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PubMed2002

P-R segment depression: an early diagnostic feature in acute pericarditis: a telephone survey of UK accident and emergency departments.

P-R segment depression is an early ECG change in the evolution of acute pericarditis. This is widely recognized in the USA and appears in several major emergency medicine texts. A telephone survey was conducted to gain an overview of the knowledge of accident and emergency career doctors in the UK. We hope to use the results to highlight this potentially useful sign. One hundred accident and emergency departments, listed in the 1999 British Association for Accident and Emergency Medicine as seeing more than 40,000 new patients per year, were contacted in a telephone survey. The registrar, staff grade or consultant on call was asked to respond to a brief questionnaire. One hundred accident and emergency (A&E) specialist doctors were contacted--60 specialist registrars, 23 consultants and 17 staff grades. Of those questioned, 24% had a background in general medicine. The remainder had trained in surgery, A&E medicine or anaesthetics. None of the doctors questioned volunteered knowledge of P-R depression when asked an open question. Six doctors (6%) admitted, when prompted, to having previously heard of this sign. Knowledge of P-R segment depression is not widespread amongst UK A&E specialists. It is a potentially useful early electrocardiogram change in the evolution of acute pericarditis. Its recognition may aid diagnosis and prevent the inappropriate administration of thrombolytic therapy.

Adult↗
PubMedDate not supplied

Nonsteroidal anti-inflammatory drugs in the treatment of pericarditis.

Nonsteroidal antiinflammatory drugs (NSAIDs) represent the mainstay of treatment of acute pericarditis. We systematically reviewed efficacy and safety of NSAIDs, management of NSAID-induced side effects and potential superiority of specific agents in the treatment of pericarditis. We also reviewed the role of NSAIDs in specific pericardial disease entities that may represent therapeutic challenge.

Acute Disease↗
PubMedDate not supplied

The hemodynamic signs of constrictive pericarditis can be mimicked by tricuspid regurgitation.

A case with clinical and hemodynamic findings consistent with constrictive pericarditis is reported. At surgery, the pericardium was not thickened or adherent to the epicardial wall. As suggested by echocardiography, a diagnosis of severe tricuspid regurgitation was confirmed. This case illustrates that invasive hemodynamic findings consistent with a picture of pericardial constriction can be produced by processes other than constrictive pericarditis.

Aged↗
PubMedDate not supplied

Effusive-constrictive calcific pericarditis associated with Streptococcus salivarius. Case report and review of the literature.

We report the case of a 40-year-old patient presenting with a 6-month history of dyspnea and edema, with significant worsening of his clinical manifestations for the 2 weeks before admission to our department. During this 14-day preadmission period, continuous positive airway pressure (CPAP) was prescribed elsewhere for management of a working diagnosis of obstructive sleep apnea. The patient presented to us hemodynamically compromised. Management of the patient included emergency cardiac surgery for tamponade caused by effusive-constrictive, calcific pericarditis in addition to antimicrobial treatment as a result of the growth of Streptococcus salivarius from the pericardial fluid. This is the first report in the literature of association of this microorganism with pericarditis. The use of CPAP made the patient's symptoms worse as a result of an increase of the intrathoracic pressure, which was a pathophysiological mechanism, added to the interference of the localized pericardial effusion and the effect of the pericardial constriction. In an era of rapidly increasing use of CPAP systems, clinicians should be aware of their possible detrimental effects on patients with some types of cardiopulmonary diseases.

Adult↗
PubMedDate not supplied

Chest pain resulting from histoplasmosis pericarditis: a brief report and review of the literature.

Histoplasmosis is an endemic disease in many regions of the United States. Physicians must be aware of the clinical syndromes and take advantage of epidemiologic clues when diagnosing histoplasmosis pericarditis. Clinicians must also be familiar with the uses and limitations of a battery of serologic and mycologic tests. Finally, further clinical trials are needed to study the role of antifungal therapy in the treatment of histoplasmosis pericarditis.

Adult↗
PubMedDate not supplied

Acute pericarditis: diagnostic cues and common electrocardiographic manifestations.

Acute pericarditis (AP) is basically a clinical diagnosis. Although specific electrocardiographic (ECG) manifestations may indeed point to its diagnosis, sole reliance on such findings in isolation of the clinical setting, however, is often the common pitfall that could lead to a misguided diagnosis. We briefly review the anatomy of the pericardium and the pathophysiology of pericarditis to highlight common signs and symptoms as well as clinical findings that may assist in the diagnosis of AP. We also feature the characteristic evolution of its ECG manifestations and point out some of its typical and atypical features to help better differentiate AP from commonly confused conditions.

Acute Disease↗
PubMed2004

W135 meningococcal pericarditis: report of two cases and review of the literature.

Pericarditis is a rare but recognized complication of meningococcal disease. After the 2000 and 2001 hajj in Saudi Arabia, a worldwide outbreak of meningococcal W135:2a:P1.2,5 (epidemic strain) was reported including the United Kingdom. Cases of meningococcal disease occurred in pilgrims and their household contacts; and community spread occurred among non-Muslims. Between July 2001 and January 2002, 2 children with pericarditis associated with W135 meningococcal disease were admitted to our hospital in east London.

Anti-Bacterial Agents↗
PubMed2006

Delayed effusive pericarditis and recurrent pleural effusion after radiation treatment for Hodgkin's disease responsive to per os doxycycline.

We present our experience with a patient with effusive pericarditis and recurrent pleural effusion that first developed 23 yr after radiation treatment for the nodular sclerosis type of Hodgkin's disease. Extensive diagnostic work up including pericardial and pleural biopsy, excluded any other cause (than radiation) of the recurrent pleural effusion. Pericarditis and pleural effusion were not controlled with regimens including steroid and non-steroid anti-inflammatory agents. The fluid collections improved only with per os doxycycline (100 mg twice a day). Four episodes of recurrent pleural effusions were also controlled with per os doxycycline. Although the concentration of doxycycline in the pericardial and pleural fluid when given orally is smaller compared with that achieved by direct installation of the agent, the fact that all episodes of pleural effusion improved with an agent commonly used for pleurodesis is intriguing.

Administration, Oral↗
PubMed1975

Pericarditis in acute myocardial infarction.

In 1505 patients with acute myocardial infarction (MI) pericarditis was diagnosed most often in those with anterior transmural ECG changes. Those with pericarditis had a significantly greater hospital mortality and peak serum lactic dehydrogenase (LDH) levels and a greater incidence of left ventricular failure (LVF).

Acute Disease↗
PubMed1975

Constrictive pericarditis following mild non-penetrating trauma.

A case of constrictive pericarditis developed within twenty-four days of mild, blunt thoracic trauma. Rapid progression from traumatic pericarditis to constriction is documented with clinical evidence, electrocardiographic changes and cardiac catheterisation data. Other manifestations of pericardial reaction after blunt chest trauma are reviewed briefly.

Child↗
PubMedDate not supplied

Is it constrictive pericarditis or restrictive cardiomyopathy? A systematic approach.

In this case review, the authors propose a fluent diagnostic algorithm for the consideration and therapeutic approach to either constrictive pericarditis or restrictive cardiomyopathy. Additionally, while focusing on the differential diagnosis of these clinically vexing entities, the authors outline the therapeutic expectations from surgical pericardiectomy in constrictive pericarditis.

Adult↗
PubMed1994

Doppler echocardiography in cardiac tamponade and constrictive pericarditis.

Doppler echocardiography has greatly facilitated the assessment of patients with compressive cardiac disease. Patients in whom cardiac tamponade or pericardial constriction are suspected should undergo a complete echocardiographic examination including careful Doppler analysis of transmitral flow and inflow through the hepatic vein or superior vena cava (SVC). Monitoring of both the electrocardiogram and the phase of respiration are an integral part of this examination. Patients with cardiac tamponade exhibit a > 25% reduction in E wave velocity during the first inspiratory cardiac cycle; they exhibit predominant systolic inflow through the hepatic vein or SVC (with a predominant X descent with little or no Y descent). In constrictive pericarditis the pattern of transmitral flow variation is comparable to that observed in cardiac tamponade, however, a prominent Y descent is often observed on hepatic vein or SVC Doppler study. Similar changes with respiration may be observed in mitral inflow in obese patients or in those with chronic obstructive pulmonary disease, however, in these conditions the nadir of E wave velocity is observed 2-3 cardiac cycles after the first inspiratory beat. Restrictive cardiomyopathy may produce a similar systemic venous flow pattern, but increased inspiratory flow reversals and lack of respiratory variation in transmitral flow velocity distinguish it from constrictive pericarditis.

Cardiac Tamponade↗
PubMedDate not supplied

Diastolic hibernation masquerading as constrictive pericarditis.

BACKGROUND: Hibernating myocardium has traditionally been characterized in terms of systolic dysfunction. METHODS: We describe a case in which a 75-year-old patient with significant coronary artery disease was operated upon for classic constrictive pericarditis. RESULTS: At sternotomy, there was no evidence of pericarditis, but marked diastolic without systolic dysfunction remained. After successful coronary revascularization, the patient immediately exhibited dramatic improvement of diastolic performance. Ex vivo evaluation of myocardial contractile function revealed normal myocardial adrenergic responsiveness, indicating a reversible impairment of contractility. CONCLUSION: Diastolic hibernation may therefore represent a unique form of surgically correctable restrictive cardiomyopathy.

Aged↗
PubMed2004

Haemophilus influenzae pericarditis with tamponade as the initial presentation of systemic lupus erythematosus.

Although cardiac tamponade is an important and emergent complication of systemic lupus erythematosus (SLE), purulent pericarditis is rare despite the high frequency of pericardial effusion in SLE. We describe the first SLE case of Haemophilus influenzae type-f pericarditis with cardiac tamponade with SLE as the initial presentation. The pathophysiology and therapy are discussed.

Cardiac Tamponade↗
PubMed1987

Idiopathic effusive pericarditis with tamponade in the horse.

Pericarditis and pericardial effusion are considered to occur rarely in the horse. The clinical and laboratory features of idiopathic pericarditis with effusion diagnosed in 10 horses over a seven-year period were reviewed. Consistent physical findings included tachycardia, ventral oedema, jugular venous distention and diminished heart sounds. Electrocardiographic features included diminished voltages and electrical alternans, and the effusion was identified by echocardiography in the six horses in which it was performed. Pericardiocentesis relieved clinical signs in nine horses. Laboratory analysis of pericardial fluid samples classified six cases as aseptic serofibrinous, three cases as eosinophilic, and one case as histiocytic. One horse died and three were destroyed. The remaining six horses recovered following pericardiocentesis (performed once or twice) with or without corticosteroid treatment, and were alive one month to seven years after diagnosis.

Animals↗
PubMed1992

Constrictive pericarditis in a mare: attempted treatment by partial pericardiectomy.

Chronic constrictive pericarditis was diagnosed in a 6-year-old Thoroughbred mare based on the clinical findings of right congestive heart failure, hyperechoic pericardium without pericardial effusion, and a dip-and-plateau shape of the right ventricular pressure curve with equilibration of the diastolic pressures in all cardiac chambers. Treatment was attempted by partial pericardiectomy using a right lateral thoracotomy approach. Because of severe epicardial involvement recurrence of the constrictive pathology was noted 6 weeks after the surgical procedure. However, in selected cases in which the disease process is limited to the pericardium, partial pericardiectomy may offer a mode of therapy in horses suffering from constrictive pericarditis.

Animals↗
PubMed1973

Association of group B coxsackie viruses with cases of pericarditis, myocarditis, or pleurodynia by demonstration of immunoglobulin M antibody.

Tests for immunoglobulin M (IgM) antibody to group B coxsackieviruses were performed on sera from 259 patients with a clinical diagnosis of pericarditis, myocarditis, or pleurodynia on whom there were no definitive serological or virus isolation findings to establish a viral etiology, and on 259 "control" patients with clinical diagnoses of viral or mycoplasmal pneumonia or pneumonitis. IgM antibodies to coxsackievirus types B1, B3, B4, B5, and B6 were detected by a micro-immunodiffusion technique, and antibodies to virus type B2 were detected by reduction of neutralizing antibodies with ethanethiol. Of the patients with pericarditis, myocarditis, or pleurodynia, 27% (70) had IgM antibody to group B coxsackieviruses, as compared with 8% in the control group. On retrospective review of the clinical diagnosis, some of the patients in the control group with IgM antibody were found to have had additional clinical findings which could be attributed to a coxsackievirus infection. Coxsackievirus IgM antibody was demonstrable in 30% of 113 patients in the study group for whom virus isolation had been attempted with negative results. The presence of coxsackievirus IgM is discussed in relation to the time of serum collection, age of the patients, and month of onset of illness.

Adolescent↗
PubMed1983

Fusobacterium nucleatum pericarditis.

A pericardial effusion was diagnosed by echocardiography in a 49 year old man who suffered acute cough, orthopnea, and chest pain. Because of a positive tuberculin skin test, mycobacteria were initially suspected as the cause of the pericarditis. The patient was therefore treated with antituberculosis drugs. The pericardial effusion failed to resolve, however, and pericardiectomy was performed. Culture of the pericardial fluid yielded pure Fusobacterium nucleatum growth. The patient responded to antibiotic therapy and was in good health 3 weeks after being discharged from the hospital. This represents the first report of F. nucleatum pericarditis.

Fusobacterium Infections↗