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The incidence of purulent pericarditis has declined. However, mortality remains high. We describe a case of purulent pericarditis with tamponade caused by Salmonella enteritidis, and emphasize the importance of early recognition, prompt institution of appropriate antibiotic therapy, and early surgical drainage for survival.
A patient with subacute pericarditis showed no evidence suggesting tuberculosis until pericardiectomy was performed because of hemodynamic deterioration. The excised pericardium had a rubbery fibroelastic consistency; histologically, there were granulomatous changes characteristic of tuberculosis. Although tuberculous pericarditis is a difficult diagnosis, this case illustrates the diagnostic and therapeutic importance of early pericardiectomy before myocardial inflammatory infiltration occurs together with end-stage pericardial fibrosis and calcification.
The expression of inducible nitric oxide synthase (iNOS), an enzyme that produces nitric oxide, was examined in the hearts of pigs infected with porcine enterovirus serotype 3 (PEV3). Piglets orally infected with PEV3 developed tremors and paralysis 3-7 days post-infection. Affected animals had pericarditis and myocarditis. There were fibrin and inflammatory cell infiltrates (macrophages and neutrophils) in the pericardial sac and myocardium. Immunohistochemically, the majority of inflammatory cells in the pericardial sac were positive for iNOS and nitrotyrosine, an end product of nitric oxide. These results suggest that iNOS is upregulated in the pericardial lesion, and that increased nitric oxide production plays an important role in the development of PEV3-induced pericarditis and myocarditis.
We describe two HIV-seropositive patients with acute pneumococcal empyema and pericarditis. Cardiac tamponade evolved rapidly in each patient and was reversed with prompt surgical intervention. In each case, immunologic abnormalities were detected which could have facilitated local spread of infection and progression to tamponade. Pericarditis, an otherwise rare manifestation of pneumococcal infection in the antibiotic era, should be anticipated in HIV-seropositive patients with pneumococcal empyema.
A case of severe constrictive pericarditis resulting from an indolent Pseudomonas aeruginosa infection of the automatic internal cardiac defibrillator is described. Total explanation of the device was attempted after nine months but was unsuccessful because of dense adhesions under the patch electrodes. The patient subsequently developed clinical and hemodynamic findings of constrictive pericarditis and a second desperate attempt to remove the patches resulted in operative death. Diagnostic modalities for detecting infection of the AICD are reviewed. As soon as there is infection involving any component, the entire lead system and pulse generator should be removed.
To elucidate the incidence and clinical factors related to the occurrence of pericardial effusion in infarction-associated pericarditis, 303 consecutive patients with their first Q-wave anterior myocardial infarction were examined carefully by means of auscultation, echocardiography, chest radiography, and hemodynamic monitoring. During the first 3 days, a pericardial rub was detected in 65 patients and was absent in 238 patients. Among the 65 patients with pericardial rub, pericardial effusion was present in 27 patients (group 1) and was absent in 38 patients (group 2). Although there were no significant differences in cardiac output, pulmonary artery wedge pressure and right atrial pressure between the two groups, patients in group 1 had significantly more left ventricular segments with advanced asynergy and higher radiographic scores (diffuse interstitial infiltrate or alveolar infiltrate) compared with those in group 2. Thus, pericardial effusion and increased extravascular lung water in infarction-associated pericarditis were not caused by left ventricular failure but by other mechanisms reflecting a larger infarct.
Platypnea is the rare symptom of dyspnea in the upright position, which is relieved by assumption of the recumbent position. This symptom has been previously described in association with several conditions, but never with constrictive pericarditis. The authors report the case of a patient with constrictive pericarditis and severe platypnea, which resolved after pericardiectomy.
Pericarditis is an uncommon extraintestinal manifestation of inflammatory bowel disease. Clinical presentations range from asymptomatic pericardial effusions to cardiac tamponade. Our patient with ulcerative colitis presented with acute pericarditis that provided an opportunity to review the literature on cardiac involvement in inflammatory bowel disease.
Amebic pericarditis in a 40-year-old man who presented with insidious onset of symptoms is reported. Pericarditis is an infrequent complication of liver abscess and accounts for 4 percent of all extraintestinal amebiasis. Communication between the left lobe of liver and pericardium has been demonstrated in this patient.
An unusual case of a patient with primary meningococcal pericarditis presenting with tamponade is reported. tdespite repeated aspiration and appropriate antibiotic therapy with eradication of group C Neisseria meningitidis, pericardial effusion continued to reaccumulate. Institution of high-dosage corticosteroid therapy resulted in rapid resolution of the effusion. Only six other cases of primary meningococcal pericarditis have been reported in the English literature. Early manifestations of this disease are due to bacterial invasion of the pericardium. The later phase of intensive reaccumulation of sterile pericardial fluid may conceivably be related to meningococcal endotoxin and appears to be responsive to corticosteroid or salicylate therapy. Recognition of this phenomenon may obviate the necessity for a pericardiectomy.
A 26-year-old man developed coccidioidomycosis which resulted in myocarditis associated with congestive heart failure. A pericardial effusion developed and progressed to constrictive pericarditis. A pericardiectomy was performed and revealed that the pericarditis was due to Coccidioides immitis. The patient was subsequently treated with amphotericin B and showed marked improvement.
We describe a patient who developed acute pericarditis with effusion six weeks following irradiation of the chest for bilateral carcinoma of the breast. Oral therapy with corticosteroids was rapidly followed by a decrease of the cardiac shadow and by clinical improvement; the pericardial fluid did not reappear during a follow-up period of four years. It seems that acute pericarditis with effusion may appear in the early period after irradiation of the chest and can be treated with corticosteroids.
Three patients with pericarditis following therapeutic irradiation for malignant tumors were studied at autopsy. In one subject, death occurred five days after the last dose of radiation. The pericardial involvement was characterized by fibrinous exudation. This was more marked in degree over the right side of the heart than the left and corresponded with the field of irradiation. In the remaining two patients, two and four courses of radiation had been applied, the interval between the last dose and death being seven weeks in one patiet and 1 1/2 years in the other. The lesions were those of organizing pericarditis.
Following insertion of an epicardial pacemaker, our patient developed cardiac tamponade complicated by subacute constrictive pericarditis. Echocardiographic findings and intracardiac pressures were typical of constrictive pericarditis, which was confirmed at surgery. Although rare, these unusual complications should be considered in patients who develop evidence of reduced cardiac output following either transvenous or epicardial electrode placement.
In three cases of acute pericarditis with pericardial effusion, the presence of fibrous strands within the fluid-filled pericardial cavity was demonstrated by M-mode and cross-sectional echocardiography. Pericardiocentesis proved difficult in all three. No patient progressed to constrictive pericarditis.
Occult constrictive pericarditis complicating purulent pericarditis and meningitis is reported in a four-month-old infant. The diagnosis by noninvasive studies and the value of rapid volume expansion in this setting are discussed in detail.
Two cases of pericarditis associated with Hemophilus influenzae bacteremia and pneumonia are reported and the literature reviewed. Both patients were treated with antibiotics alone and had resolution of their illnesses without apparent adverse sequelae. Neither patient required pericardial drainage. It is suggested that there is a stage in the development of H influenzae pericarditis at which antibiotic treatment alone can be curative.
Exercise testing is contraindicated during active pericarditis because of the possibility of myocarditis. In a patient suspected of having ischemic heart disease, a pericardial rub appeared for the first time following a maximal exercise test, during which the elevated J-points descended to baseline. In two normal volunteer subjects with early repolarization during a maximal exercise test, the elevated J-points behaved similarly. We conclude that, contrary to previous belief, electrocardiographic exercise responses cannot distinguish between pericarditis and early repolarization.