Plz help me out with thos coronary tamponode condition!The coditions keep gettin worse day by day.Can u help?

Question

Due 2 fluid acumulatd in cavity srrnding heart,pain persists in chest area after 2 mnths of angioplasty.Help!?
Angioplasty performed(successfully) after detection of blockage in two coronary arteries.Something went wrong & blood started accumulating in the heart which was extracted through injections and syringes for over 36 hrs.But,after the blood was reinjected in the body,via the wrist vein,the fluid kept accumulating,which was drained out gradually.Even then,after medications,some fluid is still visible in the cavity surrounding heart which causes CONSTANT pain,even after two months of angioplasty.Doctor remains baffled and helpless.Recommends steroids which have already started showing side effects.Can anybody please help or suggest some alternate remedy/doctor?

Answer 1

In looking into your inquiry, it turns out that a very rare complication can be artery perforation and resulting cardiac tamponade. I located a study from back in the 90's about this complication. Here is some background information that will help you gain perspective on the whole matter.

During the 3-year study period, a total of 15 patients had cardiac tamponade during or within 36 hours after 6999 coronary interventions, yielding an incidence of 0.21%. No cases of tamponade occurred among 14,927 patients undergoing diagnostic catheterizations during the same period.

The diagnosis of tamponade was usually confirmed by echocardiography, with the exception of 1 patient who had hypotension and tamponade physiology while in the laboratory. Fluoroscopy revealed immobile heart borders, and pericardiocentesis was performed immediately without prior echocardiography, with rapid restoration of normal blood pressure. The echocardiogram was performed within 30 minutes of onset of hypotension in 9 of 15 cases, and in all, within 2 hours.

The clinical circumstances leading to emergency echocardiography and therapy varied, but with a common theme of hypotension. The 6 patients who had tamponade in the catheterization laboratory were immediately recognized on the basis of sudden profound hypotension and (in the 4 coronary artery cases) by obvious contrast extravasation. Of the 9 patients with delayed tamponade, 8 had unexplained hypotension. Four of these also had chest pain, 3 had dizziness, and 2 had severe bradycardia. Only 2 patients had asymptomatic hypotension.

Treatment was surgical in 9 (60%) of 15 patients. These patients had various indications. In 1 patient, tamponade was not suspected until the chest was opened for emergency coronary bypass graft surgery. In 5 patients, pericardiocentesis was not successful in controlling the bleeding, whereas in the remaining 3 patients, pericardiocentesis was not attempted.

The mean time from surgical consultation to arrival in the operating room was 1 hour. Four patients had surgery as the primary treatment, whereas 5 had a percutaneous pericardial drain placed but required surgery for continued active bleeding. Six (40%) patients responded well to conservative treatment with pericardiocentesis alone. In cases of coronary perforation, prolonged balloon inflations, often with the use of perfusion balloons, usually were used to achieve hemostasis or as a temporizing measure before pericardiocentesis.

Here is a case of having cardiac tamponade/pericarditis incidental to the procedure. Two problems not necessarily related to each other. Infectious complications of coronary angioplasty and stenting are uncommon. A 70-year-old man is presented who underwent percutaneuous transluminal coronary angioplasty (PTCA) and stenting of an occluded left anterior descending artery. This was complicated by Staphylococcus aureus pericarditis with tamponade. He was successfully treated with a closed drainage and antibiotics. This is the first reported case in the literature that documents purulent pericarditis and tamponade following percutaneous revascularization.

Bacterial pericarditis is very unlikely but then your whole experience has been very unlikely. See the attached link to learn more about pericarditis, which is what you are currently suffering from. As you will see viruses and inflammatory diseases can also account for this presentation too.

http://www.emedicine.com/med/topic1781.htm

So now that I have done all of this footwork for you...two questions: 1) Why couldn't you look this up yourself? 2) Why didn't you select a best answer on your last question about this matter?

Answer 2

Surrounding the muscle of the heart is a thin lining called the "pericardial sack". Its job is to produce a small amount of fluid that lubricates the heart so it can swing back and forth freely inside this sack.

Sometimes there is inflammation of the sack and fluid accumulates. When enough of it is present its called pericardial effusion. When too much is present and the heart can't expand properly enough to work, a condition called "pericardial tamponade" occurs and blood pressure can fall.

Most of the time, inflammation is caused by viruses, autoiimune conditions, or a heart attack. In your case, if blood was extracted it may have been due to a rupture of the artery they were trying to open. This happens ~1% of the time. Usually its self limiting, as eventually blood closes off the hole. Ifthe hole is persistent it won't accumulate slowly, blood tends to accumulate fairly quickly given that the artery is a high pressure system.

More than likely your "blood being removed" is actually a mixture of serum and some blood. So instead of "sanguinous", its "sero-sanguinous" fluid they are removing. This may be becouse of residual inflammation.

treatment initially is high dose aspirin for reduction of inflammation. Then cholchicine for prevention of recurrence. Prednisone is used for cases that persist. Failing that, if there is alot of fluid they do a "pericardial window" which is a hole the sack allowing the fluid to drain into the belly and be absorbed there. Otherwise they can do percardial stripping, where the sack is surgically removed. These are very invasive and last ditch kind of efforts.

If you have only a little remaining, its unlikely to be causing any real hemodynamic (blood pressure) problems. The treatment will be aimed at you feeling of pain. Sometimes this pain can take omths to go away. Its usually worse lying down, or with deep breaths. In rare cases it can persist forever. If the pain is bearable, its kay. If its unbearable, remember that as you go with more and more invasive treatments, the likelihood of side-effects is higher. At some point you will have to decide if the aggressive surgery is worth the pain.

In the meantime, take your prednisone. Make sure you are on a stomach pill such as Nexium or Losec. For pain take a full Aspirin or Motrin every four to six hours. Check back woth your doctor every two weeks while on this, to make sure your kidney and blood pressure remain okay.

If you plan to take herbal remedies, talk to your pharmacist first. Most of them interact with medications you will be on. Herbal or not, there is no such thing as a "side effect free" pill. Anything desined to change your chemistry for the better, will also change it for the worse. Thats nature...

Answer 3

Real friends are much better . If you don't have any ,and you talk out loud when you are by yourself ,and when potential friends seek interaction you say you'll pray for them , and you are having sad and crummy days , you NEED to talk to a professional couselor to find out why . There is so much out there to enjoy and so many people you could join . You must have a problem that needs attention before it gets any worse .