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PubMed1994

Circus movement atrial flutter in the canine sterile pericarditis model. Relation of characteristics of the surface electrocardiogram and conduction properties of the reentrant pathway.

OBJECTIVES: This study was designed to elucidate the basis for the electrocardiographic (ECG) appearance of atrial flutter in the canine sterile pericarditis model. BACKGROUND: During atrial flutter, the surface ECG may show typical F waves or isolated P waves of any polarity. METHODS: Electrocardiographic leads II, III and aVF and epicardial atrial activation maps constructed from 127 simultaneously recorded bipolar electrograms were compared in 20 dogs with sterile pericarditis and inducible atrial flutter. RESULTS: In 10 dogs with F wave atrial flutter, single loop reentry occurred around combined functional/anatomic obstacles that included one or both caval veins and a vertically oriented arc of functional conduction block. In 10 dogs with P wave atrial flutter, a merely functional (n = 4) or combined (n = 6) obstacle involving any atrial vessel and more vertically (n = 5) or more horizontally (n = 5) oriented arcs of block was present. The isoelectric interval between P waves corresponded to the conduction time within the slow zone of the reentrant circuit (96 +/- 27 vs. 100 +/- 24 ms, mean +/- SD). Slow conduction accounted for 65 +/- 8% of the cycle length in P wave atrial flutter, but for only 29 +/- 7% in F wave atrial flutter (p < 0.05). Slow conduction was usually associated with activation of fewer than five epicardial electrodes per 10-ms isochronal interval, reflecting only a small amount of atrial tissue. The polarity of P or F waves was determined by the direction of the major wave front activating the most electrodes per 10-ms isochronal interval, irrespective of whether the right or the left atrium was activated. CONCLUSIONS: The F waves result from reentrant activation at a relatively constant speed around a vertically oriented functional/anatomic obstacle involving one or both caval veins. The P waves occur when the circuit contains a marked area of slow conduction.

Animals↗
PubMed1992

Pericarditis constrictiva after aortic valve replacement simulating tricuspid stenosis.

Pericarditis constrictiva after cardiac surgery is rare and may occasionally lead to congestive heart failure. The case of a 29-year-old patient is described who presented with pericarditis constrictiva after aortic valve replacement with localized tamponade, causing functional tricuspid stenosis. Pericardiectomy as the treatment of choice was curative.

Adult↗
PubMed2005

Management, risk factors, and outcomes in recurrent pericarditis.

Fifty-five of 294 consecutive patients with acute pericarditis had first attacks of recurrent pericarditis and were evaluated and treated according to a management protocol. Corticosteroids were restricted to aspirin contraindication or failure. Colchicine was added in cases of aspirin and prednisone failure and was the treatment of choice for the second and subsequent recurrences. After logistic regression multivariate analysis, only the previous use of corticosteroids (odds ratio 10.35, 95% confidence interval 4.46 to 23.99, p <0.001) was associated with an increased risk for recurrence. After a mean follow-up of 72 months (range 48 to 108), a similar rate of complications was found in patients with or without recurrences.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2004

Guillain-Barré syndrome coexisting with pericarditis or nephrotic syndrome after influenza vaccination.

A 68-year-old woman and a 72-year-old man presented with distal weakness of the limbs and numbness following an influenza vaccination within 2 weeks. Moreover, Guillain-Barré syndrome (GBS) was diagnosed in two patients. Pericarditis was diagnosed in the first patient who also had precordial chest pain with referral to trapezius ridge, and nephrotic syndrome, was observed in the second patient who had leg edema and proteinuria. The relationship among GBS, pericarditis and nephrotic syndrome after an influenza vaccination is discussed.

Aged↗
PubMed2005

Cytokine activation in purulent pericarditis caused by Neisseria meningitidis serogroup C.

Herein, we report a case of purulent pericarditis caused by Neisseria meningitidis serogroup C in a previously healthy 5-year-old boy, which was detected in pericardial fluid by polymerase chain reaction. The concentrations of interleukin-6, interferon-gamma and interleukin-10 in pericardial fluid were notably increased compared with serum. The role of polymerase chain reaction, counterimmunoelectrophoresis and latex agglutination test in the diagnosis, as well as the participation of cytokines in the pathogenesis of meningococcal pericarditis, are discussed.

Child, Preschool↗
PubMed2005

The usefulness of three-dimensional multidetector computed tomography to delineate pericardial calcification in constrictive pericarditis.

Constrictive pericarditis is a rare heart disease but potentially curable with pericardiectomy. Conventional image modalities such as echocardiography, CT and MRI have been used as useful diagnostics for constrictive pericarditis. However, they have limitations in delineating accurate extent of calcified pericardium three-dimensionally (3-D) to aid the surgical management to release the constricted chambers. We present a patient with typical severe extensive myopericardial calcifications visualized by 3-D multidetector CT who was successfully treated by pericardiectomy.

Calcinosis↗
PubMed2004

Transient constrictive pericarditis: causes and natural history.

OBJECTIVES: This study was designed to elucidate the causes and natural history of transient constrictive pericarditis (CP). BACKGROUND: In some patients with acute CP, the symptoms and constrictive physiologic features resolve with medical therapy alone, a phenomenon that has been labeled "transient constrictive pericarditis." No large studies have examined the causes or natural history of transient CP. METHOD: Review of the Mayo Clinic echocardiogram database identified 212 patients who had echocardiographic findings of CP from 1988 through 1999. Demographic, clinical, and echocardiographic findings were identified in all patients. In 36 of these patients, follow-up echocardiograms showed resolution of the constrictive hemodynamics without pericardiectomy. RESULTS: The average age of the patients was 49 +/- 21 years, and 72% were men. The causes for the CP were diverse, the most common being prior cardiovascular surgery (25%). In a subset of 22 patients who were followed serially during the course of their illness, resolution of the constrictive physiologic features occurred at an average of 8.3 weeks after diagnosis. CONCLUSIONS: A subset of patients with CP experience resolution of the disorder without requiring pericardiectomy.

Adolescent↗
PubMed2004

A rare case of concomitant viral myocarditis and pericarditis in a 44-year-old patient.

Concomitant severe myocarditis and pericarditis are under-recognized or rare. We report a case of a 44-year-old woman who presented in shock after a week of a flu-like illness and several hours of severe back pain. Emergent echocardiography revealed cardiac tamponade for which pericardiocentesis achieved transient improvement. Unfortunately, the patient died 2 days later secondary to progressive cardiomyopathy and multi-system organ failure. Post-mortem studies of the heart were consistent with coxsackie virus myocarditis. Diagnosis and treatment of myocarditis and pericarditis are discussed, including clues to detecting concurrent disease processes.

Adult↗
PubMed2006

Morganella morganii pericarditis 3 years after allogenic bone marrow transplantation for mantle cell lymphoma.

We report herein a case of Morganella morganii-associated acute purulent pericarditis that developed 3 years after allogenic bone marrow transplantation. The patient was successfully treated with surgical drainage and cefotaxime for 6 weeks. Splenectomy and immunosuppression for chronic GVH-D are likely to have favored the development of this rare infectious complication after BMT. M. morganii should be added to the list of bacteria causing purulent pericarditis, especially in immunocompromised hosts.

Bone Marrow Transplantation↗
PubMed1999

Constrictive pericarditis: clinical and pathophysiologic characteristics.

Constrictive pericarditis is an uncommon disorder with various causes. Although most often idiopathic, it may also occur after cardiovascular surgery, radiation therapy, and tuberculosis, especially in developing countries. The encasement of the heart by a rigid, nonpliable pericardium results in characteristic pathophysiologic effects, including impaired diastolic filling of the ventricles, exaggerated ventricular interdependence, and dissociation of intracardiac and intrathoracic pressures during respiration. Constrictive pericarditis typically presents with chronic insidious signs and symptoms of predominantly systemic venous congestion. Notoriously difficult to diagnose and distinguish from restrictive cardiomyopathy (RCM), the use of cardiac catheterization, echocardiography (transthoracic and transesophageal), central venous (hepatic and pulmonary) and transvalvular Doppler measurements, and magnetic resonance imaging should secure the diagnosis in most cases, eliminating the need for diagnostic thoracotomy. Although medical treatment may temporarily alleviate symptoms of heart failure, patients do poorly without pericardiectomy.

Animals↗
PubMed2002

Pericarditis after trauma resulting in delayed cardiac tamponade.

Pericarditis complicating cardiac trauma and resulting in tamponade is uncommon. Possible causes include an autoimmune reaction or an inflammatory response to blood entering the pericardium. We present two patients, one with effusive and one with constrictive pericarditis occurring within 2 weeks of a penetrating trauma close to but not directly involving the heart. These cases illustrate the importance of clinical suspicion and aggressive management in the diagnosis and management of such patients.

Adult↗
PubMed2003

Coccidioidal pericarditis: implications of surgical treatment in the elderly.

Coccidioidal pericarditis, an uncommonly diagnosed entity, may evolve to a constrictive process. Constrictive coccidioidal pericarditis requires pericardiectomy and antifungal therapy. In the elderly, pericardiectomy may be complicated by coagulopathy and septic shock. Despite potential toxicity, use of antifungal therapy early postoperatively offers the best chance for survival.

Aged↗
PubMed2004

Left ventricular dysfunction after pericardiectomy for constrictive pericarditis.

A 56-year-old man was admitted to our hospital with a diagnosis of suspected constrictive pericarditis. After the diagnosis was confirmed by cardiac catheterization, an elective pericardiectomy was performed without complication. Four days after surgery dyspnea developed in the patient, and he was found to have an acute decrease in left ventricular ejection fraction (LVEF) by echocardiography. The patient's symptoms and the LVEF improved over time and returned to normal 4 weeks after surgery. Transient hemodynamic dysfunction of the left ventricle has previously been reported after pericardiectomy or pericardiocentesis; however, we know of no reports in the literature that confirm an acute reduction in LVEF by echocardiography after pericardiectomy for constrictive pericarditis.

Echocardiography↗
PubMed2004

Constrictive pericarditis due to Coxiella burnetii.

Q fever is characterized by its clinical polymorphism. Cardiac involvement in acute Q fever is rare. We report a case of pleuro-pericarditis that rapidly evolved to pericardial constriction during an acute episode of Coxiella burnetii infection. Constrictive pericarditis was confirmed by hemodynamic measurements, echocardiography, and magnetic resonance. Indirect immunofluorescence assay revealed positive serology for acute Q fever. The patient underwent a successful pericardiectomy and was given antibiotics. The histopathologic study of the excised pericardium showed C. burnetii in a large cluster of organisms. After a 6-month follow-up period, the individual was asymptomatic.

Antibodies, Bacterial↗
PubMed1998

Fungal purulent constrictive pericarditis in a heart transplant patient.

Purulent pericarditis caused by Candida species is rare and is associated with very high mortality. Immunosuppressed transplant patients are particularly susceptible to fungal infections. We report a case of Candida purulent constrictive pericarditis in an immunocompromised heart transplant patient who was treated successfully with antifungal agents, surgical drainage, and pericardiectomy.

Amphotericin B↗
PubMed1999

Constrictive pericarditis due to coccidiomycosis.

Coccidiomycosis is a fungal infection that rarely causes cardiac disease. Constrictive pericarditis in the setting of disseminated coccidiomycosis can be fatal, despite antifungal therapy and pericardiectomy. We report on a patient with constrictive pericarditis due to localized infection by Coccidioides immitis. The patient underwent successful surgical pericardiectomy and antifungal chemotherapy, and remains well 1 year later.

Adult↗
PubMed2000

Constrictive pericarditis after bypass leading to internal mammary graft failure.

Constrictive pericarditis is an infrequent consequence of cardiac operation. The etiology remains unknown, but the consequences include a restrictive process that leads to congestive failure and diminished cardiac output. In addition, the desmoplastic reaction, associated with fusion of the visceral and parietal pericardial layers, has been implicated in failure of saphenous vein grafts. We report a case of constrictive pericarditis, after coronary bypass operation, with occlusion of an internal mammary graft.

Humans↗