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Forum Name: Pericardial Diseases

Question: Pericarditis and Sudden Cardiac Death


 Hackettsue - Thu May 20, 2004 2:25 pm

:cry: My mother was diagnosed with bronchitis without pneumonia (per chest x-ray) by her primary care physician. She died 24 hours later at home from sudden cardiac death. In her autopsy it was pointed out that she had a very severe pericarditis
(Pericardial effusion - 100 cc) with myocardial fibrosis and moderate hypertrophic cardiomyopathy (Bilateral pleural effusions - 200 cc each). She had never been diagnosed with any of this. How did the bronchitis turn into pericarditis and result in sudden cardiac death? Also, would the pericardial effusion and bilateral pleural effusions not be visible on the chest x-ray? Is it possible that a "Rub" would not have been detectable upon the primary care physician listening to her heart? I am trying to figure out how the pericarditis got missed and how she wound up with a sudden cardiac death. Any information would be much appreciated; I am at a complete loss for answers.
Thank-You.

Susan Hackett
 Dr. Tamer Fouad - Fri May 21, 2004 4:21 am

User avatar Susan,
Please accept my deapest condolences. Sudden death is always a medical dilemma. However, it appears that in your mother's case a possible theory is that she had a longstanding case of cardiomyopathy that lead to her sudden death. Please check our page on cardiomyopathy for more info:

cardiomyopathy.htm" class="postlink">Click here!

Hypertrophic cardiomyopathy in particular has been associated with arrhythmias leading to sudden death. A hypertrophic cardiomyopathy may have been missed by the x-ray. Again pleural effusions of more than 150-200 mL usually are apparent as blunting of the costophrenic angle on upright posteroanterior (PA) chest radiographs. So there is a chance that both the pericardial and pleural effusion get missed by the x-rays. Again the effusion may have happened only after the heart stopped due to congestive heart failure.

The main thing for you to do now, is to get back to your doctor and make sure you do not have hypertrophic cardiomyopathy yourself (If you read the article above you will find that 50% of cases are inherited via autosomal dominant trait).

This can easily be diagnosed in your case by echocardiogram.

Best regards.
 Hackettsue - Fri May 21, 2004 9:23 am

:?: Dr. Fouad,
Thank-you very much for your reply and your concern. I did get an echocardiogram recently and thankfully, it did not show any signs of hypertrophic cardiomyopathy. Regarding my mother, it appears that you are saying that the arrhythmia she had which caused her death came more from her longstanding cardiomyopathy rather than the pericarditis. From all that I have read, this is very likely the case. I wonder though, why it happened exactly when she was sick with bronchitis/pericarditis? Is there a connection there? Also, I'm still confused as to how the bronchitis became pericarditis? Again, thanks much for any answers you may have.

Susan Hackett
 Dr. Tamer Fouad - Mon May 24, 2004 12:27 am

User avatar Susan,
The bronchitis probably has nothing to do with it. It was concidental. The main reason for her death was probably a fatal arrhythmia. Whether her fever, cough, or nutritional status during the bronchitis attack contributed to the arrhythmia would only be speculation. In theory they all could but alone none of them would lead to much without her cardiomyopathy. Her pericarditis was either present for a very long time and missed by the x-ray or it was the result of her sudden death. I don't think it was related to her bronchitis attack.

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