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PubMed1991

Two-dimensional echocardiographically guided pericardiocentesis in a horse with traumatic pericarditis.

Two-dimensional echocardiographic (2DE) examination was performed on a horse with clinical signs of pericardial effusion. Thickening of the pericardium, excess amount of pericardial fluid, elevation of the cardiac apex, and right ventricular compression, characteristic of cardiac tamponade, could be seen on 2DE recordings. Fibrinous pericarditis was suspected by observation of fibrinous strands in the pericardial fluid and epicardial fibrin deposits. Echocardiographically guided pericardiocentesis was performed, and 4 L of fluid was removed from the pericardial sac. Streptococcus zooepidemicus was isolated from the fluid. Pericardiocentesis was repeated for 3 days, and medication was administered. Despite temporary improvement in cardiac function, the horse's condition deteriorated gradually, and euthanasia was performed on the ninth day of hospitalization. Necropsy revealed chronic serofibrinous pericarditis of traumatic origin, attributable to an intercostal stab wound entering the pericardium and the apical portion of the myocardium.

Animals↗
PubMed1991

Diagnosis and management of purulent pericarditis. Experience with pericardiectomy.

Twelve cases of purulent pericarditis seen over 6 years are described. Staphylococcus aureus was the most common causative organism (six patients), and a respiratory infection was the most common preceding illness. The chest radiograph and echocardiogram were useful pointers to the diagnosis, but the electrocardiogram was not reliable. Antibiotics, surgical drainage, and pericardiectomy were used in all 12 cases. There was one death (8.3%), which occurred in a patient who was seen late. A review of the literature dealing with the diagnosis and management of this condition is presented. The importance of early diagnosis before a significant degree of cardiac tamponade occurs is noted. Although there is general agreement that surgical drainage is mandatory, the approach, methods of drainage, and extent of pericardial resection have been the subject of some discussion, and at least seven techniques are available. We conclude that pericardiectomy has a definite place in the management of purulent pericarditis.

Adult↗
PubMed1991

[A case of chronic constrictive pericarditis with rheumatic valvular heart disease successfully treated by surgery].

Chronic constrictive pericarditis and rheumatic valvular heart disease are common surgical conditions, but the simultaneous occurrence of both is extremely rare and poses problems in diagnosis and treatment. A 47-year-old male with constrictive pericarditis and rheumatic valvular heart disease was successfully treated with operation. The valvular dysfunction had included aortic, mitral and tricuspid regurgitations. He had also complicated severe hepatic dysfunction due to the cardiac constriction and the secondary tricuspid valve regurgitation. With the aid of cardiopulmonary bypass radical pericardiectomy was performed for almost all cardiac surfaces including that of both ventricles, the right atrium, and the venae cavae. After the pericardiectomy, aortic valvular replacement, mitral and tricuspid valvular annuloplasties were performed. Postoperative course was uneventful and the hemodynamic abnormalities (elevated right atrial and ventricular end diastolic pressures) as well as the depressed hepatic functions were dramatically improved postoperatively.

Chronic Disease↗
PubMed1991

[Acute pericarditis as the initial manifestation in Still's disease in an adult].

Almost 90% of primary acute pericarditis are idiopathic. Between specifics forms, a very low percentage of cases are due to chronic rheumatic diseases. A case of adult Still's disease (juvenile chronic rheumatoid arthritis) with acute pericarditis being the first clinical manifestation (besides fever and general syndrome) is presented. Therapy with oral prednisone was rapidly effective, and pericardial effusion resolved after 3 weeks of treatment, as echocardiography showed.

Acute Disease↗
PubMed1990

[The electrocardiographic changes in constrictive pericarditis before and after pericardiectomy. The role of the myocardium in the genesis of preoperative electrocardiographic changes].

We studied 19 patients diagnosed of chronic pericarditis and treated surgically with pericardiectomy, to evaluate the role of the pericardium and myocardium on the preoperative electrocardiogram. Before surgery, there was atrial fibrillation in 17 cases, the P axis was between 0 and +70 and pseudomitral morphology was found in 10 of the 12 cases with normal sinus rhythm. The mean voltage in the QRS complex was (13.8 mm), and the R wave in V5 8.6 mm. The T wave was negative in 17 patients. After surgery there was only a case of atrial fibrillation that converted to normal sinus rhythm; the P wave axis moved to the right between +30 and +150 (p less than 0.002), the pseudomitral morphology of the P changed to normal in 3 cases, the voltage of the QRS increased to 16.7 mm (p less than 0.003) and that of the R wave in V5 to 9.4 mm (p less than 0.001). The T wave became positive in only 3 cases. Because of the persistence of some alterations, we concluded that both components, pericardium and myocardium are important in the changes of the electrocardiogram of constrictive pericarditis.

Adult↗
PubMed1990

[Surgical treatment of constrictive pericarditis].

Since 1957, 30 patients with constrictive pericarditis have been treated surgically in Kyushu University Hospital. The surgical approaches were the left anterolateral thoracotomy in 17 patients (group I); the median sternotomy without cardiopulmonary bypass (CPB) in 6 patients (group II); and the median sternotomy with CPB in 7 patients (group III). The hospital mortality was 3.3 percent. The mean postoperative follow-up period was 11.7 years (longest 30 years). The actuarial survival rate at 5 years postoperatively was 88% in total cases (100% in group I, 82% in group II and 52% in group III), 88% at 10 years, 75% at 15 years and 67% at 20 years. Several patients in group III, who underwent complete pericardiectomy using CPB showed severe congestive heart failure and arrhythmia postoperatively. The comparative study between an poor result group (patients who died within 10 years post-operatively) and a good result group (patients who survived more than 10 years postoperatively revealed that preoperative hepatomegaly, atrial fibrillation and the interval between the onset of symptoms and the pericardiectomy influenced the survival rate significantly. These results suggested that pericardiectomy using CPB was a safe method for removing the calcified pericardium in the patient with severe constrictive pericarditis. However, a careful long term follow-up was necessary for the patient with severe myocardial damage even though the complete pericardiectomy was performed.

Adolescent↗
PubMedDate not supplied

Pericarditis. Nursing care makes the difference.

Nursing care of the patient with pericarditis, a commonly seen syndrome in the clinical setting, is discussed in this article. Pericarditis is particularly prevalent in the patient following myocardial infarction. Astute nursing assessment is described. Goals of nursing care include management of pain, maintenance of adequate cardiac output, and provision of support to manage anxiety and fear. Interventions to meet the goals, as well as outcome criteria, are identified.

Humans↗
PubMed1990

[A case of infective endocarditis with hemorrhagic fibrinous pericarditis].

A case of infective endocarditis which was complicated with hemorrhagic fibrinous pericarditis was reported. The hemorrhagic fibrinous pericarditis is a rare complication of infective endocarditis of the aortic root and is observed massive hemorrhage into the pericardial space. These patients should be considered for the aortic valve replacement early in the course of the disease.

Aortic Valve↗
PubMed1990

[A case of acute pericarditis secondary to mediastinitis].

A 45-year-old man who complained of swallowing disturbance and chest pain in inspiration phase was admitted for evaluation of "pericarditis". A chest X-ray film on admission disclosed a wide mediastinal shadow and pleural effusion on the right side. Bilateral tonsils were swollen, and covered with pus. A Computed tomogram of the chest showed a shadow of exudate contained with air in the mediastinum. Mediastinal drainage, tonsillectomy and drainage of fistula from pre-tracheal space to upper mediastinum were immediately performed. Staphylococcus aureus was confirmed from the sputum and mediastinal effusion. Thus, acute mediastinitis was confirmed as an etiological diagnosis of "pericarditis" in this patient.

Acute Disease↗
PubMed1990

Pericarditis in end-stage renal disease.

Our approach to the clinical management of uremic and dialysis-associated pericarditis has been presented previously and is outlined in Figure 1. In hemodynamically stable patients with no effusion and in those with small to medium effusions, we recommend initial therapy with intensified dialysis. Close monitoring, perhaps every third day, with echocardiography should be carried out. If pericardial effusion progressively increases or if a large pericardial effusion fails to resolve after 7 to 10 days of intensive dialysis, the pericardial effusion may be drained by subxiphoid pericardiotomy or by pericardiectomy. Similarly, if hemodynamic evidence of cardiac pretamponade or tamponade appears, surgical drainage also should be carried out. If the echocardiogram is inadequate for interpretation but tamponade physiology is present, we recommend confirmation by cardiac catheterization before surgical drainage is attempted, recognizing that there may be circumstances such as left ventricular failure and pulmonary hypertension that may complicate the interpretation of the catheterization data. The type of invasive pericardial procedure chosen is determined by local experience. As stated, we prefer not to perform pericardiocentesis before surgery unless tamponade-induced hypotension is so severe that an adequate blood pressure cannot be maintained by means of plasma volume expansion. Under these circumstances, we prefer that pericardiocentesis be performed in the operating room immediately before the induction of anesthesia for the definitive surgical procedure. Although pericardiectomy is a definitive procedure for pericarditis with effusion in the uremic patient, the procedure has substantial morbidity. The results of subxiphoid pericardiotomy are encouraging, and it is clear that it can be carried out safely in patients who are debilitated or who are at increased risk from general anesthesia and major surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1990

Pericarditis in systemic diseases.

Acute pericarditis is associated with four categories of systemic diseases: vasculitis-connective tissue disease; immunopathies and hypersensitivity states; disorders of metabolism; and diseases of uncertain origin or in association with various syndromes. Multiple overlapping may occur among these categories. This article discusses clinical signs and treatment of pericarditis as it occurs with these diseases.

Connective Tissue Diseases↗
PubMed1990

[The degree of functional circulatory failure according to NYHA classification and the state of hemodynamic disorders in constrictive pericarditis].

Selected indices of left and right ventricular function and pulmonary circulation have been compared in two groups of patients with constrictive pericarditis: i.e. in 10 patients classified as NYHA functional class II and 13 patients as NYHA class III. The patients with NYHA class III showed higher average values of left ventricular end-diastolic pressure (mean + 19.4 vs 11.4 mm Hg) and right ventricular end-diastolic pressure (mean + 17.3 vs 9.5 mm Hg) as well as pulmonary systolic (mean + 39.5 vs 24.5 mm Hg) and diastolic pressure (mean + 20.6 vs 9.9 mm Hg). Mean total pulmonary resistance and left and right ventricular stiffness indices were slightly higher whereas cardiac index was slightly lower. Complaints of patients with constrictive pericarditis, fatigability and dyspnea are to a large extent determined by the level of end-diastolic pressure in both ventricles and pulmonary hypertension that is by similar direct mechanism as in congestive heart failure.

Adolescent↗
PubMed1990

[Pulmonary circulation in constrictive pericarditis].

Certain indices of pulmonary haemodynamics were determined at rest in 39 patients with constrictive pericarditis. The most frequent anomaly was raised value of total pulmonary resistance (in 82% of cases) and, in a lower percent, raised pulmonary vascular resistance. The systolic pressure in the pulmonary artery was raised in 30.8% of the patients, reaching values regarded as low or medium degree hypertension. In only 2 cases the systolic pressure in the pulmonary artery was 100 mm Hg or more. The systolic pressure in the pulmonary artery showed a slight positive correlation with the end-diastolic pressure in the left ventricle, and the subgroup with pulmonary hypertension had higher average values of the end-diastolic pressure in the left ventricle than patients with normal pressure in the pulmonary circulation (means = 21.0 +/- 5.7 vs 15.2 +/- 6.5 mm Hg). These results show a significant role of increased filling pressure of the left ventricle in the mechanism of pulmonary hypertension in patients with constrictive pericarditis.

Adolescent↗
PubMed1990

Purulent pericarditis and cardiac tamponade caused by Nocardia asteroides in mixed connective tissue disease.

Pericardial nocardiosis is extremely rare, but may affect especially immunocompromised hosts. We describe the first reported case of purulent pericarditis with cardiac tamponade as the initial presentation of systemic nocardiosis in a patient with mixed connective tissue disease. Our case emphasizes the importance of identifying infectious causes of pericarditis in patients with connective tissue diseases. Longterm survival was achieved with a combined medical and surgical approach.

Cardiac Tamponade↗
PubMed1990

[A case of tuberculous pericarditis].

A case of tuberculous pericarditis successfully managed with medical treatment alone was reported. A 78-year-old male was admitted because of cough, dyspnea and fever. Chest X-P and echocardiogram revealed massive pericardial effusion. His clinical symptoms and signs suggested cardiac tamponade. Mycobacterium tuberculosis was detected from pericardial fluid. ADA activity in pericardial fluid was high. Thoracic CT scan showed tracheobronchial, pretracheal, paratracheal and superior mediastinal lymph-node swelling. The diagnosis of tuberculous pericarditis was confirmed. Anti-tuberculous therapy consisting of INH, RFP, EB in combination with prednisolone was started. One month later pericardial effusion was controlled and six months later he was in good clinical condition without surgical treatment.

Adenosine Deaminase↗
PubMed1990

Pericarditis in horses: six cases (1982-1986).

Records of 6 horses with pericarditis were reviewed. Septic pericarditis was suspected in all horses, based on historic and clinical findings. In horses 1, 2, and 4, cytologic examination of the pericardial effusion revealed acute inflammation with severe neutrophil degeneration. In horses 3 and 5, cytologic examination of pericardial fluid revealed subacute inflammation with degenerated neutrophils, and in horse 6, chronic active inflammation, with well preserved neutrophils. In horses 1 and 3, bacteria were identified on cytologic examination of pericardial fluid. Results of microbiologic cultures of pericardial fluid were positive in horse 3. All horses were treated with broad-spectrum antibiotics. An indwelling pericardial catheter was used to lavage and directly administer antibiotics into the pericardial sac. Horses 1, 4, 5, and 6 survived, horse 2 died of unrelated causes, and horse 3 was euthanatized at the owner's request. Surviving horses returned to athletic performance.

Animals↗
PubMed1989

[Lassa fever associated with effusive constrictive pericarditis and bilateral atrioventricular annular constriction: a case report].

A case of Lassa fever associated with effusive constrictive pericarditis and bilateral atrioventricular annular constriction was reported. A 49-year-old man, who had been diagnosed by indirect fluorescent antibody test as the first case of Lassa fever in Japan, was referred to the Hiroo Hospital because of syncope, progressive hepatomegaly, ascites and pericardial effusion in spite of pericardiocentesis and corticosteroid therapy. On admission, his blood pressure was 92/60 mmHg and he had a paradoxical pulse. Two-dimensional echocardiography revealed a localized pericardial effusion adjacent to the right ventricular wall and behind the left ventricular posterior wall. Bilateral atrioventricular annular constriction was also present. On pulsed Doppler echocardiography, the peak inflow velocities of the right and left ventricles increased during atrial systole. Right heart catheterization revealed a mean diastolic pressure gradient of 8 mmHg across the tricuspid valve. After pericardiectomy, a diastolic dip and plateau pattern became evident in the right ventricular pressure tracing, suggesting the presence of residual constriction. However, the atrioventricular annular constriction was no longer evident on two-dimensional echocardiography. This is considered the first reported case of subacute effusive constrictive pericarditis caused by Lassa fever.

Cardiac Catheterization↗