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PubMed2000

Nocardia asteroides pericarditis in association with HIV.

This case report describes Nocardia pericarditis in a newly diagnosed human immunodeficiency virus (HIV) patient as an initial manifestation. Previously, two cases of Nocardia pericarditis were reported in patients with established HIV infection. To our knowledge this is the first case of Nocardia pericarditis as an initial manifestation of HIV infection. This case substantiates and emphasizes the importance of identifying Nocardia as an infectious cause of pericarditis in patients with acquired immunodeficiency. Long-term survival may be achieved with a combined medical and surgical approach.

AIDS-Related Opportunistic Infections↗
PubMed1982

Purulent pericarditis complicating systemic infection with Candida tropicalis.

A patient with a purulent pericarditis due to Candida tropicalis is described. A 77-year-old woman undergoing chemotherapy for Hodgkin's disease was admitted to the hospital with a history of several febrile episodes. She was thought to be septic and was begun on broad-spectrum antibiotics, despite treatment, however, the patient expired. Among the multiple premortem blood, urine, and cerebrospinal fluid cultures, one blood culture yielded C. tropicalis 2 days postmortem. Autopsy revealed purulent pericarditis accompanied by endocarditis and myocarditis due to culture-proven C. tropicalis. This is the first reported case of purulent pericarditis complicating systemic infection with this organism and is indicative of the fulminant course of fungal pericarditis.

Aged↗
PubMedDate not supplied

Purulent pericarditis caused by Candida: report of three cases and identification of high-risk populations as an aid to early diagnosis.

Purulent pericarditis due to fungal organisms is rare and often unrecognized because of the subtle clinical clues and insidious onset. The records of 11 cases of purulent pericarditis were selected from records of 11,000 cases of pericarditis at Duke University Medical Center and reviewed, and experience with three cases of candida purulent pericarditis (CPP) was evaluated. One case occurred in a patient recovering from complicated cardiac surgery, one in a patient with hematologic malignancy, and one in an alcoholic patient requiring intubation for a severe respiratory infection. Each case is representative of a group at increased risk for the development of CPP. Given the poor prognosis for CPP, treatment should include both medical and surgical interventions. Although amphotericin B achieves good penetration into the inflamed pericardial space, the only survivors of CPP have received both amphotericin B and pericardiectomy. Careful attention to clinical indications of pericardial inflammation and systemic infection in the three groups of patients may lead to earlier recognition of CPP, implementation of appropriate therapy, and perhaps a higher rate of cure.

Adult↗
PubMed1995

Purulent pericarditis caused by Candida species: case report and review.

Purulent pericarditis caused by Candida species is a rare and often undiagnosed disease. We recently treated a patient in whom purulent pericarditis due to Candida albicans developed following thoracic surgery. The patient survived after receiving a combination of surgical and medical therapy. A literature review revealed 24 additional cases of purulent pericarditis caused by Candida species. Twenty-one of the patients either had undergone thoracic surgery or had had disseminated candidiasis. None of the 12 patients described before 1980 survived, whereas six (46%) of the 13 patients described after 1980 survived. No patient survived without pericardiectomy (five of six survivors) or at least pericardiocentesis (one survivor). All survivors received full courses of amphotericin B therapy. An increased utilization of echocardiography, along with an increased recognition of the patient populations at risk, has been instrumental in early detection and improved outcome of purulent pericarditis. A combination of prolonged amphotericin B therapy and pericardiectomy appears to be the best approach for achieving a cure.

Aged↗
PubMed1995

Clinical relevance of Doppler pulmonary venous flow characteristics in constrictive pericarditis.

The purpose of this study was to determine the diagnostic value of Doppler pulmonary venous flow in constrictive pericarditis, as assessed by transoesophageal echocardiography. It has been demonstrated previously that increased respiratory variation in Doppler pulmonary venous, but not in transmitral flow velocities, can identify patients with constrictive pericarditis, when transoesophageal echocardiography is used. In the present study we compared a group of 10 patients with constrictive pericarditis and a control group of 15 normal subjects with respect to pulmonary venous and transmitral flow velocities and their respiratory variation. Peak velocities and velocity time integrals of the systolic, early diastolic and late diastolic reversed pulmonary venous flow waves were measured. Peak velocities and velocity time integrals of the early and late diastolic transmitral flow waves were also measured. Measurements were made irrespective of the respiratory cycle, at the onset of inspiration and at the onset of expiration. Values for inspiration and expiration were expressed as percent difference of those obtained irrespective of the respiratory cycle. Peak velocity and velocity time integral of the pulmonary venous systolic and diastolic waves were significantly lower than in normal subjects. Furthermore, the difference between peak velocities of the diastolic wave obtained at the onset of inspiration and obtained irrespective of the respiratory cycle was significantly larger in constrictive pericarditis than in the control group (-20% vs -9%, P < 0.05). This also applied to the difference between velocity time integrals of the diastolic wave obtained at the onset of inspiration and obtained irrespective of the respiratory cycle (-22% vs -12%, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Diagnosing tuberculous pericarditis.

BACKGROUND: Definitive diagnosis of tuberculous pericarditis requires isolation of the tubercle bacillus from pericardial fluid, but isolating the organism is often difficult. AIM: To improve diagnostic efficiency for tuberculous pericarditis, using available tests. DESIGN: Prospective observational study. METHODS: Consecutive patients (n = 233) presenting with pericardial effusions underwent a predetermined diagnostic work-up. This included (i) clinical examination; (ii) pericardial fluid tests: biochemistry, microbiology, cytology, differential white blood cell (WBC) count, gamma interferon (IFN-gamma), adenosine deaminase (ADA) levels, polymerase chain reaction testing for Mycobacterium tuberculosis; (iii) HIV; (iv) sputum smear and culture; (v) blood biochemistry; and (vi) differential WBC count. A model was developed using 'classification and regression tree' analysis. The cut-off for the total diagnostic index (DI) was optimized using receiver operating characteristic (ROC) curves. RESULTS: Fever, night sweats, weight loss, serum globulin (>40 g/l) and peripheral blood leukocyte count (<10 x 10(9)/l) were independently predictive. The derived prediction model had 86% sensitivity and 84% specificity when applied to the study population. Pericardial fluid IFN-gamma >or=50 pg/ml, concentration had 92% sensitivity, 100% specificity and a positive predictive value (PPV) of 100% for the diagnosis of tuberculous pericarditis; pericardial fluid ADA >or=40 U/l had 87% sensitivity and 89% specificity. A diagnostic model including pericardial ADA, lymphocyte/neutrophil ratio, peripheral leukocyte count and HIV status had 96% sensitivity and 97% specificity; substituting pericardial IFN-gamma for ADA yielded 98% sensitivity and 100% specificity. DISCUSSION: Basic clinical and laboratory features can aid the diagnosis of tuberculous pericarditis. If available, pericardial IFN-gamma is the most useful diagnostic test. Otherwise we propose a prediction model that incorporates pericardial ADA and differential WBC counts.

Female↗
PubMed1982

Purulent pericarditis complicating coronary artery bypass.

We have described the first survivor with Proteus purulent pericarditis after coronary artery bypass. Purulent pericarditis, which must be differentiated from postpericardiotomy syndrome, should be suspected in a patient with fever and pericardial effusion after bypass surgery. Pericardiocentesis established the diagnosis of purulent pericarditis. Today, with prophylactic antibiotics being used routinely, purulent pericarditis in the postoperative period may be caused by an aerobic gram-negative bacillus. Treatment consists of surgical drainage and appropriate antibiotics.

Anti-Bacterial Agents↗
PubMed2006

Recommendations for participation in competitive sport and leisure-time physical activity in individuals with cardiomyopathies, myocarditis and pericarditis.

Several relatively uncommon, but important cardiovascular diseases are associated with increased risk for acute cardiac events during exercise (including sudden death), such as hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and myo-pericarditis. Practising cardiologists are frequently asked to advise on exercise programmes and sport participation in young individuals with these cardiovascular diseases. Indeed, many asymptomatic (or mildly symptomatic) patients with cardiomyopathies aspire to a physically active lifestyle to take advantage of the many documented benefits of exercise. While recommendations dictating the participation in competitive sport for athletes with cardiomyopathies and myo-pericarditis have recently been published as a consensus document of the European Society of Cardiology, no European guidelines have addressed the possible participation of patients with cardiomyopathies in recreational and amateur sport activities. The present document is intended to offer a comprehensive overview to practising cardiologists and sport physicians of the recommendations governing safe participation in different types of competitive sport, as well as the participation in a variety of recreational physical activities and amateur sports in individuals with cardiomyopathies and myo-pericarditis. These recommendations, based largely on the experience and insights of the expert panel appointed by the European Society of Cardiology, include the most up-to-date information concerning regular exercise and sports activity in patients with cardiomyopathies and myo-pericarditis.

Cardiomyopathies↗
PubMed2006

Idiopathic pericarditis in dogs: no evidence for an immune-mediated aetiology.

OBJECTIVE: To ascertain whether specific immunological changes are associated with canine pericardial effusion due to idiopathic pericarditis. METHODS: In this prospective study, serum antinuclear antibody and serum and pericardial fluid immunoglobulin (Ig) G, Ig M and Ig A concentrations were measured in dogs with pericardial effusion due to idiopathic pericarditis or pericardial neoplasia. The secretory index relative to albumin concentration was calculated in order to distinguish between Ig actively secreted into the pericardial fluid and that derived from the blood accumulating within the pericardial sac. Statistical analysis was performed comparing the results obtained between the two groups of dogs. RESULTS: Only three dogs were antinuclear antibody positive; two of these dogs had idiopathic pericarditis and one had neoplasia. Mean serum Ig M and Ig A concentrations were lower than the reference values in both groups, and the secretory indices for Ig M and Ig A were greater than 1.0. However, there was no significant difference with respect to any Ig measurement between the two groups of dogs (P>0.1). CLINICAL SIGNIFICANCE: The results of the present study do not support the hypothesis that canine idiopathic pericarditis has a significant 'immune-mediated' aetiology or immunological features that distinguish it from the pericardial changes associated with local neoplastic disease.

Animals↗
PubMed1975

Management of uraemic pericarditis.

Of 250 patients undergoing haemodialysis from 1967 to 1974 17 presented with uraemic pericarditis. Seven of these patients who had been transferred early enough to peritoneal dialysis treatment were cured without pericardiectomy (mean survival 18 months (range 6-36); no deaths). Only one patient was cured from his pericarditis by "aggressive haemodialysis." In seven out of 10 patients treated with haemodialysis, pericardiectomy finally had to be performed because of pericardial tamponade (postoperative survival 20 months (range 8-36); one death). Two patients died from pericardial tamponade before surgery. In patients with evidence of uraemic pericarditis frequent peritoneal dialysis with high fluid withdrawal is the treatment of choice, but in cardiac tamponade pericardiectomy should follow a preoperative pericardiocentesis with limited fluid aspiration. Of possible significance in the aetiology of pericarditis were the findings that 10 of the 17 patients had hypertension with cardiac enlargement and that 14 presented with evidence of underdialysis, possibly due to the reuse of dialysis components.

Cardiac Tamponade↗
PubMed2000

Double blind randomised placebo controlled trial of adjunctive prednisolone in the treatment of effusive tuberculous pericarditis in HIV seropositive patients.

OBJECTIVE: To determine the effect of adjunctive prednisolone on morbidity, pericardial fluid resolution, and mortality in HIV seropositive patients with effusive tuberculous pericarditis. DESIGN: Double blind randomised placebo controlled trial. SETTING: Two medical school affiliated referral hospitals in Harare, Zimbabwe. PATIENTS: 58 HIV seropositive patients aged 18-55 years with tuberculous pericarditis. INTERVENTIONS: All patients received standard short course antituberculous chemotherapy and were randomly assigned to receive prednisolone or placebo for six weeks. MAIN OUTCOME MEASURES: Clinical improvement, echocardiographic and radiologic pericardial fluid resolution, and death. RESULTS: 29 patients were assigned to prednisolone and 29 to placebo. After 18 months of follow up there were five deaths in the prednisolone treated group and 10 deaths in the placebo group. Mortality was significantly lower in the prednisolone group (log rank chi(2) = 8. 19, df = 1, p = 0.004). Resolution of raised jugular venous pressure (p = 0.017), hepatomegaly (p = 0.007), and ascites (p = 0.015), and improvement in physical activity (p = 0.02), were significantly more rapid in the prednisolone treated patients. However, there was no difference in the rate of radiologic and echocardiographic resolution of pericardial effusion. CONCLUSIONS: Adjunctive prednisolone for effusive tuberculous pericarditis produced a pronounced reduction in mortality. It is suggested prednisolone should be added to standard short course chemotherapy to treat HIV related effusive tuberculous pericarditis.

AIDS-Related Opportunistic Infections↗
PubMed1977

Pericarditis in diabetic ketoacidosis.

A 25-year-old insulin-dependent diabetic man who was admitted to hospital with severe diabetic ketoacidosis and dehydration showed sequential electrocardiographic abnormalities of acute pericarditis. Though the patient had retrosternal chest pain, no pericardial friction rub was heard. None of the usual causes of pericarditis was found and the electrocardiographic abnormality may have been attributable to subepicardial injury caused by dehydration associated with the ketoacidosis. The abnormalities on the electrocardiogram were transient, returning to normal after 5 days. Whatever the exact underlying nature of the pericarditis, it is important to recognise that such transient changes may occur as, in the absence of other obvious causes of pericarditis, the condition is benign.

Adult↗
PubMed1984

Constrictive pericarditis as a complication of coronary artery bypass surgery.

Although it is now recognised as a rare complication of cardiac surgery, constrictive pericarditis was diagnosed in three patients after coronary artery bypass surgery. The time interval between cardiac surgery and the development of constrictive features varied from two to six weeks. All three patients presented with severe congestive heart failure. Haemodynamic findings were characteristic of constrictive pericarditis. Pericardial thickening detected by computed tomography in one patient was useful in establishing a definite diagnosis. One of the patients had a serous constrictive effusive pericarditis, and surgical pericardial drainage was needed. The other patient underwent pericardiectomy with preservation of the grafts. The diagnosis of constrictive pericarditis should be considered in patients presenting with unexplained right sided heart failure after cardiac surgery.

Aged↗
PubMed1996

Collagen network remodelling and left ventricular function in constrictive pericarditis.

OBJECTIVE: To investigate whether patients with constrictive pericarditis have changes in collagen content and architecture that could influence left ventricular function. DESIGN: Cohort study. SETTING: University teaching hospital. PATIENTS: Biopsy specimens of myocardium from 13 patients admitted consecutively for treatment of chronic constrictive pericarditis were compared with normal heart tissue taken at necropsy from 15 patients free of cardiac disease. INTERVENTION: Pericardiectomy through median sternotomy. Biopsy specimens (4 or 5) were taken from the left ventricular free wall. MAIN OUTCOME MEASURES: Biochemical and histological assessment of total collagen content, relative proportion of type I and III collagen, and amount of orthogonal collagen fibre meshwork (crosshatching) in the left ventricular tissue. RESULTS: There was more collagen in the myocardium of patients with constrictive pericarditis than in controls when measured either biochemically by hydroxyproline content (89.4 v 50.4 mg/g dry weight) or by histological measurement of the collagen fraction of the myocardium (2.4% v 7.0%). Neither of these measurements, however, correlated with left ventricular ejection fraction, pulmonary wedge pressure, or right ventricular end diastolic pressure. The thickness of the fibrous trabeculae in the myocardium was, however, inversely related to both left ventricular ejection fraction (r = -0.76) and deceleration time (r = -0.68). Trabecular thickening was also related to NYHA class, with those in class III and IV having the greatest thickening. CONCLUSION: Changes in collagen content and architecture may contribute to impaired ventricular function in patients with chronic constrictive pericarditis.

Adult↗
PubMed1978

99mTc-pyrophosphate imaging in acute pericarditis: a clinical and experimental study.

Fifteen patients with clinical and electrocardiographic features of acute pericarditis underwent myocardial scintigraphy using 99mTc-pyrophosphate. All had normal images. In 5 additional patients with acute pericarditis and evidence of ischemic heart disease, 99mTc-pyrophosphate images showed focal abnormalities in 2 patients and equivocal findings in 2. Serial myocardial radionuclide images were obtained 2 to 18 days after induction of pericarditis in 8 dogs; all images were normal. No stainable tissue calcium was demonstrated histochemically in the pericardium or myocardium of these dogs. Our results suggest that 99mTc-PYP myocardial radionuclide images are normal in acute pericarditis in the absence of ischemic heart disease.

Acute Disease↗
PubMed2006

Comorbidity of constrictive pericarditis and hemophilia A.

OBJECTIVE: To report a case of comorbidity of constrictive pericarditis and hemophilia A. CLINICAL PRESENTATION AND INTERVENTION: A 21-year-old male with hemophilia A was referred to our clinic and was examined with the subsequent evaluation of shortness of breath, leg edema and ascites. Clinical and laboratory examinations were performed. The results were consistent with constrictive pericarditis (CP), and the symptoms were completely relieved following institution of medical therapy. CONCLUSION: Because hemophilia A and pericarditis may be coincidentally present clinical conditions, avoidance of surgical procedures in hemophilic patients is preferable unless the resolution of the symptoms of pericarditis cannot be effected by medical therapy.

Adult↗
PubMedDate not supplied

Humoral immune reactions in uremic pericarditis.

Clinical data from 41 patients with pericarditis or pericardial effusion in acute and chronic renal failure were analyzed in respect to the diagnostic relevance of humoral immune reactions. In patients with pericardial effusion in acute renal failure due to surgery or trauma (n = 10), antimyocardial antibodies were rarely detected. In contrast, in the sera of all patients with pericarditis or pericardial effusion following renal failure in chronic or acute glomerulonephritis (n = 6), complement-fixing antisarcolemmal antibodies of the IgM and IgG classes were observed. In patients in whom pericarditis or pericardial effusion evolved during chronic hemodialysis (n = 25), the incidence of complement-fixing antimyolemmal antibodies was 64%. Only sera with complement-fixing antimyolemmal antibodies induced cytolysis of vital adult cardiocytes in vitro suggesting that the antimyolemmal antibodies may not only play a diagnostic but also a pathogenetic role in 'uremic' pericarditis in vivo.

Acute Kidney Injury↗
PubMed1991

Pathogenesis of edema in constrictive pericarditis. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones before and after pericardiectomy.

BACKGROUND: The pathogenesis of sodium and water accumulation in chronic constrictive pericarditis is not well understood and may differ from that in patients with chronic congestive heart failure due to myocardial disease. This study was undertaken to investigate some of the mechanisms. METHODS AND RESULTS: Using standard techniques, the hemodynamics, water and electrolyte spaces, renal function, and plasma concentrations of hormones were measured in 16 patients with untreated constrictive pericarditis and were measured again in eight patients after pericardiectomy. The average hemodynamic measurements were as follows: cardiac output, 1.98 l/min/m2; right atrial pressure, 22.9 mm Hg; pulmonary wedge pressure, 24.2 mm Hg; and mean pulmonary artery pressure 30.2 mm Hg. The systemic and pulmonary vascular resistances (36.3 +/- 2.5 and 3.2 +/- 0.3 mm Hg.min.m2/l, respectively) were increased. Significant increases occurred in total body water (36%), extracellular volume (81%), plasma volume (53%), and exchangeable sodium (63%). The renal plasma flow was only moderately decreased (49%), and the glomerular filtration rate was normal. Significant increases also occurred in plasma concentrations of norepinephrine (3.6 times normal), renin activity (7.2 time normal), aldosterone (3.4 times normal), cortisol (1.4 times normal), growth hormone (21.8 times normal), and atrial natriuretic peptide (5 times normal). The ratio of left atrial to aortic diameter measured by echocardiography was only minimally increased (1.29 +/- 0.04), indicating that in constrictive pericarditis the atria are prevented from expanding. The studies repeated after pericardiectomy in the eight patients showed that all measurements returned toward normal. CONCLUSIONS: The restricted distensibility of the atria, in constrictive pericarditis, limits the secretion of atrial natriuretic factor and, thus, reduces its natriuretic and diuretic effects. This results in retention of water and sodium greater than that occurring in patients with edema from myocardial disease. The arterial pressure is maintained more by the expansion of the blood volume than by an increase in the peripheral vascular resistance.

Adult↗