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PubMed1977

[Benign acute pericarditis: choice of treatment?].

101 cases of acute benign pericarditis covering a period of 18 years are reported, and it is stressed that 80% of patients who relapsed had been treated with corticosteroids. It was also found that corticotherapy did not favourably influence the evolution of the tamponade risk, the persistence of cardiomegaly or pericardic constriction. It is concluded that, except for a few well-defined indications, corticotherapy is to be avoided in the treatment of acute benign pericarditis because of the high risk of recurrence. Some suggestions regarding the indications for corticotherapy are presented.

Adrenal Cortex Hormones↗
PubMed2003

[Acute purulent pericarditis due to Haemophilus influenzae treated successfully with subxiphoid pericardial drainage; report of a case].

A surgical case of acute purulent pericarditis in 1-year 2-month old boy who developed pericardial tamponade rapidly is reported. A subxiphoid pericardiectomy through a median incision was performed. Haemophilus influenzae was isolated from the effusion. He recovered successfully with an administration of antibiotics after the drainage procedures and did not develop constructive pericarditis. Our experience suggested that early subxiphoid pericardial drainage was effective in treatment of acute purulent pericarditis.

Acute Disease↗
PubMed2004

Chylous ascites and chylothorax due to constrictive pericarditis in a patient undergoing haemodialysis.

Chylous ascites and chylothorax are rare clinical entities and usually caused by neoplasms, particularly lymphomas, liver cirrhosis, superior vena cava thrombosis, nephrotic syndrome, and some cardiac events such as dilated cardiomyopathy or right heart failure. Constrictive pericarditis is an extremely rare cause of this clinical state. We report a 41-year-old male patient undergoing haemodialysis who presented with chylous ascites and chylothorax. Echocardiography and heart catheterisation revealed constrictive pericarditis. He underwent pericardiectomy and after the operation the ascites and pleural effusion resolved rapidly. We suggest that constrictive pericarditis should be considered in the differential diagnosis of chylous ascites and chylothorax.

Adult↗
PubMedDate not supplied

Management of purulent pericarditis.

A 50 year old man was admitted to ICU due to purulent pericarditis, purulent inflammation of the soft tissue of the neck, purulent mediastinitis and pneumonia. Subxyphoid periocardiotomy followed by the insertion of a drain into the pericardial space was performed. Four other drains were also inserted to drain purulent fluid from the neck (two drains) and mediastinum (two drains). During the surgical procedure, 700 ml of purulent pericardial fluid from the pericardial sac and 200 ml of purulent fluid from the mediastinum were drained. Antibiotic therapy was started upon admission to the hospital. Streptococcus species, Acinetobacter baumani and Enterococcus casseliflavus were cultured. Antibiotic therapy was adjusted to the results of the antibiogram. Despite revised antibiotic therapy, daily drainage from the pericardium--during several days after surgery--was around 200 ml. Due to the huge purulent pericardial drainage streptokinase, delivered directly into pericardial space, was given. The clinical effect of intrapericardial streptokinase administration was excellent. After 17 days drainage of purulent pericardial fluid was not observed. No clinical signs and symptoms of constrictive pericarditis developed. Repeated echocardiography examinations showed no signs of constrictive pericarditis and no pericardial fluid. The patient was discharged in good general condition.

Acinetobacter baumannii↗
PubMed2005

HCV infection and pericarditis: an extrahepatic manifestation?

The authors describe a clinical case in which they found the unusual combination of acute hepatitis caused by HCV and pericarditis in a young person, resulting in complete recovery from the pericarditis but in a deterioration of the chronic HCV. A close examination of the literature on this subject revealed that, although no similar case was recorded, an aetiological relationship between the hepatitis C virus and pericarditis cannot be excluded since an HCV infection often gives rise to extra-hepatic cardiac problems.

Acute Disease↗
PubMed2005

Cholesterol pericarditis--relapsing pericardial effusion in a patient with rheumatoid arthritis.

Cholesterol pericarditis is an uncommon form of pericardial disease, of unknown pathophysiology, that is characterized by chronic relapsing, usually large, pericardial effusions that are distinctive due to a high level of cholesterol. Usually it is idiopathic, but it can be associated with various systemic diseases such as hypothyroidism, rheumatoid arthritis and tuberculosis, among others. Its clinical course is usually indolent and complications such as cardiac tamponade and chronic constrictive pericarditis are relatively rare. However, the need for surgery for complete treatment has been reported in at least 10 % of cases. When rheumatoid arthritis is the underlying cause, this outcome is more frequent among those with an acute episode of pericarditis during the course of the disease. We report the case of a 61-year-old female rheumatoid arthritis patient, who presented with heart failure due to a large pericardial effusion and was successfully treated by a surgical approach.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Adenosine deaminase activity--more than a diagnostic tool in tuberculous pericarditis.

AIM: To improve the understanding of factors that influence adenosine deaminase ( ADA) activity in large pericardial effusions. METHODS: A prospective study was carried out at Tygerberg Academic Hospital, South Africa. Patients underwent echocardiographically guided pericardiocentesis. ADA activity, as well as biochemistry, haematology, cytology, and in some cases, histology, were determined. Human immunodeficiency virus (HIV) status was assessed in all patients. RESULTS: Two hundred and thirty-three patients presented to Tygerberg Hospital with large pericardial effusions requiring pericardiocentesis. Tuberculous pericarditis accounted for 162 effusions (69.5%). An ADA cut-off level of 40 U/l resulted in a test sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic efficiency of 84.0%, 80.0%, 91.0%, 66.0% and 83.0%, respectively. Pericardial exudates with an ADA activity > or = 40 U/l were associated with increased total leukocyte and neutrophil counts. Patients with tuberculous pericarditis and ADA > or = 40 U/l also had increased lymphocyte counts. Pericardial ADA activity < 30 U/l was associated with severe depletion of CD4 cell counts in HIV-positive patients. ADA levels were higher in cases with histological evidence of granulomatous inflammation than in cases with serofibrinous pericarditis. CONCLUSIONS: An ADA cut-off level of 40 U/l results in best diagnostic test results. ADA production appears to be influenced by factors associated with the antituberculous immune response.

Adenocarcinoma↗
PubMed2005

Electrocardiographical case. ST elevation: is this an infarct? Pericarditis.

A 25-year-old man presented at the emergency department with complaints of fever and chest pain. The electrocardiogram (ECG) showed concave ST segment elevation that was not confined to any arterial territory. There was PR segment elevation in lead aVR as well as PR segment depression in leads II, V5 and V6. This was consistent with pericarditis. The electrocardiographical changes associated with pericarditis are discussed. A second case of a 64-year-old man with uraemic pericarditis with similar ECG changes is illustrated.

Adult↗
PubMed1992

[An unusual case of annular constrictive pericarditis--a "framed heart"].

We presented a 62-year-old female with constrictive pericarditis of an unusual anatomy. A calcified constrictive band, 2-3 cm wide, ran parallel to the frontal plane, coursing circularly along the anterior aspect of the great arteries, right atrium, diaphragmatic surface of the right ventricle, posterolateral aspect of the left ventricle and back to the great arteries. The course of the constrictive band was circular but completely different from that of typical annular constrictive pericarditis in which a constrictive band runs along the atrioventricular groove. Hemodynamic consequences of our patient was rather non-specific impairment of ventricular filling than functional valvular stenoses due to external compression characteristic for the typical annular constrictive pericarditis. Effective surgical relief of the constriction was accomplished under cardiopulmonary bypass and cardioplegic cardiac arrest.

Calcinosis↗
PubMed1992

The 'hot halo' sign. Pyogenic pericarditis on In-111 leukocyte scintigraphy.

The authors report a patient with diffuse pyogenic pericarditis and focal myoendocarditis initially detected using In-111 WBC scintigraphy. The patient was in septic shock after hemodialysis for the treatment of chronic renal failure. This was preceded by clinical signs and symptoms of pericarditis thought to be viral in nature. Initial investigations found no septic focus, and the patient was referred for In-111 WBC scintigraphy. This revealed a striking "halo" of increased activity around the heart, strongly suggesting bacterial pericarditis. A subsequent pericardiocentesis yielded 400 ml of purulent material, confirming the diagnosis.

Female↗
PubMed2006

[Acute pericarditis: results of a survey of treatment practices of cardiologists].

UNLABELLED: Benign acute pericarditis is a common disorder. Although, at first glance, its management appears well defined, the guidelines issued by professional societies with respect to optimal treatment and length of its administration remain vague. METHODS: a brief, anonymous questionnaire probing into treatment practices was sent in April 2005 to all cardiologists of Brittany. RESULTS: we collected 164 analyzable questionnaires out of 248 submitted (66%). The initial investigations in presence of acute pericarditis included an electrocardiogram in 100% of cases, an echocardiogram in 95%, and screening biochemistry in 93% of cases. Systematic hospitalisation was advised by only 24% of cardiologists. Aspirin was prescribed as first choice treatment in 92.5% of cases. Duration of treatment recommendations varied widely, from <5 days by 2.5%, between 5 and 10 days by 25.5%, 11 and 15 days by 23.0%, 16 to 21 days by 35.3%, and for >21 days by 14% of cardiologists. Hospital-based cardiologists were more likely to systematically hospitalise their patients than outpatient practice-based physicians (79.5% versus 5.1%; p<0.001) as well as to order an initial biochemical screening tests (100% versus 81.4%, p<0.01). Cardiologists <42 years of age recommended significantly fewer hospitalisations than older physicians (6.8% versus 36.4%: p<0.001). CONCLUSIONS: the management of acute, benign pericarditis was limited nearly exclusively to the prescription of aspirin. Duration of treatment varied widely. These observations are concordant with data published in the literature (where the recommended duration of treatment is systematically missing).

Acute Disease↗
PubMedDate not supplied

Therapy for recurrent acute pericarditis: a rheumatological solution?

OBJECTIVE: To assess the efficacy of a multidrug protocol in recurrent acute pericarditis. We tried also to assess the specific role of colchicine. METHODS: We studied 58 patients (34 males) in the largest monocentric observational study. All patients received prolonged courses of non-steroidal anti-inflammatory drugs; generally we do not start a corticosteroid in recurrent acute pericarditis, but if a steroid had already been started, we planned a very slow tapering; if necessary azathioprine, hydroxychloroquine, and other immunosuppressive drugs were used; 44 patients (27 males, 61.4%) were treated also with colchicine and 14 patients (7 males, 50%) were not given this drug. RESULTS: After starting our protocol recurrences dropped from 0.48 to 0.03 attacks/patient/month (p < 0.00001) within 12 months and remained at the same level till the end of the follow-up (mean 8.1 years) in the whole cohort. In the 44 patients treated with colchicine recurrences dropped from 0.54 to 0.03 attacks/patient/month (p < 0.00001) within 12 months, and in 14 patients not given colchicine recurrences decreased from 0.31 to 0.06 attacks/patient/month (p = 0.002). In patients treated with colchicine the decrease was significantly higher (0.51) than in patients not taking this drug (0.25) (p = 0.006). Colchicine was discontinued by 16.3% of patients because of side effects. CONCLUSION: A multidrug protocol including non-steroidal anti-inflammatory drugs at high dosage, slow tapering of corticosteroid, colchicine, reassurance and close clinical monitoring is very effective in recurrent pericarditis; this improvement is more dramatic in colchicine treated patients, but also patients who do not tolerate it can achieve good control of the disease.

Acute Disease↗
PubMed1991

[Tuberculous pericarditis: diagnostic value of adenosine deaminase].

Adenosine desaminase activity was measured in the pericardiac fluid of 35 patients with pericarditis of undetermined origin who were operated upon for diagnostic or therapeutic purposes. The causes of pericarditis fell into 6 categories: I, tuberculosis (8 cases); II, idiopathy (17 cases); III, neoplasia (6 cases); IV, purulent bacterial infection (2 cases); V, constriction (2 cases) and VI, radiotherapy (1 case). The highest mean adenosine desaminase value (143 U/l) was found in group I. Other values were 34 in group II, 48 in group III and 45 in groups IV to VI. There was a statistically significant difference in this respect between group I and the other groups (P less than 0.0001). If 60 U/l is taken as discriminant value for the diagnosis of tuberculous pericarditis, then the adenosine desaminase value has a 100 percent sensitivity and an 80 percent specificity. Measuring this value therefore is a very promising procedure.

Adenosine Deaminase↗
PubMed1991

Recurrent pericarditis and cardiac tamponade in a patient with hypocomplementemic urticarial vasculitis syndrome.

We describe a patient with hypocomplementemic urticarial vasculitis syndrome complicated by recurrent pericarditis and cardiac tamponade. The episodes of pericarditis were associated with urticarial vasculitis, hypocomplementemia, and circulating IgG antibodies to the collagen-like region of Clq. Histopathologic examination of the skin and pericardium demonstrated vasculitis associated with immunoglobulin and complement deposition suggesting an immune complex mediated etiology. Recurrent pericarditis should be included in the clinical spectrum of hypocomplementemic urticarial vasculitis syndrome.

Cardiac Tamponade↗
PubMed1976

[Richettsial pericarditis and pleurisy].

The authors report two cases of rickettsial disease due to R. Conori with mainly pericarditis in one case, sero-fibrinous pleurisy in the other. They then recall a few general data concerning this rickettsial disease and the very restricted place that it occupies in the etiology of pericarditis and, even more so, in the case of pleurisy. The conditons of diagnosis, which are mainly serological, are discussed, in particular with regard to pericarditis and tuberculous pleurisy.

Acute Disease↗
PubMed1991

[Purulent pericarditis in children. A continuously life-threatening disease].

Acute purulent pericarditis in children is usually fatal, if not recognized and adequately treated. The history of three children with acute purulent pericarditis is presented. In every septic child who presents with signs of right heart decompensation, acute purulent pericarditis should be seriously considered. Echocardiography is essential for the diagnosis. If possible, diagnostic pericardiocenthesis should be performed. Experience of the last years suggests that excellent results can be obtained when adequate surgical drainage and antibiotic therapy are combined.

Acute Disease↗
PubMed1991

[Medical pericarditis: study of 19 cases].

19 cases of medical pericarditis admitted to the PICU from 1978 to 1989 were reviewed, to asses the diagnostic and therapeutical approach. The overall incidence is low, 0.32% of the patients admitted to the PICU in that time period. We have found neither tuberculous nor purulent pericarditis, with a 42% of idiopatic forms. Echocardiography was the best method for syndromic diagnosis. The ethiological diagnosis of pericarditis was made, in most cases, by means of non invasive methods or in association with the underlying disease. The cualitative analysis of the pericardial fluid was not useful for the ethiological diagnosis, therefore, we suggest pericardiocentesis should be performed mainly as a therapeutical tool. There were no correlation between the amount of fluid obtained on the first pericardiocentesis and the later incidence of the pericardial effusion. Biopsy brought no ethiological specificity in the cases it was performed.

Adolescent↗
PubMed1990

Mycotic pseudoaneurysm of the thoracic aorta with purulent pericarditis.

Mycotic pseudoaneurysms are vascular lesions composed of laminated clot and fibrous tissue and containing bacterial microorganisms. The case reported here it the third in the English literature to describe the association of purulent pericarditis with rupture of a mycotic aortic aneurysm. A 65-year-old male developed cardiac tamponade secondary to Staph. aureus pericarditis. Following a surgical procedure to drain the pericardial sac, the postoperative course was complicated by fatal hemorrhage from a ruptured thoracic pseudoaneurysm. Postmortem examination indicated that the aortic pseudoaneurysm originated at the site of an ulcerated atherosclerotic plaque. A Staph. aureus infection of the aortic lesion, with erosion into the pericardial space, was the apparent cause of purulent pericarditis.

Aneurysm, Infected↗