Possible Pericardial Effusion after Ablation

I've been experiencing discomfort and pressure in the chest when I walk or do anything that involves a degree of exertion since my Bordeaux ablation five weeks ago. I finally got a response today to my e-mails to Prof Jais.

He has recommended an echocardiogram to check for Pericardial Effusion. I'll hopefully get an appointment with a GP tomorrow morning but the state of the Health Service here will probably mean a considerable wait. I understand the initial treatment is simply an NCAID. I already take recommended supplements like Garlic, Magnesium, Vit C etc.

In the meantime recommendations from anyone who has dealt with this would be much appreciated.

Sam

You don't wait for an appointment to investigate a possible pericardial effusion. Go to A&E.

CT scan can also be diagnostic. Echo is cheaper and faster, but CT should be an option as well.

[academic.oup.com]

[a-fib.com]

Apparently PE is a common clinical finding regardless of whether ablation has been carried out:
[link.springer.com]

PE is not uncommon after an ablation and was one of the first things they checked for after mine. They checked three times over the time I was there and as it was reducing each time they said it would disappear on its own.

Guys, you really had me confused for a moment there. The standard medical meaning of PE is pulmonary embolism.

Sorry to confuse you, Carey. I used it because I thought mcwf had come up with a simple abbreviation.

Saw my GP this morning and had an ECG done right away but she said she couldn't tell from it if I had Pericardial Effusion and gave me a letter with the printout and full medical history to take to A&E .

Initial waiting time there was unusually short but was followed by almost three hours of blood tests, chest x/ray, another ECG and hundreds of questions.

Finally got to see a cardiologist. Very likeable and down to earth. Said it was impossible to tell if if I had effusion from an ECG. Obviously Prof Jais disagrees. However when Effusion was being checked in Bordeaux they used ultrasound each of the 3 times. This cardiologist also said Effusion usually wasn't anything to worry about unless I looked at deaths door and had difficulty breathing. He offered to refer me for an ultrasound which I accepted. Could take a while though.

I always thought the problem might be vertebral or costovertebral joints in need of mobilizing. I've had this type of problem over the years and resolved it each time with my wife doing the movements I taught her. However these involve lying on my front and having pressure applied to my back; a bit worrying so close to an ablation.

Why on earth would they not have an ultrasound machine in the ER dept? It literally takes 5 minutes to do. At least they did a chest x-ray so I'm guessing they didn't see too much enlargement of the pericardium and thus weren't overly concerned.

The concern for pericardial effusion is progression to cardiac tamponade. That needs an echo to diagnose. I think they can get some diagnostic information from an EKG, but it would probably involve them having access to a baseline EKG from prior to the effusion to look for any changes. Since they don't have that, they're telling you its useless. Which probably isn't far from the truth, so I wouldn't push it. I would push for the echo, though, sooner rather than later.

I think maybe there was a communication problem. Only a massive pericardial effusion produces significant ECG changes, and that's still not diagnostic. Diagnosis is by x-ray, echo, CT, or MRI, with echo usually being preferred.

Sam,

You said in your last post that your cardiologist said ‘it was impossible to tell if if I had effusion from an ECG. Obviously Prof Jais disagrees.’

But in your original post you stated “I finally got a response today to my e-mails to Prof Jais. He has recommended an echocardiogram to check for Pericardial Effusion.”

In what way is Prof Jais disagreeing? Looks like everyone is agreeing that an US is the best way forward diagnostically. Surprised you didn’t have fairly immediate access to an US in the circumstances - even here in the U.K. on the NHS!

(Also surprised at your comment ‘finally got a response today to my emails to Prof Jais.’ He always answers mine - and there have been a few! - within 24hrs.)

Hoping you feel better soon Sam

Mike

One can tell PCE by EKG if it's severe enough that there are electrical alternans. Also, if the effusion comes on slowly you wouldn't necessarily have prominent/significant symptoms. PCE can be life threatening. You'll want to investigate. Please don't let anyone belittle the situation. Echo is the best test. I don't think X-ray is helpful. The others are helpful, but I've seen it called by CT and can't find anything on echo.

Received my appointment for an ultrasound this morning. It will be on 16th August. For the Health Service here that is very quick. It was only when I received this that I realised I've been confusing Echocardiogram with Electrocardiography. (Now I understand your comment, Mike!)
My only excuse is that I've been feeling very poorly since the operation.

My apologies to all of you.

Quote
libby
One can tell PCE by EKG if it's severe enough that there are electrical alternans.

Yes, if it's severe, but nobody's going to diagnose it based on ECG. A paramedic might base their clinical impression on that, but the ER is going to do an immediate echo or CT for the actual diagnosis.

But I completely agree with your comments about the seriousness. I'm shocked they would make a suspected effusion wait weeks.