glad that isn't the case with you. What a roller coaster, in any case! I'll be sending good vibes your way!
 

pellicle

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Nov 4, 2012
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Queensland, OzTrayLeeYa
Hi

sorry about your rocky recovery road.

A final (third) endocarditis blood culture was taken before I was discharged as a precaution. They said this can take up to five days to grow any organisms if present.
I just wanted to say that this is often inadequate. Depending on the type of infection (and lets assume it isn't viral in nature which won't culture) some bacteria can take much longer (but they don't because they don't want to usually). Myself I had a post surgical infection of Propionibacterium which takes much longer to culture. In a sort of strange way it was interesting to watch the interplay between my surgeon and the infection specialist when the infection specialist said "there is no bacterial infection" to the surgeon. He then said something like "well you weren't the one in there scraping out the pus so you need to actually look properly".

P. acnes takes something over 7 days (and the right media) to culture and isolate: Optimal Length of Cultivation Time for Isolation of Propionibacterium acnes in Suspected Bone and Joint Infections Is More than 7 Days

I hope you don't have that, but if you do it'll be just a few weeks of a PICC to deliver some antibiotics and then a few months on oral antibiotics (I'm still on mine from 2012). You can search for my thread here if you are interested.

Best Wishes
 

Seaton

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Joined
May 13, 2015
Messages
338
Location
London, UK
Brilliant info @pellicle. Thank you!

I’m always overcautious when it comes to fevers and pain since surgery and I usually get things checked quickly. So far I’ve been right to.

I hadn’t mentioned endocarditis to them when I went in, but they seemed to automatically err on the side of caution towards that anyway, finally deciding on pericarditis.

Fascinating and certainly worth knowing that P. acnes takes 7 days to culture. I’ll bear that in mind!

Hope all good with you.
 

Paleowoman

VR.org Supporter
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Jun 14, 2010
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Location
Surrey, UK
Oh gosh @Seaton what a scare you've been having, sounds very painful too. Glad they were so careful and caring with you at St Thomas's. Wishing you all the best for a quick recovery from this.
 

Protimenow

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Aug 10, 2010
Messages
3,149
Location
California
Seaton -- thanks for the complete history. I hope that everything gets better soon - if not almost immediately.

There's one thing to consider - colchicine. It's given to people with gout and helps break up the uric acid crystals in their joints. There's an issue with extended use causing damage to white blood cells. I'm sure that your doctors are on top of this, regularly testing your blood, but it's something that you should know about.

BTW - here in the United States, the stuff is EXTREMELY expensive. Overseas, it's practically given away.
 

Seaton

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Joined
May 13, 2015
Messages
338
Location
London, UK
@Protimenow ... Thank you!
The doctor mentioned colchicine was used as a gout drug. Said nothing about the effects of long term use, though. Fingers crossed I’ll not be needing it after the two week supply I have. They’d just run out at St Thomas’ hospital on the day of my discharge, so had to taxi some over from Guy’s Hospital here in London while I waited. Incredible service, really.

Hope all good with you.
 
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tom in MO

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Jan 17, 2012
Messages
1,226
Location
MO USA
Sorry about your troubles Seaton, sounds like you drew the short straw on an uneventful recovery. Remember, sleep, rest, fluids and healthy food and drink are good medicine.
 
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