REHABILITATION OUTCOME FOLLOWING PERICARDIECTOMY IN PERICARDITIS COMPLICATED BY RECURRENT PERICARDIAL EFFUSION AND CARDIAC TAMPONADE: A CASE REPORT

Abstract

Background: Recurrent pericarditis is the most problematic complication following acute pericarditis and occurs in 20–50% patients of all age groups. Clinical manifestations vary and range from asymptomatic to life-threatening. Despite normally good prognoses, it ensues a negative impact on patients. Cardiac rehabilitation (CR) has demonstrated a cardinal role in management of patients who undergo pericardiectomy, yet no specific rehabilitation protocols are available for reference.

Case Presentation: A 27-year-old man presented with pericardial effusion and cardiac tamponade in recurrent pericarditis. His prior admission history included chest pains for 3 months. He was diagnosed with tuberculous pericarditis and commenced on ATT. Patient complained of worsening difficulties in breathing, orthopnoea, cough, chest pains and had a significant history of exposure to PTB during childhood, but was HIV negative.

His physical examination revealed tenderness on the left chest and muscle weakness in left arm. His baseline spirometry and 6MWT scores were 68% and 250 meters. Patient had right lower lobe atelectasis associated with reduced air entry. He received a pre-operative regimen of chest-physiotherapy and resistance exercises and radical pericardiectomy was performed three weeks later. Post-operative physiotherapy continued in ICU within 24 hours. He was transferred to the ward and discharged on day 8 with a prescribed physiotherapy home program. On follow-up, the patient made incredible progress on the three reviews at 2 weeks, 3 months and 1 year.

Conclusion: Our case demonstrates a cardinal role of exercise-based CR in patients undergoing pericardiectomy hence the need to establish a standardized exercise protocol and identify means to transform post-hospital care for people with heart disease.