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PubMed1975

[Pericarditis and heart tamponade in patients on regular hemodialysis].

Among 137 patients with terminal renal failure maintained on chronic haemodialysis, pericarditis was found in 37. In 11 cases it developed prior to the onset of haemodialysis therapy, and in 26 during various periods within the therapeutic course. In patients maintained on haemodialysis pericarditis is characterized by a protracted course, severe pain syndrome, ability to cause or intensify cardiac failure, to produce cardiac rhythm disorders. In 15 patients pericarditis was complicated by a massive effusion into the pericardiac cavity. In 3 of them the effusion gradually dissolved, 3 other ultimately developed subacute constrictive pericarditis, in the remaining 9 the effusion resulted in tamponade. Two patients died of cardiac tamponade, in the remaining 7 patients 12 transdiaphragmal pericardial punctures were performed. In 2 cases the latter caused severe complications. The discussion deals with the methods of treatment of pericarditis in patients on chronic haemodialysis, with the preventive measures against the effusion, and the means of its management.

Adult↗
PubMed2002

Pericarditis and pericardial effusion in acute ST-elevation myocardial infarction in the thrombolytic era.

BACKGROUND: Myocardial infarction-associated pericarditis is a common cause of chest pain following MI, its frequency depending on how it is defined. OBJECTIVES: To investigate the incidence of acute pericarditis and pericardial effusion in the acute phase of ST-elevation MI treated with thrombolytic therapy. METHODS: The study group comprised 159 consecutive patients fulfilling the criteria for acute MI who were admitted to our department during 18 months. Infarct-associated pericarditis was defined as the finding of a pericardial friction rub, a typical pleuropericardial pain, or both. All patients underwent physical examination of the cardiovascular system four times daily for 7 days, as well as daily electrocardiogram and echo Doppler examinations. RESULTS: Fourteen patients (8.8%) developed a friction rub and 11 patients (6.9%) had a mild pericardial effusion. Six patients (4.0%) had both a friction rub and pericardial effusion. Two patients had a friction rub for more than 7 days. Pleuropericardial chest pain was present in 31 patients (19.5%) but only 7 of them had a friction rub. The in-hospital mortality rate was 1.3% and no mortality was observed in the acute pericarditis group. CONCLUSION: The incidence of signs associated with acute pericarditis was lower in MI patients treated with thrombolysis, compared with historical controls, when a friction rub and/or pericardial effusion was present. There was no significant reduction in the incidence of pleuropericardial chest pain.

Adult↗
PubMed2002

Diagnosing pericarditis.

Pericarditis, or inflammation of the pericardium, is most often caused by viral infection. It can also develop as a result of bacterial or other infection, autoimmune disease, renal failure, injury to the mediastinal area, and the effects of certain drugs (notably hydralazine and procainamide). The clinical features of pericarditis depend on its cause, as well as the volume and type of effusion. Patients with uncomplicated pericarditis have pleuritic-type chest pain that radiates to the left shoulder and may be relieved by leaning forward. Chest radiographs, Doppler studies, and laboratory tests confirm the diagnosis and provide information about the degree of effusion. In most patients, pericarditis is mild and resolves spontaneously, although treatment with a nonsteroidal anti-inflammatory drug or a short course of a corticosteroid may be helpful. When a large pericardial effusion is produced, cardiac function may be compromised, and cardiac tamponade can occur. In patients with longstanding inflammation, the pericardium becomes fibrous or calcified, resulting in constriction of the heart. Drainage or surgical intervention may be necessary in patients with complicated pericarditis.

Algorithms↗
PubMed2004

[Pericarditis and exudative pleuritis in patients with systemic lupus erythematosus before and after therapy].

AIM OF THE STUDY: To establish the presence of pericarditis and exudative pleuritis in patients with systemic lupus erythematosus (SLE) prior to and after glicocorticoid and cytotoxic therapy. PATIENTS AND METHODS: In 43 patients, 39 women and 4 men, with SLE (disease was diagnosed according to revised American College of Rheumatology ACR criterias, 1997), aged between 20 and 61 and averaged disease duration of 5.54 +/- 5.74 years, heart/lung radiology and heart echosonography were performed in order to discover possible serositis (pericarditis and exudative pleuritis) prior to and after cytotoxic and glucocorticoid therapy. RESULTS: The presence of pericarditis and exudative pleuritis was established in 20 patients (47%) before the therapy. After the therapy pericarditis was present in 2 patients, average volume of 150 ml, and exudative pleuritis was also present in phrenicocostal sinus, but its volume was minimal. This table is showing the results of our study on patients with SLE and serositis. The results were compared with the results of European and Belgrade group in year 2000. [table: see text] CONCLUSION: Higher frequency of serositis (pericarditis and exudative pleuritis) in our study is probably a result of more active disease, and the effects of cytotoxic and glucocorticoid therapy were satisfing exept in two patients who were resistant on therapy. That is the reason why we had to consider plasmapheresis.

Adult↗
PubMed1992

Cardiac tamponade secondary to haemophilus pericarditis: a case report.

Pyogenic pericarditis is encountered uncommonly in clinical practice. The majority of cases of clinically apparent pericarditis are viral in origin. When bacterial infection of the pericardial space does occur the causative organism is usually Staphylococcus or Streptococcus species. Isolation of an haemophilus organism from the pericardial space in this condition is distinctly unusual. There are only 10 previously reported cases in the literature of pericarditis secondary to Haemophilus influenzae. This report describes the case of a 36-year-old woman who presented with haemophilus empyema and purulent pericarditis progressing to cardiac tamponade. There are isolated reports of successful treatment of pyogenic pericarditis with closed drainage and antibiotics. In the absence of clear evidence demonstrating the efficacy of this approach the authors favour open exploration of the pericardial space.

Adult↗
PubMed1991

[Vena caval flow patterns in patients with constrictive pericarditis: analysis by catheter-tip Doppler flowmetry].

Changes in superior and inferior vena caval flow patterns were analyzed in 5 patients with constrictive pericarditis and were compared with those of 10 normal control subjects. Caval flows were measured using catheter-tip Doppler flowmeters. The normal controls showed biphasic M-shaped flow patterns; the peaks of the first forward flow (S wave) and of the second forward flow (D wave) appeared coincident with mid-systole and mid-diastole, respectively. Reverse flows fell during the atrial contraction period (A wave) and late systole (V wave). In the normal controls, the ratios of the S wave to the D wave (S/D ratio) and the A wave to the S wave (A/S ratio) were 2.15 +/- 0.41 and 0.18 +/- 0.10, respectively, and there was a disproportionate respiratory variation in the S and D waves in the normal controls. In constrictive pericarditis, superior and inferior vena caval flow velocities were lower than those in the normal controls. The S/D and A/S ratios were 1.46 +/- 0.27 (p < 0.05 vs control) and 0.66 +/- 0.15 (p < 0.01 vs control), respectively, with the A wave increasing in proportion to the severity of constrictive pericarditis. In addition, there was only a minimal respiratory variation in constrictive pericarditis. In conclusion, recognition of the patterns of the superior and inferior vena caval flow velocities may be useful for diagnosing constrictive pericarditis.

Adult↗
PubMed1990

Rheumatoid pericarditis: clinical features and survival.

We describe the clinical characteristics and actuarial survival of a consecutive cohort of 41 patients with rheumatoid arthritis and clinical pericarditis who were seen at the Mayo Clinic between 1970 and 1987 and followed up until death or through 1987. The survivors were followed up for a median of 5.1 years. Approximately three-fourths of our patients had acute pericarditis, the remainder having recurrent acute pericarditis, chronic pericarditis with effusion, or chronic constrictive pericarditis. Most patients had symmetrical joint swelling, morning stiffness, subcutaneous nodules, rheumatoid factor, and classic radiographic changes of rheumatoid arthritis. Common extra-articular features included fatigue, loss of weight, and fever. Dyspnea or orthopnea, typical pericardial pain, peripheral edema, tachycardia, tachypnea, a diminished mean blood pressure, a pericardial friction rub, jugular venous distension, rales, radiographic evidence of cardiomegaly and pleural effusions, and abnormal echocardiograms were the most common cardiac manifestations. An elevated erythrocyte sedimentation rate and anemia were other common laboratory findings. Our cohort demonstrated decreased survival in comparison with an age- and sex-matched North Central white population (from the upper midwestern United States), especially during the first year after diagnosis. Increasing age, the presence of other heart disease, an increasing total number of other extra-articular manifestations of rheumatoid arthritis, jugular venous distention, and a lower mean blood pressure were associated with decreased survival.

Adult↗
PubMed1989

[Complications of rheumatoid pericarditis: constriction and tamponade].

Pericarditis is frequent in patients with rheumatoid arthritis. It is usually asymptomatic, but cases of constrictive pericarditis or, more rarely, tamponade have been reported. In such cases, the study of pericardial fluid is of special interest for the aetiological diagnosis. Early medical treatment with or without pericardiocentesis is effective in most cases of tamponade, but constrictive pericarditis demands pericardiectomy. We report here three cases of pericarditis responsible for cardiac compression: two cases of tamponade and one case of constrictive pericarditis.

Adult↗
PubMedDate not supplied

[Tuberculous pericarditis].

A case of specific tuberculous pericarditis is described. A short clinical and etiological classification of pericarditis is given. There are so many new forms of pericarditis today, like autoimmune, postirradiation, drug induced, etc. Specific tuberculous pericarditis is rarely registered today. One must intend to specify TB pericarditis almost if pericardial effusion is present. Pericardial punction is of much help in the diagnosis and treatment of pericardial effusion. Steroid therapy is very important in prevention of forming pericardial adhesions.

Female↗
PubMed1988

[Pericarditis and acquired immunodeficiency syndrome].

In order to evaluate the frequency and clinical features of pericarditis caused by the HIV virus, 17 patients (mean age 28 years) presenting with pericarditis were investigated at the University Clinics of Mont-Amba (Zaïre), between January, 1985 and December, 1986. The clinical diagnosis of AIDS had been made on the basis of the WHO criteria. An ELISA test, a tuberculin test and a T4-lymphocyte count were performed in all patients. Cardiovascular explorations were limited to electrocardiography, radiography of the chest, echocardiography and pericardial needle aspiration. HIV pericarditis accounted for 50 p. 100 of all cases of pericarditis. It was either dry or effusive with little fluid, and its clinical signs at the early stage of AIDS were retrosternal pain and pericardial friction rub. A search for anti-HIV antibodies may be negative at that stage. Diagnostic errors can be avoided if the tuberculin test is negative and if an ELISA test is performed repeatedly at 3 weeks' intervals. Pericarditis should be counted among the minor signs of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1983

[Pericarditis in acute myocardial infarct].

The incidence, diagnostics and significance of pericarditis in acute myocardial infarction (AMI) were studied, depending on some factors - sex and age of the patients and site of infarction in four patients groups and deceased: I-132 deceased with AMI abd cardiac rupture; II 337 deceased with AMI, 46 of them with aneurysms; III-334 deceased and 153 patients with subendocardial infarction and IV - 140 patients with AMI. Pericarditis was diagnosed in 8.1 per cent of the patients with AMI, in 16.6 per cent of the deceased with AMI and aneurysms, in 24,2 per cent of those with cardiac rupture and very rarely in the deceased with subendocardial infarction. It is more frequent in males, with anterior infarction and in the younger subjects. Pericardial friction occurred on 2-3 day, localized behind the sternum and in IV left intercostal space, whereas in posterior infarction - a little below. Pain is an important sign of pericarditis. imposing a very careful search of pericardial friction. ECG signs of acute pericarditis are not very often. The presence of pericarditis suggests a possibility of aneurysm formation, manifestation of cardiac insufficiency, increases the probability of cardiac rupture and mortality rate is greater with pericardial complications, hence it is an unfavourable prognostic sign.

Acute Disease↗
PubMed1980

[Clinical and bacteriological aspects of purulent pericarditis (author's transl)].

The clinical and bacteriological characteristics of eight cases with purulent pericarditis observed over the last five years are studied. The route of the infection and dissemination in the majority of the cases (75 percent) was through pleuropulmonary lesions in the form of pneumonia and/or empyema, attributing the remaining cases to a subhepatic abscess and a pericardial infection after a thoracic surgical operation. In seven patients the diagnosis of the disease was established while they were alive. The more orientative clinical data were the pericardial pain (50 percent), pericardial friction murmur (25 percent), and signs of cardiac tamponade (62.5 percent). The observation of the above mentioned clinical signs together with the presence of cardiomegaly and electrocardiographic alterations suggestive of pericarditis, obliged the practice of a pericardial puncture, which confirmed the diagnosis of a purulent pericarditis by the macro and microscopic characteristics of the fluid. Staphylococcus and pneumoncoccus were isolated in two cases, respectively; other Gram-negative bacillus (E. coli and Pseudomonas aeruginosa) were isolated in the remaining cases. All patients were treated with the appropriate antibiotic according to the isolated germ; surgical drainage was carried out in six cases, and a pericardiectomy in one. Two patients died, one as a consequence of a septic myocardiopathy and the other in which the diagnosis of purulent pericarditis was not clinically suspected. During the follow-up period one case presented a constrictive pericarditis, which was corrected by a pericardiectomy.

Adolescent↗
PubMed1994

[Pericarditis during inflammatory bowel diseases. Extra-intestinal or iatrogenic complication?].

Acute pericarditis is rarely associated with inflammatory bowel disease. In such cases, when usual aetiologies have been excluded, pericarditis can be considered to be either an extraintestinal manifestation of inflammatory bowel disease or due to an adverse drug effect. We report a case of acute pericarditis in a 17-year old patient with ulcerative colitis treated with mesalazine for 15 days. Mesalazine was discontinued with a prompt and spontaneous resolution of the symptoms. Extensive investigations revealed no known cause for his pericarditis. Eight days and 75 days after the diagnosis, a lymphoblastic transformation test in the presence of mesalazine was performed and was positive for concentration greater than or equal to 10 micrograms/mL; this test was negative in 3 control patients treated with mesalazine without adverse drug effect. This observation together with the rare documented cases allows to consider the possibility that pericarditis may be caused by an adverse drug reaction in these patients.

Adolescent↗
PubMed1976

[Pericarditis and fresh myocardial infarction (author's transl)].

Among 400 patients with myocardial infarction who had been admitted to the intensive care department, pericarditis was observed in 64 cases (16%). It occurred more frequently with anterior wall infarctions. The influence of the pericarditis on the mortality and complications threatening in the acute period were particularly investigated: There was no significant difference with regard to the mortality (20.6% in the group with pericarditis, 26.2% in the control group) or the occurrence of cardiac insufficiency or arrhythmias as complications. Atrial flutter, however, is more frequent (25% against 15%). Anticoagulant therapy was discontinued when pericarditis appeared, with one exception. In spite of the high frequency of atrial flutter, embolic complications were not more frequent after discontinuing the anticoagulant therapy. A postmyocardial infarction syndrome was observed seven times (1.7%), it was frequently found in a pericarditis with angina pectoris (4/7) and with ventricular aneurysm (3/7). Hemopericardium occurred in one patient in whom anticoagulant therapy had not been discontinued.

Acute Disease↗
PubMed1977

A clinicopathological study of post-thoracotomy purulent pericarditis. A continuing problem of diagnosis and therapy.

Cardiac infections after operations are infrequent but, when present, are often fatal. The 14 autopsied patients in whom purulent pericarditis developed after thoracic operations over an 88 year period at The Johns Hopkins Hospital were studied. Purulent pericarditis developed after cardiac operations in 10 and after pulmonary resections in 4. In 12 of the 14 cases the pericardial sac had been opened. Associated postoperative infection, present in 13 patients, included mediastinitis in 7 and empyema in 3. Staphylococcus was the infection organism in half of the patients. Associated cardiac infection, including endocarditis, myocardial abscess, and graft infection, was present in 5 (36 per cent) patients. Death occurred within 2 months of operation in 11 (79 per cent) patients; it was due to infection in 9, cardiac tamponade in 4, and arrhythmias and heart failure in one. The diagnosis of purulent pericarditis was made before death in only 5 (36 per cent) cases, in part owing to masking of the usual signs of pericarditis in the postoperative patient. Since the introduction of antibiotics, the over-all incidence of purulent pericarditis has decreased. However, pericardial infection after thoracotomy has increased tenfold, and patients undergoing cardiac operations in particular provide a new and increasing population at risk for this disease.

Adolescent↗
PubMed1996

[Primary pericardial thymoma: an unusual etiology of neoplastic pericarditis].

We present a case of a primary pericardic thymoma, revealed by a pericardic effusion. This ectopic localisation is very unusual; neoplastic pericarditis are usually due to metastasis of carcinomas or lymphomas. Sometimes, they are secondary to pericardic invasion by mediastinal malignant thymomas or a metastasis of thymomas. Our patient presented a single pericardic localisation of thymoma without any other site. We discuss ectopic localisations of thymic tissue and thymomas and the diagnostic usefulness of the MIC 2 antibody.

Humans↗
PubMed1998

[Pericarditis: 5 year records of general hospital].

Among patients admitted to the therapeutic department of the general hospital for 5 years, diagnosis of pericarditis was made in 110 patients (0.44%). Among the most common causes of secondary pericarditis were: chronic renal failure (31.8%), diffuse lesion of the connective tissue (17.7%), tumor metastases to the pericardium (15.5%). Primary pericarditis was, as a rule, of tuberculous etiology. Morphologically, it was adhesive or adhesive-exudative, constrictive, exudative in 13, 4.5 and 76% of patients, respectively. Half of the patients with exudative pericarditis had 300 to 800 ml of fluid in the pericardial cavity. Typical clinical manifestations were dyspnea and tachycardia. X-ray was diagnostically valuable in pericardial exudate 300 ml and more. ECG voltage fell in exudate more than 400-500 ml. Echocardiography remains an effective tool in diagnosis of pericarditis. The treatment consisted of antibiotics, antiinflammatory therapy, evacuation of the liquid from the pericardial cavity.

Adult↗
PubMed1976

Surgery in acute and chronic pericarditis. Pathophysiology and management.

Forty-two cases of surgically treated pericarditis are presented, with comments on the management and pathophysiology of the acute, recurrent, and chronic stages of the disease. The spectrum of aetiological factors has changed within the last few decades in that tuberculosis is now rare, whereas uraemic pericarditis is referred to surgery with increasing frequency. With the advent of haemodialysis and renal transplantation, these cases should be treated vigorously, since they are amenable to surgical cure. Rapid surgical intervention is advocated in impending tamponade, and in all other acute cases which do not respond promptly to conservative management. In recurrent and chronic pericarditis, surgery is also preferable to long-term medical treatment with steroids and diuretics. Chronic pericarditis should not be allowed to progress to an advanced stage of disease with myocardial involvement and impairment of liver function. Early operation carries little hazard and gives lasting relief in the majority of cases. Microscopical examinations and laboratory analyses point towards an abnormal permeability of capillaries and visceral pericardium as an early and major event in the development of pericardial effusions. Destruction or preservation of the mesothelial cell lining is probably an important factor in determining the progression of acute disease towards adhesions and constriction.

Acute Disease↗