The current recommendations for exercise and acute pericarditis are not well supported, in that cessation of exercise is generally prescribed from anecdotal experience and extrapolation from basic science research in myocarditis and “inflammatory markers”. Pretty weak grounds to base if you ask me. For the sake of not noceboing, what is the best course of action to take here?
Person of Interest (POI):
25y/o female, 170 lbs, 5’1", 33% BF
Family Hx: Father: two Myocardial Infarctions within the last year, most recent around May.
Medical Hx: Shoulder dislocation ~10 years ago, recent diagnosis by PCP of acute pericarditis after C/C of chest pain and dyspnea since about 10/3/18, still persisting and worsened in the present (10/10/18). PCP ordered for no exercise until seen by Cardiologist, so unclear to see if Sx worsen with physical activity or not. POI wants to try walking or light lifting on 10/11/18.
Fitness Hx: Wrestling in High School (~10 years ago), Frequent Exposure to Squat, Bench, Deadlift, Press, Power Clean, and Conditioning Work with Sprints, Rower. Currently trains doing a Novice LP with added Rower work for conditioning and GPP.
Diet Hx: Breakfast - yogurt and granola or a protein/fruit smoothie, Lunch - Sandwiches or Fast Foods, Dinner - Lean Protein (e.g. chicken, fish), rice, veggies. Currently following macros through MyFitnessPal.
POI is currently working to lose weight, more specifically lower body fat percentage, and also get stronger and better conditioned.
Hi there. Thanks for the interesting question and detailed history.
It sounds like her condition was not severe enough to warrant hospitalization? Has she had an echocardiogram? How is she being treated? Has she responded to treatment quickly?
As you noted (presumably from reading this article, given some of the wording in your post), unfortunately we have no evidence to base any recommendations on here, and we don’t have quite enough diagnostic information here, either. I will say, however, that I am extremely, extremely skeptical of the mechanistic hypotheses described in that article for complications like myocarditis.
Thanks for approving and responding to this post Austin! Greatly appreciated.
The POI described Sx of pain (unclear if sharp/dull) from the chest as well as in the left shoulder. POI did not receive an echo to my knowledge, but did get an EKG and showed normal sinus rhythm. She has yet to be treated with colchicine, prednisone, NSAIDs, or anything that is typically prescribed with acute pericarditis. She may or may not be given further treatment once she sees the cardiologist on 10/12/18. All her PCP did was recommend to abstain from exercise except for walking or yoga, and was referred to the cardiologist. And yes! I was indeed referencing that article from the ACC. I searched and searched and could not find any compelling contraindications for exercise with acute pericarditis. I was also highly skeptical of the mechanistic hypothesis. I read on some forums by health providers recommending to keep the heart rate under 100 BPM and other things, or to do yoga or swimming post-recovery. Yet there is no rationale for these statements.
POI was diagnosed upon evaluation of chest x-ray and EKG and recognizing POI’s Sx. EKG was normal sinus, no abnormal segments or intervals, BUT chest x-ray indicated fluid accumulation in the pericardium. With Sx of chest pain radiating to left shoulder and x-ray results, PCP diagnosed POI with acute pericarditis.
Wanted to follow-up Austin, just modified POI’s LP a bit to work with Sx and she is back up to speed. Turns out it was bacterial pericarditis from water contamination, so at least treatment and management are promising and clear going forward. Thank you for your help as always!