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PubMed1992

[Colchicine treatment of recurrent steroid-dependent pericarditis in a patient with post-myocardial-infarction syndrome (Dressler's syndrome)].

The usual treatment of pericarditis consists of non-steroid anti-inflammatory agents. In cases where the symptoms and/or the pericardial effusion persist or progress, the disease can be arrested in the majority of cases by employing steroids. In some patients, it may prove difficult to conclude steroid treatment as gradual withdrawal results in recurrence and it may, therefore, be necessary to continue with large doses of steroid for prolonged periods. There is, however, a possibility for another form of treatment. The present authors present the case history of a patient with pericarditis on the basis of the post-myocardial-infarction syndrome and in whom the symptoms recurred several times during attempts at gradual withdrawal of prednisolone. Treatment with colchicine was commenced. The patient rapidly became symptom free and has now been symptom free for 45 weeks without prednisolone. Colchicine was withdrawn after 33 weeks without recurrence. It is considered that trial of colchicine treatment can be recommended in cases of recurring pericarditis particularly when there are problems (recurrence) on attempted withdrawal of steroid treatment. Naturally, it is important to exclude specific causes requiring other forms of treatment as the cause of the pericarditis (e.g. malignant disease, tuberculosis, systemic disease etc.).

Colchicine↗
PubMed2005

[Diagnosis difficulty in occult constrictive pericarditis].

We report the case of a 42 years woman known to have a cardiac heart failure attributed to restrictive cardiomyopathy for want of any other plausible diagnosis. Evolution and repeted investigations finally permitted to rectify the diagnosis by revealing a constrictive pericarditis, remained occult 9 years during. The differentiation of restrictive cardiomyopathy and constrictive pericarditis has been a perennial problem in clinical cardiology. Diagnosis of constrictive pericarditis is based on associated signs sometimes too poor to go straight to thoracotomy. We discuss the mean to approach more precisely this uncommon pattern named occult constrictive pericarditis.

Adult↗
PubMed2006

[A case of systemic sclerosis and Sjogren's syndrome with cardiac tamponade due to steroid-responsive pericarditis].

A 75-year-old woman was admitted to our hospital because of abnormal lung shadow and necrosis of the left feet. She had a history of Raynaud's phenomenon from her twenties. On admission, she was diagnosed as having diffuse systemic sclerosis (SSc) and Sjögren's syndrome (SjS) because of scleroderma, interstitial pneumonia (IP), positive result of anti-Scl-70 and SS-A antibody, sicca, decreased tear excretion, and dysfunction of salivary glands. Seventy days after amputation of her left leg, she presented with edema, hypoxemia, chest discomfort, and fever. Blood test revealed inflammation and cardiac echography revealed pericardial effusion with a collapse sign of right atrium, thereby leading to the diagnosis of cardiac tamponade. After starting the daily dose of 20 mg of prednisolone, the pericardial effusion and cardiac tamponade sign disappeared. Pericarditis is seen in half of patients with SSc and rarely with SjS, and is usually asymptomatic. Pericarditis due to SSc has been reported unresponsive to steroid therapy, but several cases of steroid responsive pericarditis due to SSc or SjS have been reported. Clinically, they shared inflammatory responses and the presence of IP in the cases of SSc, which will be important when considering the pathogenesis and treatment of pericarditis due to SSc or SjS.

Aged↗
PubMed2006

[Long term evolution of chronic constrictive pericarditis. A study of 56 patients].

OBJECTIVE AND METHOD: We retrospectively analysed 56 consecutive patients with a confirmed diagnosis of chronic constrictive pericarditis over a period of 23 years. The objective was to analyse the evolution of the annual frequency of constrictive pericarditis, its aetiology and to define the prognostic factors for mortality. RESULTS: The annual frequency of constrictive pericarditis has not diminished over the 23 years of this study, remaining at 2.4 cases per year. Cases with a tuberculous origin have diminished progressively, being replaced by complications of cardiac surgery and mediastinal radiotherapy. Pericardectomy was performed in 41 patients and the average follow up was 9.5 +/- 8.6 years. By the end of the study, 34 patients had died (61.8%), 18 from a cardiovascular cause (38.3%). The independent predictive factors for overall mortality were a history of mediastinal radiotherapy, the age, and plasma sodium level. Only the presence of first degree atrio-ventricular block was an independent predictive factor for cardiovascular mortality. In the pericardectomy group, 24 patients died (60%). A history of mediastinal radiotherapy and the presence of pre-operative hyponatraemia were independent predictive factors for overall mortality. CONCLUSION: Constrictive pericarditis remains a serious pathology. Pericardectomy allows a clear functional improvement, but following pericardectomy more than 60% of patients will die within 10 years of the diagnosis being made.

Adolescent↗
PubMed1975

[Recurrent acute pericarditis and corticoid dependence. Apropos of 10 cases].

The authors report ten cases of acute recurrent pericarditis observed over a period of 5 years and emphasize the frequency of these relapses involving 15 to 20% of cases of acute pericarditis. Usually, no cause is found and, althrough an immunological mechanism has been suggested, there is no common test which may confirm or disprove this theory. The risk of ultimate constrictive pericarditis is minimal and this risk is thus not taken into consideration in deciding on treatment. On the other hand, the undesirable effects of corticosteroids which favour relapses, seem to be demonstrated. The use of corticosteroids in cases of acute pericarditis should thus be exceptional and one should prefer non-steroid anti-inflammatory drugs. Immunosuppressors and pericardectomy should be reserved for the rare forms where the disease progresses and relapses continue after cortisone has been stopped.

Acute Disease↗
PubMed1991

Tuberculous pericarditis and the cardiac conduction system.

Nine cases of acute and 8 cases of chronic tuberculous pericarditis were studied for involvement of epicardial structures such as the S-A node, A-V node and large coronary arteries. Extensive caseation was seen in the region of the S-A node in 2 cases of chronic and one case of acute pericarditis. No nodal tissue was identifiable in these cases. In one more case of chronic pericarditis, granuloma with fibrosis was seen in the S-A node. Minor mononuclear infiltration of the S-A node was seen in 2 cases. In the rest of the cases, the S-A node was normal though inflammation was very close to it in 4 cases of acute and all the cases of chronic pericarditis. The A-V node, bundle of His and coronary arteries were normal in these cases.

Electrocardiography↗
PubMed1991

Tuberculous pericarditis.

Tuberculosis is responsible for approximately 4% of cases of acute pericarditis, 7% of cases of cardiac tamponade, and, in older studies, 6% of instances of constrictive pericarditis. However, in some nonindustrialized countries, tuberculosis is a leading cause of pericarditis. The diagnosis is based on demonstration of tubercle bacilli in pericardial fluid or on histologic section of the pericardium, or proof of tuberculosis elsewhere in a patient with otherwise unexplained pericarditis. Treatment consists of triple drug therapy for at least 9 months (isoniazid, rifampin, and streptomycin or ethambutol). Pyrazinamide can be used for the first 2 months, and the total therapeutic period can then be shortened to 6 months after culture conversion. Three months of corticosteroid therapy may be useful in patients in whom pericardial effusion persists or recurs despite the use of antituberculous drugs. Surgical resection of the pericardium is indicated for recurrent or life-threatening tamponade, or when there is persistent elevation of systemic venous pressure unrelieved by pericardiocentesis. As many as one third to one half of patients will eventually require pericardiectomy despite adequate drug therapy.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Pericarditis at the Internal Disease Clinic of the Institute of Tuberculosis and Lung Diseases (1981-1987)].

Causes, symptoms, clinical forms, and methods of diagnosis of pericarditis were analysed in a group of 30 patients. Chest pain, dyspnea, and tachycardia were prevailing clinical symptoms of the disease. Particularly useful diagnostic technique is ultrasound, being a method of choice in the diagnosis of the most frequent exudative pericarditis. The most frequent cause of cardiac tamponade was malignant pericarditis. Diagnostic problems with particular reference to tuberculous etiology of pericarditis have also been discussed.

Adult↗
PubMed1990

[An operative case of chronic constrictive pericarditis with silicosis and lumbar caries].

We reported a case of chronic constrictive pericarditis complicated with silicosis and lumbar caries, who was improved by the operation. The patient was a 65 year old man whose past occupation was a mason. He was admitted to our hospital with chronic heart failure on March, 1986. Atypical silicosis was diagnosed from the occupational history and the histopathological silicotic changes in mediastinal lymph nodes and fibrosis of alveolar wall. The diagnosis of chronic constrictive pericarditis was made from chest roentgenogram and intracardiac catheterization. The symptoms of chronic constrictive pericarditis was improved by the pericardial resection. The exact pathogenesis of the chronic constrictive pericarditis could not be identified from the histology of pericardial tissue, but tuberculosis was suspected because of the past history of tuberculous pleurisy and the recurrence of lumbar caries.

Aged↗
PubMed1989

[Arthritis and purulent pericarditis as presenting form of sepsis caused by serogroup C meningococcus].

Meningococcal sepsis is usually a severe disease with very varied clinical manifestations. In our surrounding the most frequently appearing Neisseria meningitidis belongs to serogroup B, and only 10.2% belongs to group C. Both arthritis and exudative pericarditis are described as late, independent complications of N. Meningitidis C infections. The coexistence of both arthritis and suppurative pericarditis caused by this organism is extremely rare. A case of sepsis due to serogroup C N. Meningitidis in a patient who developed a right shoulder arthritis followed by septic shock and purulent pericarditis is presented. The characteristics of arthritis and pericarditis as complications of the acute meningococcal infection are analyzed, emphasizing the rareness of the coappearance of both as a form of clinical manifestation, as well as the purulent characteristic in order to keep them in mind and facilitate a prompt diagnosis and appropriate treatment.

Acute Disease↗
PubMed1989

[Significance of disturbances of cardiac filling in constrictive pericarditis].

Using pulsed Doppler echocardiography, blood filling patterns of the right atrium and left and right ventricles in constrictive pericarditis were studied to evaluate the physiological role of the pericardium in the hemodynamics of this disease. Thirteen cases were examined including five cases with atrial fibrillation. The control subjects consisted of 16 healthy persons and six cases of lone atrial fibrillation. 1. Peak velocity of the atrial filling wave during ventricular systole was reduced, and the filling time was shortened, suggesting reduced compliance and restricted motion of the atrial wall, because of the thickening and adhesions of the pericardium. Duration of the atrial filling wave during ventricular diastole was also shortened, reflecting disturbance of the early diastolic filling of the right ventricle. 2. In healthy subjects, duration of the rapid filling wave was longer in the right ventricle than in the left ventricle, probably due to the greater compliance of the right ventricular wall as compared to that of the left ventricular wall. In constrictive pericarditis, the rapid filling time of the right ventricle is shortened, so that the difference in this time between the right and left ventricles is minimized, which may be related to a thinner right ventricular wall. Duration of the rapid filling wave of the right ventricle correlated with right ventricular end-diastolic pressure, indicating that the duration of the right ventricular rapid filling wave is proportional to the severity of constrictive pericarditis. In conclusion, constriction of the pericardium definitely influences the hemodynamics of the right side of the heart more than it does the left side in constrictive pericarditis. This difference appears to result from the difference in thickness of the myocardial layers of both ventricles.

Adult↗
PubMed1989

Constrictive pericarditis presenting as pleural effusion of unknown origin.

Despite the known association of pleural effusion with constrictive pericarditis, the presentation of constrictive pericarditis as pleural effusion of unknown origin has, to our knowledge, never been described. After evaluating such a case, we retrospectively analyzed all cases of established constrictive pericarditis seen in this institution in the last six years. The clinical and laboratory features of this cohort of 30 patients are similar to those of other reported series. Pleural effusion was present in 18 (60%) of 30 cases. In six (12%) of the 18 cases, pleural effusion was a major component of the clinical presentation, and in three (10%) of these six cases, the persistence of pleural effusion of unknown origin was the indication for referral to this institution. Analysis of pleural fluid in four cases revealed three exudates and one transudate. We believe this is the first report of unexplained pleural effusion as the presenting manifestation of constrictive pericarditis, and this diagnosis should be added to the list of causes of unexplained pleural effusion.

Adolescent↗
PubMedDate not supplied

[Acute nonspecific pericarditis].

In order to learn the natural history of nonspecific acute pericarditis in our environment, we studied retrospectively 50 patients seen at The Instituto Nacional de Cardiología Ignacio Chávez, between 1972-1985. The clinical history, electrocardiogram, chest x ray, laboratory findings, as well as the outpatient follow-up were analyzed. There was a history of a respiratory or gastrointestinal infection, probably viral in origin, in almost half of the cases (46%). Chest pain was present in 96% of the patients and was the most common symptom. In only half of the patients a pericardial friction rub was heard. A typical S-T elevation was found in 90% of the electrocardiograms. Arrhythmias and conduction disorders were unusual. The echocardiogram showed a pericardial effusion in seven patients and six had a pleural effusion. Only one patient developed signs of cardiac tamponade. None of the patients in this study developed a chronic constrictive pericarditis and there were no deaths. Before or after hospitalization, 14 patients (28%) had multiple episodes of chest pain suggestive of recurrent pericarditis. This study shows that nonspecific acute pericarditis seems to be a self-limited illness with a good prognosis, few recurrences and practically no complications.

Acute Disease↗
PubMed1988

Assessment of the left ventricular diastolic function in constrictive pericarditis by digitised M-mode echocardiography.

Digitised M-mode echocardiography was used to study the diastolic left ventricular function in ten patients with constrictive pericarditis. Each patient was matched for heart rate and stroke volume with a control patient who had normal left ventricular end-diastolic pressure and coronary arteries. All 20 patients underwent right and left cardiac catheterisation. In patients with constrictive pericarditis compared with controls, the median (range) left ventricular peak diameter lengthening rate, normalised for end-diastolic dimension, was 4.5 (2.5-8.0) s-1 and 2.9 (1.6-4.1) (p less than 0.01), and the rapid filling period fraction of diastole was 0.28 (0.18-0.37) and 0.37 (0.21-0.58) (p less than 0.05), while the mitral valve E-F slope was 20.1 (10.5-39.2) cm/s and 11.8 (7.6-14.5) (p less than 0.05), respectively. Thus, the early rate of left ventricular diameter lengthening is increased in constrictive pericarditis independent of heart rate and stroke volume, while the actual duration of the rapid filling period is decreased. These results, obtained noninvasively, extend the findings of previous invasive studies. The method may help in the difficult clinical diagnosis of constrictive pericarditis, although there is some overlap with the normal control range.

Adult↗
PubMed1974

Lupus pericarditis.

This report documents a case of systemic lupus erythematosus in which the major presenting feature was pericarditis and in which the diagnosis was made after pericardiocentesis by the demonstration of typical LE cells in pericardial fluid stained with Wright's stain. Review of the literature indicates that pericarditis in lupus is more common than is generally suspected, and when it is the initial manifestation it is often misdiagnosed as "benign viral pericarditis".Screening for collagen disease should be a part of the work-up of any patient presenting with pericarditis, especially a woman. Occasionally lupus may be present even when the serologic tests have given negative results. Under such circumstances, or when the patient manifests an atypical or prolonged course, a diagnostic pericardiocentesis is in order, provided an effusion can be confirmed on scan. A search for LE cells should be included in the analysis of the aspirated fluid.

Female↗
PubMed1979

Fibrinous pericarditis and fibrinolysis in chronic dialysis patients.

During a four year period 6 patients from the total of 120 on home dialysis developed pericarditis with effusions. Plasma fibrinolytic activity, measured by euglobulin clot lysis time, was significantly reduced in these patients compared with either normal controls or dialysis patients without pericarditis. These dialysis patients without pericarditis as a group tended to have reduced plasma fibrinolytic activity compared with controls, but the difference was not significant. It is suggested that a reduction in the body's fibrinolytic activity may be a factor in the development of fibrinous pericarditis in chronic renal failure.

Adult↗
PubMed1983

[Pericarditis with recurrent cardiac compression in rheumatoid polyarthritis].

The authors report the case of seventy-two-year-old man with severe rheumatoid arthritis in whom onset of right ventricular failure led to the discovery of pericarditis. After fluid withdrawal, the anterior part of the pericardium was resected. Analysis of the fluid and histological findings suggested a rheumatoid origin. Pericarditis recurred two and a half years later causing subacute compression of the heart leading to repeated centeses in spite of corticosteroid therapy. In the terminal stage, M. tuberculosis was discovered but this finding was not confirmed subsequently. The main features of rheumatoid pericarditis are reviewed. Tuberculous pericarditis should be considered in patients under corticosteroids or immunosuppressive agents.

Aged↗
PubMed1983

[Evaluation of constrictive pericarditis by computed tomography].

Since extensive studies of constrictive pericarditis by CT have not been reported, we performed a plain and contrast enhanced CT on 4 patients of constrictive pericarditis diagnosed by cardiac catheterization or echocardiography and confirmed at the time of surgical operation. The CT findings were as follows: The normal pericardium was smooth, could be visualized in the right and anterior regions of the heart, and was approximately or less 2 mm in thickness. On the other hand, the pericardium in constrictive pericarditis was irregularly thickened, was visualized even in the left and posterior regions of the heart, and was more than 2 mm in thickness. The mean CT value of the pericardium in constrictive pericarditis was significantly increased as compared with that of the normal pericardium. The contrast enhanced CT image revealed a marked dilatation of superior and inferior caval veins (SVC and IVC) even in the cases with normal size of each cardiac chamber. The ECG gated CT performed on one case demonstrated the impaired ventricular expansion. After pericardiectomy, the ventricular chambers showed a tendency to dilate, and the dimension of the SVC and IVC were reduced. Thus, CT is thought to be a useful noninvasive technique in evaluating the thickness of the pericardium, its pathology and the degree of dilatation in each cardiac chamber or the vena cavae.

Adult↗