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Rilonacept for Recurrent Postcardiac Injury Syndrome Pericarditis in a Young Hockey Player: When to Return to
Faysal Massad1, Akiva Rosenzveig1, Samuel Reiss1
1Center for the Diagnosis and Treatment of Pericardial Disease, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Background:
Postcardiac injury syndrome (PCIS) pericarditis is a common complication following cardiac surgery. Exercise counseling is critical for recovery, but guidelines for return-to-activity are often generalized.
Case Summary:
A 35-year-old male experienced a ventricular tachycardia arrest due to a left anterior descending infarct while playing hockey. He underwent coronary artery bypass grafting and developed acute pericarditis due to PCIS. Despite colchicine and prednisone, he had 3 recurrences of pericarditis. Rilonacept (an interleukin-1 blocker) was started in October 2023. After 6 months, his condition improved, and exercise was gradually reintroduced with heart rate limits, initially <130 beats/min, later increasing to 145 to 150 beats/min.
Discussion:
Exercise restriction is essential in acute and recurrent pericarditis until symptoms resolve and inflammatory markers normalize. Limited data exist regarding exercise while on interleukin-1 blockers such as rilonacept, and shared decision-making is critical.
Take-Home Message:
Gradual reintroduction of exercise based on clinical stability and inflammatory markers is key in managing recurrent pericarditis due to PCIS after coronary artery bypass grafting.
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