Pericarditis Pain in Uremic Patients-Reply

Abstract

In Reply. —We appreciate Dr Spodick's comments regarding our observations on atherosclerosis as a possible cause of pain associated with uremic pericarditis. Appropriate testing for CPK and LDH did not indicate any elevation of the myocardial specific fraction. It should be noted, however, that the detection of such enzyme fractions does not necessarily rule out pericarditis as the underlying disease process. Profound subepicardial myocarditis has been increasingly recognized as a cause of elevated myocardial specific CPK and LDH fractions in subjects with pericarditis. In the usual case of isolated uremic pericarditis, this phenomenon generally is not observed. Dr Spodick's comments regarding relief by assumption of the upright position as equally characteristic of ischemic and pericardial pain are of great interest. Inspection of the leading textbooks of cardiovascular disease indicates that relief after sitting upright is characteristic of pericardial rather than ischemic pain. 1,2 Perhaps, some confusion concerning this point is related to