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Pericarditis in rheumatoid arthritis. A clinical and radiological study.

The annual incidence of clinically manifest pericarditis was found to be 0.34% in 157 females and 0.44% in 77 males with rheumatoid arthritis, observed for a mean time of 5.7 years. The development of pericarditis was independent of disease duration, but was related to extensive joint involvement, subcutaneous nodules, and a high Waaler Rose titre. Concomitant pleural effusion was present in four of five patients. Pericarditis in rheumatoid arthritis may indicate a serious prognosis quo ad vitam. Four of the five patients died within eight years, but their age at death was relatively high (62-73 years).

Adult↗

Pericarditis associated with ulcerative colitis and Crohn's disease.

Extracolonic manifestations of inflammatory bowel disease are common and diverse. However, cardiac complications are unusual and we therefore wish to report two cases in which pericarditis occurred. The first was a patient with Crohn's disease of the colon, in whom the pericarditis developed postoperatively. In the second case an acute pericarditis came on simultaneously with the initial presentation of ulcerative colitis.

Adult↗

Adult celiac disease and recurrent pericarditis.

Three patients presented with acute pericarditis. No cause was found and, in each case, the pericarditis was recurrent. Investigation revealed evidence of malabsorption due to adult celiac disease. Two of the patients responded to a gluten-free diet and cortiscosteroid therapy. The third patient responded to a gluten-free diet alone and remains well. Celiac disease is a multisystem disorder in which extraintestinal involvement is common. Recurrent pericarditis may be such a manifestation.

Acute Disease↗

Treatment of uremic pericarditis and pericardial effusion by augmented hemodialysis.

Six out of 21 patients attending maintenance hemodialysis had uremic pericarditis. Three patients had one or more recurrences of pericarditis while under regular intermittent dialysis. Two patients developed pericardial effusion and one of them had ascites. Augmented hemodialysis was successful in treating uremic pericarditis even in patients with pericardial effusion. The single instance of ascites was also controlled by augmented hemodialysis.

Adult↗

Constrictive pericarditis simulating intestinal lymphangiectasia in a patient with the Noonan syndrome.

A case of constrictive pericarditis with marantic endocarditis in a patient with the Noonan syndrome is reported. Congenital heart defects are often diagnosed in the Noonan syndrome and are undoubtedly the most problematic of its pathologies. Our patient had surgery for pulmonic stenosis at age 10 and 16 years. Over a period of 1-2 years prior to death at age 23 years, he developed elevated jugular venous pressure, hypoproteinaemia, pedal oedema and pleural effusions. The hypoproteinaemia and resulting signs were initially attributed to intestinal lymphangiectasia. The latter, unlike constrictive pericarditis, has been reported in the Noonan syndrome. Post-mortem examination revealed constrictive pericarditis with a marantic endocarditis. There was no evidence of intestinal lymphangiectasia.

Adult↗

[One-stage surgery for Stanford type-A aortic dissection, annulo-aortic ectasia, and chronic constrictive pericarditis--a case report].

A case is reported of a rare combination of chronic constrictive pericarditis and aortic dissection. A 23-year-old male was diagnosed with constrictive pericarditis and annulo-aortic ectasia concomitant with type-A dissection. A pericardiectomy was performed under cardiopulmonary bypass, and an aortic segment, from the root to the arch, was totally replaced by a composite graft using selective cerebral perfusion. Both procedures were performed in one stage. An aged clot was found in the pericardial cavity. Sustained rupture of the aortic dissection into the pericardial cavity is considered to be a possible explanation for the development of constrictive pericarditis. The postoperative course was uneventful and the patient was discharged 34 days after the operation.

Adult↗

[A case of constrictive pericarditis with atrial fibrillation after mitral valve repair and Maze III procedure].

We report a case of constrictive pericarditis with atrial fibrillation after mitral valve repair and the Maze III procedure. A 66-year-old male underwent mitral valve repair and the Maze procedure for mitral valve regurgitation and chronic atrial fibrillation. About 4 months after discharge, he suffered from shortness of breath. Physical examination revealed a heart rate of 80 beats/min with irregular rhythm, external jugular venous dilatation and abdominal ascites. Electrocardiography revealed atrial fibrillation, and chest X-ray revealed moderate left pleural effusion. Computed tomographic images of the chest showed a that thickened pericardium. A distinct diastolic dip and plateau pattern were recognized on cardiac catheterization. The right atrial, right ventricular end-diastolic, and pulmonary wedge pressures were elevated. Idiopathic pericarditis and recurrent atrial fibrillation were diagnosed and pericardiectomy was performed through a median sternotomy incision. Intraoperatively, the atrial fibrillation converted spontaneously to sinus rhythm. The postoperative hemodynamics improved after pericardiectomy. Total pericardiectomy alone may not convert the rhythm to sinus rhythm in patients with constrictive pericarditis and chronic atrial fibrillation. In this case, atrial fibrillation converted to sinus rhythm during the procedure. This case report suggests that adequate unloading of atrial pressures is necessary for the maintenance of sinus rhythm in patients who have undergone the Maze procedure.

Aged↗

[Acute and chronic-constrictive pericarditis].

Acute pericarditis is an inflammatory disease of the pericardium of variable etiology. A viral infection may sometimes precede symptoms but frequently the etiology re-mains unknown (idiopathic pericarditis). The disease is typically associated with left-sided chest pain and ECG abnormalities mimicking acute myocardial infarction. At physical examination the characteristic finding is a pericardial friction rub. A pericardial effusion of varying extent may be present or develop in the course of the disease. Pericardial tamponade, which may develop insidiously, represents a life-threatening complication. Pathophysiologically, filling of the cardiac chambers is impeded resulting in orthopnea, tachycardia, and eventually shock. Emergency pericardiocentesis is the treatment of choice. Constrictive pericarditis is the result of a chronic inflammation of the pericardium. Clinically it is characterized by dyspnea during exercise, symptoms of right heart failure and typical hemodynamic findings. Treatment primarily includes surgical removal of the thickened pericardium.

Acute Disease↗

Severe heart failure due to subacute effusive-constrictive pericarditis in a child.

We report a 9-year-old boy with progressive heart failure due to effusive-constrictive pericarditis. The patient was successfully rescued by extensive surgical removal of the thickened pericardium. The histopathological examination revealed degenerative changes of myocardium without significant inflammation, indicating that surgical pericardiectomy should be performed for subacute effusive-constrictive pericarditis before progression to definite constrictive pericarditis.

Child↗

Pericarditis: diagnosis, management, and return to play.

In athletes who present to their team physician with complaints of chest pain, the diagnosis of pericarditis should be entertained. Although generally self-limited, potential complications include cardiac tamponade and recurrent pericarditis. The typical scenario is of an athlete who had a recent viral upper respiratory illness and now presents with chest pain, friction rub, and characteristic electrocardiographic changes. Additional recommended testing includes complete blood count, erythrocyte sedimentation rate and/or C-reactive protein, cardiac enzymes, chest radiographs, and echocardiogram with Doppler. During acute pericarditis, participation in athletics is contraindicated. Return to play is permissible after there is no longer evidence of active disease. This is confirmed by the absence of effusion on echocardiography and normalization of serum markers of inflammation.

Acute Disease↗

The septal arteries in the differential diagnosis of constrictive pericarditis.

Angiographic study of the motion of the septal and left marginal arteries was performed in patients with restriction in ventricular diastolic filling in order to separate patients with constrictive pericarditis from those with restrictive cardiomyopathy. Twelve patients with constrictive pericarditis (group I) and 10 patients with restrictive cardiomyopathy (group II) were evaluated and compared with 21 patients with normal coronary angiograms (group III). The displacement of the septal arteries (23 +/- 2.04 mm) was abnormally exaggerated in group I and normal (9 +/- 0.81 mm) in groups II and III. The displacement of the left marginal arteries as seen by the "corrugating index" was similar in all groups. We conclude that study of the displacement of the septal arteries is a useful angiographic sign that helps to separate constrictive pericarditis from restrictive cardiomyopathy and normals.

Cardiomyopathies↗

Constrictive pericarditis in procainamide-induced lupus erythematosus syndrome.

A rare case of constrictive pericarditis in procainamide-induced lupus erythematosus syndrome is reported. After 6 months of procainamids therapy fever, pleuritic chest pain, arthralgia and muscle soreness developed in a 47 year old man. These symptoms were soon followed by the onset of acute pericarditis and rapidly accumulating massive pericardial effusion. After withdrawal of procainamide therapy and administration of corticosteroids in large doses, there was marked subjective improvement and rapid reduction in pericardial effusion. However, constrictive pericarditis with massive leg edema and ascites developed 6 weeks after admission as corticosteroid therapy was gradually discontinued. These manifestations subsided after pericardiectomy was performed.

Humans↗

Constrictive pericarditis after myocardial revascularization: report of three cases.

Although postoperative constrictive pericarditis is rare, the diagnosis should be considered when unexplained right-sided heart failure develops after cardiac surgery. Within a 6 week interval, evidence of constrictive pericarditis developed in three patients who had recently undergone myocardial revascularization. One patient presented with biventricular failure, pericardial effusion and suspected tamponade. Severe constrictive pericarditis was demonstrated at subsequent operation. An apparent postpericardiotomy syndrome preceded evidence of right heart failure in the other two patients. Etiologic considerations include the possibility that pericardial irrigation with povidone-iodine (Betadine) solution may have contributed to subsequent fibrosis.

Cardiac Catheterization↗

Frequency of arrhythmias in acute pericarditis determined by Holter monitoring.

Twenty-four-hour electrocardiographic monitoring in 49 of 50 consecutive patients with acute pericarditis and sinus rhythm at onset (29 with etiologic or unrelated heart disease) disclosed 4 instances of intermittent supraventricular tachycardia, 2 in patients in whom tamponade developed and 1 in a patient with acute myocardial infarction. Eight other arrhythmias, also nonsustained. occurred exclusively in patients with heart disease. Ectopic beats without other arrhythmia occurred in 10 patients without heart disease, but were infrequent (1 to 30 per hour) in 9. Ectopic beats without other arrhythmias occurred in 19 patients with heart disease but were infrequent in 16. Pericarditis per se does not appear to be a recognizable arrhythmogenic influence. As a corollary, significant rhythm disturbance--particularly continuous-beat arrhythmias--during acute pericarditis implies a cardiac abnormality.

Acute Disease↗

Transient cardiac constriction: an unrecognized pattern of evolution in effusive acute idiopathic pericarditis.

In 16 of 177 patients with effusive acute idiopathic pericarditis (10 men, 6 women, mean age 38 years), features of cardiac constriction were detected (by physical examination in 6 patients and by noninvasive recordings in all) between 5 and 30 days after an echocardiogram had shown pericardial effusion, at a time when signs of activity had abated and effusion was already minimal or had altogether disappeared. Cardiac catheterization was performed in 5 patients, showing either overt (3 patients) or occult (2 patients) cardiac constriction. Two patients had clinical signs of cardiac failure. After a mean of 2.7 months, the features of constriction had spontaneously disappeared in all patients in the clinical examination and noninvasive recordings, and remained so in subsequent control studies (mean follow-up 31 months). Repeat cardiac catheterization in the 5 patients in whom it had been previously performed showed normal features both in the basal state and after fluid overload. The results of the present study show that some patients may go through a transient phase of cardiac constriction at the end of the effusive period of acute idiopathic pericarditis. Features of constriction are, in most cases, subtle and can go unrecognized if not specifically sought. However, they may have clinical relevance in some patients. These findings provide insight into the resolution phase of effusive acute idiopathic pericarditis, and an unnecessary pericardiectomy may be avoided.

Acute Disease↗

Bacterial pericarditis in infancy and childhood.

The authors report on a cooperative study of 43 cases of bacterial pericarditis observed in children. This disorder was suspected in patients with septicemia who developed symptoms and signs of pericarditis (precordial pain, muffled heart sounds, pericardial friction rub, cardiomegaly). Early diagnosis of this condition is now facilitated by echocardiography. A combination of medical and surgical treatments (appropriate antibiotic therapy after culture and sensitivity tests and early pericardial drainage) led to complete recovery in almost all of the cases (42 of 43). After long-term follow-up, no cases of constrictive pericarditis were observed.

Adolescent↗

Candida pericarditis.

Purulent pericarditis due to species of Candida is rare. Only seven cases were found in the literature. Described here is a man with Candida tropicalis colonization of the urinary bladder in whom C. tropicalis pericarditis later developed. Amphotericin B was given intravenously. The amphotericin B level in pericardial fluid was approximately 50 percent of the concentration in serum. Although microbiologic cure was achieved with amphotericin B, the patient died of other causes. Autopsy showed sterile constrictive pericarditis.

Adult↗

Legionella pneumophila pericarditis proved by culture of pericardial fluid.

Serogroup 1 Legionella pneumophila was isolated from the pericardial fluid of a nonimmunosuppressed patient with pulmonary infiltrates, cardiac tamponade, and histologic evidence of pericarditis. This is the first reported case in which the association of L. pneumophila infection and pericarditis has been proved by growth of the organism from pericardial fluid. Physicians caring for patients with pericarditis of unknown cause should consider L. pneumophila in their differential diagnosis because special diagnostic efforts and relatively specific therapy are required for its optimal management.

Adult↗