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PubMed1986

"Acute pericarditis": myocardial enzyme release as evidence for myocarditis.

The relationship between the serial ECG ST-T wave changes held to be characteristic of acute pericarditis and serum cardiac enzyme levels was studied in 18 young men with symptoms of acute infectious disease. Creatine kinase MB enzyme (CK-MB) was detected in 14 patients (78%); its peak levels were as high as 186 U/L during the first days of ST segment elevation. Normal values were only noted during the subsequent T wave inversion stage of the disease. ST segment elevation was more marked (p less than 0.01) and T wave inversions were deeper (p less than 0.01) and more prolonged (p less than 0.05) in the 12 patients with CK-MB levels over 10 U/L than in those with values under 10 U/L. Pericardial friction rub and/or pericardial effusion by echocardiography occurred in only one third of the patients. We conclude that the serial ECG changes of ST segment elevation, with subsequent T wave inversions in connection with acute infection, are caused by acute myocardial injury, myocarditis, as reflected by myocardial enzyme release.

Acute Disease↗
PubMed1989

Constrictive pericarditis after cardiac surgery: report of three cases and review of the literature.

Constrictive pericarditis after cardiac surgery is a rare phenomenon occurring with an incidence of 0.2% to 0.3%. To date only 158 cases have been reported in the world literature. Symptoms include dyspnea (81%), chest pain (34%), and fatigue (29%). Peripheral edema (90%) and an elevated jugular venous pressure (86%) were the most common abnormal signs found during physical examination. Chest x-ray and ECG abnormalities were not helpful in making the diagnosis, and abnormal echocardiographic findings were reported in less than half of the cases. Computerized tomography and magnetic resonance imaging scans of the heart were usually of great diagnostic benefit. Diastolic equalization of cardiac pressures remains the sine que non for diagnosis. Oral steroids have been reported to favorably alter the course early in the disease, but pericardial stripping remains the definitive form of therapy. Operative mortality rates vary from 5.5% to 14.5%.

Cardiac Surgical Procedures↗
PubMed1989

Constrictive pericarditis after cardiac surgery.

Forty-five patients were identified as having constrictive pericarditis after cardiac surgery. The mean patient age was 61 years (range, 40 to 77 years). Twenty-three of 37 patients with adequate clinical information were reported to have had a diagnosis of postpericardiotomy syndrome after the original surgery. The mean interval from original surgery to presentation with constriction was 23.4 months (range, 1 to 204 months). Computerized tomography was helpful in establishing a diagnosis of constriction in 23 of 29 patients (79%). Bypass graft patency was 93% (85 of 91 grafts). Severe pulmonary hypertension (pulmonary artery systolic pressure greater than or equal to 60 mm Hg) was present in nine patients; 8 had coexistent valvular disease (seven cases of mitral valve disease, and aortic valve disease in one). Thirty-seven of the 45 patients underwent pericardial stripping, 28 of whom experienced marked symptomatic improvement. One patient had persistent right heart failure, which was not documented to be secondary to constriction. Four patients had persistent constrictive physiologic conditions. Three of these patients had more extensive pericardial stripping and showed clinical improvement. Four patients (11%) died within 30 days of stripping. Eight patients received medical therapy alone. The decision to treat patients medically was based either on favorable response to medical therapy (five patients), or poor general clinical status.

Coronary Artery Bypass↗
PubMed1978

Echocardiography: pericardial thickening and constrictive pericarditis.

A total of 167 patients with pericardial thickening noted on M node echocardiography were studied retrospectively. After the echocardiogram, 72 patients underwent cardiac surgery, cardiac catheterization or autopsy for various heart diseases; 96 patients had none of these procedures. In 49 patients the pericardium was directly visualized at surgery or autopsy; 76 percent of these had pericardial thickening or adhesions. In another 8 percent, pericardial adhesions were absent, but no comment had been made about the appearance of the pericardium itself. In the remaining 16 percent, no comment had been made about the pericardium or percardial space. Cardiac catheterization in 64 patients revealed 24 with hemodynamic findings of constrictive pericarditis or effusive constrictive disease. Seven echocardiographic patterns consistent with pericardial adhesions or pericardial thickening are described and related when possible to the subsequent findings at heart surgery or autopsy. The clinical diagnoses of 167 patients with pericardial thickening are presented. The hemodynamic diagnosis of constrictive pericardial disease was associated with the echocardiographic finding of pericardial thickening, but there were no consistent echocardiographic patterns of pericardial thickening diagnostic of constriction. However, certain other echocardiographic abnormalities of left ventricular posterior wall motion and interventricular septal motion and a high E-Fo slope were suggestive of constriction.

Echocardiography↗
PubMed1985

Constrictive pericarditis after myocardial infarction. Sequela of anticoagulant-induced hemopericardium.

Hemopericardium developed following adequate (and not excessive) anticoagulation in a patient with acute transmural anterior myocardial infarction and an early pericardial friction rub. Drainage of a bloody effusion by pericardiocentesis did not prevent progression to constrictive pericarditis within one year. The clinical features of this case and of the only two other similar occurrences reported in the medical literature are described and lead to a discussion of therapeutic and preventive measures.

Anticoagulants↗
PubMed1986

Constrictive pericarditis mimicking Budd-Chiari syndrome.

Budd-Chiari syndrome and constrictive pericarditis share many clinical and histologic features. Clinicians must continue to reassess patients when given histologic data that are not specific for a particular disease entity, so that subtle clinical differences are recognized, appropriate diagnosis made, and therapy instituted.

Adult↗
PubMed1986

Constrictive pericarditis and pregnancy.

A case discussing the medical management of a 30-year-old gravid patient with recurrent pericarditis and pericardial constriction secondary to juvenile rheumatoid arthritis is presented.

Adult↗
PubMed1990

Easy dissection of hard and thickened pericardium on constrictive pericarditis.

The keys to successful pericardiectomy for constrictive pericarditis are early operation and as complete a pericardiectomy as possible. With the high-speed burr it is easy and safe to dissect the calcified pericardium and define the epicardium even in a small operative field such as the inferior or posterior portion of the heart. This method has the important ability to perform very complete pericardiectomy.

Adult↗
PubMed1991

Constrictive pericarditis from Nocardia asteroides infection.

Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ. It occurs in immunocompromised hosts as well as individuals with no apparent predisposition. Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates surgical management. This report describes the course of a patient with chronic constrictive pericarditis from nocardia successfully treated with pericardiectomy and appropriate antibiotic therapy.

Humans↗
PubMed1994

Mitral insufficiency after pericardiectomy for constrictive pericarditis.

We report the case of a 24-year-old man in whom a clinical syndrome developed while he was on active military duty in Saudi Arabia that was subsequently diagnosed as constrictive pericarditis. Phrenic nerve to phrenic nerve pericardiectomy and posterior pericardial release successfully relieved the ventricular constriction with a resultant increase in the cardiac index from 1.9 to 3.8 L.min-1.m-2. Transesophageal echocardiographic monitoring during the operation disclosed trace mitral regurgitation before median sternotomy. The severity of the regurgitation noticeably increased to the moderate level immediately after pericardial resection. This echocardiographic finding had improved 1 week later, but the regurgitation still was greater than baseline. Mitral valve function had returned to baseline by 4 weeks after the operation. Possible mechanisms of this evolving pattern of perioperative mitral valve dysfunction are discussed.

Adult↗
PubMed1994

Constrictive pericarditis due to ingestion of a toothpick.

A case of a 53-year-old man with constrictive pericarditis due to the ingestion of a toothpick is presented. Computed tomography was unable to show the toothpick, and the diagnosis was made during the operation. Ingested toothpicks have often been reported as a cause of gastrointestinal injuries but in this rare case a toothpick actually migrated into the pericardium.

Candidiasis↗
PubMed1995

Legionella pericarditis diagnosed by direct fluorescent antibody staining.

Legionella pericarditis is a rare and serious manifestation of Legionnaire's disease. A case is presented in which the diagnosis was established by direct fluorescent antibody staining on a pericardial tissue specimen. Video-assisted thoracoscopy was used safely and effectively in diagnosis and management in this case.

Biopsy↗
PubMed1983

Purulent pericarditis in Papua New Guinea: report of 12 cases and review of the literature in a tropical environment.

Twelve cases of purulent pericarditis (P.P.) are presented. In each case diagnosis was confirmed by aspiration of pus from the pericardial sac. Clinical presentation of this condition is discussed, and therapeutic alternatives are compared. A review of the literature dealing with this condition in a tropical environment is made. It is suggested that in a environment where infectious disease prevails, the diagnosis of this condition is often missed. The importance of early diagnosis and an aggressive approach to management is stressed.

Adolescent↗
PubMed1986

Ovarian adenocarcinoma complicated by malignant pericarditis.

Neoplastic pericarditis is a rare complication of gynecologic malignancies. However, as illustrated in the case presented, the physician involved in the care of patients with cancer should be aware of this possible life-threatening complication. The case report is followed by a brief review of the pertinent clinical, pathophysiologic, and therapeutic aspects of this condition.

Adenocarcinoma↗
PubMed1992

Pericarditis, pneumonia and brain abscess due to a combined Actinomyces--Actinobacillus actinomycetemcomitans infection.

A patient is described in whom there developed a pulmonary infiltrate and constrictive pericarditis caused by a combined Actinomyces and Actinobacillus actinomycetemcomitans infection, presumably originating from his poor dentition. The diagnosis was only made following repeated thoracotomy. After surgery, long-term treatment with antibiotics led to complete clinical recovery. None the less, some months later he was found to have a brain abscess which resolved during a further course of antibiotics. The variable clinical picture of actinomycosis is discussed, as well as the role of other bacteria frequently associated with actinomycotic infection, in particular Actinobacillus actinomycetemcomitans. The therapeutic implications are described.

Actinobacillus Infections↗
PubMed1983

Constrictive pericarditis following cardiac surgery; a complication that does exist.

Constrictive pericarditis as a complication of cardiac surgery does exist. Although the problem is somewhat uncommon, it should be suspected in patients following cardiac surgery who present with deteriorating cardiac function. The clinical spectrum of the disease is wide and may present as true rigid shell constriction or a more subtle form of elastic sero-effusive construction. It is imperative for the physician to consider this entity in the differential of complications following cardiac surgery.

Adult↗