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The management of pericardial diseases is largely empirical because of the relative lack of randomized trials that involve patients with these conditions. A first attempt to bring together and organize current knowledge resulted in the publication of the first guidelines on the management of pericardial diseases. Nevertheless, a number of observati...
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DESCRIPTION A middle-aged hypertensive lady was admitted with progressive weight gain and generalised edema of 1-year duration. Examination revealed a raised jugular venous pressure, anasarca, atrial fi brillation and no signifi cant murmurs. Evaluation revealed mild anaemia with raised erythrocyte sedimentation rate. Chest radiograph and echocardi...
Introduction: Pathological involvement of pericardium by any disease that resulting in effusion may require decompression and pericardiectomy. The current article describes rare patients with effusion who after pericadiectomy and transient hemodynamic improvement rapidly developed progressive heart failure and subsequent multi organ failure.Methods...
Abstract
Introduction: Pathological involvement of pericardium by any disease that resulting in effusion may require decompression and pericardiectomy. The current article describes rare patients with effusion who after pericadiectomy and transient hemodynamic improvement rapidly developed progressive heart failure and subsequent multi organ failur...
Citations
... It typically contains a small amount (25-35 ml) of ultrafiltration of plasma, which reduces surface tension and lubricates the heart, facilitating its free movement. 1 Pericardial effusion (PE) is an abnormal accumulation of fluid in the pericardial space and is a common clinical condition. It can be asymptomatic or present as a life-threatening cardiac tamponade, which results from increased intracardiac pressure, progressive limitation of ventricular diastolic filling, and reduced cardiac output. ...
Background
Pericardial effusion (PE) is an abnormal fluid volume in the pericardial space and is a common clinical entity. The incidence of PE is estimated diversely and depends on risk factors, etiologies, and geographic locations.
Objectives
This study aimed to assess the clinical characteristics, etiologic spectrum, echocardiographic features, and outcomes among patients with different types of PE.
Method
This retrospective observational study included 93 patients with confirmed PE. Their medical records were reviewed in the hospital information system of Mogadishu Somali Turkish Training and Research Hospital between April 2022 and September 2022. Patient demographics, clinical characteristics, chest X-rays, echocardiography, laboratory findings, management approaches, and outcome reports were reviewed and recorded.
Results
Out of the 3000 participants, 3.1% (n = 93/3000) met the definition of definitive PE. In this study, we included 51 females and 42 males. Among the patients, 86% (n = 80) had at least one comorbidity, with diabetes (38.7%) and hypertension (37.6%) being the most common. The most frequently reported clinical presentation findings were shortness of breath (67.7%), chest pain (49.4%), cough (47.3%), and palpitations (47.3%). Cardiac tamponade developed in 9.7% (n = 9) of the patients. Pericardial taps were performed in 64.5% of the cases. Our analysis showed that the most common cause of PE was cardiac disease (n = 33, 35.4%), followed by tuberculosis (TB) (n = 25, 26.8%), uremic pericarditis (n = 24, 25.8%), and hypothyroidism (n = 10, 10.7%). Regarding the severity of PE based on echocardiographic findings, nearly half of the patients (n = 46, 49.4%) had mild PE, whereas 26.8% (n = 25) had moderate PE, and 23.6% (n = 22) had severe PE. Two-thirds of the cases (66.6%) were managed with furosemide, 48 (51.6%) patients were treated with an anti-inflammatory, hemodialysis was performed in 24 (25.8%) patients and antituberculous medications were administered to 7 (7.5%) patients. Out of the 93 patients, 24 (25.8%) died during the hospital stay. It was determined that the mortality risk of patients with renal failure was 7.518 times higher than those without (p = 0.004), and the risk for those with TB was 5.554 times higher than those without (p = 0.011). Other variables were not influential on mortality (p > 0.050).
Conclusion
Our study results demonstrate the epidemiological profile of PE in Somalia. The leading causes of PE were cardiac diseases, uremic pericarditis, TB, and hypothyroidism. PE is a significant cause of morbidity and mortality in Somalia, especially in individuals with renal failure and TB infection.
... Table 1. A summarized perspective for the diagnosis and management of pericarditis [63]. ...
Pericardium is a double-layered anatomic structure that surrounds the heart and output sections of the great vessels. Despite numerous functions of this layer, mains are the protection of the heart and facilitation of the heart movements. Various diseases were defined related to the pericardium and one of them is acute pericarditis caused by inflammation of the pericardium mostly by infection. In this chapter, it is aimed to give brief information about the mostly seen pericardial diseases and detailed information about the signs, symptoms, diagnosis, and treatment modalities about the acute pericarditis.
... Akutni perikarditis je najčešći patološki proces koji zahvata srčanu kesu. Dokazano je da različite vrste virusa, poput Coxsackie virusa, adenovirusa i ehovirusa mogu izazvati akutnu upalu srčane kese 5,6 . Na kliničkim obdukcijama, akutni perikarditis se može naći kao uzgredni nalaz, kod oko 1% bolesnika. ...
... Istovremeno se sledeća tri meseca daje lek kolhicin u dozi 0,5 mg dva puta dnevno ili u duplo manjoj dozi kod bolesnika sa telesnom težinom manjom od 70 kg (0,25 mg, 2 puta dnevno). Kod rekurentnih formi, prolongira se terapija kolhicinom na 6 meseci ili duže, uz protekciju inhibitorima protonske pumpe 6,8,9 . Kortikosteroidi se ne preporučuju u akutnoj fazi bolesti, jer povećavaju rizik od nastanka recidiva. ...
... Kod određenog broja bolesnika moguća je primena biološke terapije (kao što su antagonist receptora IL-1-anakinra). Ipak, kada se koriste kortikosteroidi (0,2-0,5 mg/kg/dan metilprednizona) i anakinra (2 mg/kg/ dan do 100 mg/dan), potrebno je pažljivo praćenje mogućih komplikacija u smislu pojave bakterijskih superinfekcija 4,6,10 . Biološka terapija je i dalje predmet savremenih istraživanja, ali već postoje jasne kliničke potvrde o efikasnosti i koristi ovakvog lečenja naročito kod bolesnika sa rekurentnim perikarditisom. ...
Acute pericarditis is caused by an inflammatory process in the pericardial tissue, and as a response to the inflammation, a pericardial effusion occurs. Acute accumulation of even smaller amounts of pericardial fluid can lead to cardiac tamponade. Pericardiocentesis is a procedure used to urgently evacuate pericardial effusion and treat patients with cardiac tamponade.
... Pericardiectomy is usually the only accepted curative treatment for constrictive pericarditis and several studies including ourselves have shown its efficacy in improving symptoms with normalization of hemodynamics in the majority of cases. [1][2][3][4][5][6][7] heterogeneous disease and some patients have concomitant myocarditis or myocardial fibrosis. Another reason could be due to incomplete pericardiectomy due to its severity and calcification. ...
... We concur with the observations of other investigators regarding the possibility of residual constriction, fibrous invasion of the myocardium and abnormal ventricular compliance secondary to myocardial alterations. [4,5,40,41] The utility of speckle tracking echocardiography and tissue Doppler imaging in identifying residual constrictive pericarditis requires further investigation on a large cohort of patients correlating the clinical outcomes. ...
Background: This study was designed to prospectively evaluate the changes in tissue Doppler imaging (TDI) at mitral and tricuspid annuli and two dimensional speckle tracking echocardiography in patients undergoing pericardiectomy for chronic constrictive pericarditis and identify the relationship if any of the tissue Doppler imaging and speckle echocardiographic derived variables with patient’s symptomatic status following surgery. Patients and Methods: Twelve patients undergoing pericardiectomy for constrictive pericarditis aged 7 years to 70 years (median 21; IQR: 19.75-26.5 years) were studied for 2-36 months (median 19 months). They underwent Doppler flow velocity, TDI, and 2D-speckle echocardiographic studies. Friedman’ test was used to test the changes in TDI-derived mitral and tricuspid annular velocities and speckle derived parameters in postoperative period from baseline. Results: Despite congestive heart failure, all patients had normal left ventricular ejection fraction and increased medial mitral and tricuspid early diastolic septal velocity (e¢) with “annulus reversus”. This pattern of annular velocity improved maximally in the immediate postoperative period. At closing interval, 2 (16.7%) patients continued to be in New York Heart Association class II and both of them continued to remain in atrial fibrillation. There was statistical significant improvement in the Global cirumferential strain than in global longitudinal and global radial strain after pericardiectomy. Conclusions: We conclude that tissue Doppler imaging and speckle tracking echocardiography are useful investigative modalities for serial evaluation of patients undergoing pericardiectomy. It can be performed serially with a high degree of reproducibility.
... 3 The differential diagnosis of RA pericarditis includes tuberculosis, cancer, other autoimmune diseases, and hypothyroidism, with different prognostic and therapeutic implications. 4 On the contrary, pericardial masses are rare. Primary cardiac tumours are relatively rare, with a 0.001-0.03% ...
Background
Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints, which may extend to extra-articular organs. Extra-articular manifestations have been considered as prognostic features in RA, and pericardial disease is one of the most frequent occurrences. Rheumatoid arthritis pericarditis is usually asymptomatic and is frequently found on echocardiography as pericardial thickening with or without mild effusion. Severe and symptomatic cases are rare, but pericardial masses are even rarer. We report a patient with erosive, nodular seropositive RA, and progressive functional deterioration owing to a giant pericardial mass compressing the right cardiac chambers.
Case summary
The patient was a 79-year-old man. Cardiac magnetic resonance imaging revealed a pericardial lesion measuring 10 × 9 × 6 cm with complex structures in its interior, which had compressive effects on the right atrium and right ventricle, severely limiting diastole. Late gadolinium enhancement of the lesion walls and pericardium suggested pericarditis. Surgical resection was performed, and a soft mass with liquid content was extracted. The patient recovered well with improvements in symptoms and the functional status. Histopathological studies ruled out neoplasm, vasculitis, and infection, and the entire mass showed fibrinoid material associated with fibrinoid pericarditis.
Discussion
Symptomatic RA pericarditis is a rare cardiac manifestation of RA, whilst associated significant haemodynamic compromise is even rarer. The condition could manifest with a giant compressive pericardial mass composed of fibrinous material, with particular involvement of the right ventricle. Exclusion of other conditions, such as neoplasms and infections, is necessary.
... On the other hand, non-infectious pericarditis mainly includes autoimmune systemic diseases, post-pericardiotomy syndromes and neoplastic pericardial disease [3]. In western world, most cases of acute pericarditis are idiopathic [5]. By contrast, tuberculosis is responsible for about 70 -80% of cases of pericarditis in sub-Saharan Africa; with up to 90% of the cases associated with HIV infection [5][6][7]. ...
... In western world, most cases of acute pericarditis are idiopathic [5]. By contrast, tuberculosis is responsible for about 70 -80% of cases of pericarditis in sub-Saharan Africa; with up to 90% of the cases associated with HIV infection [5][6][7]. The epidemiological features of acute pericarditis are important for an adequate management both for aetiological diagnosis, prognostic. ...
... This very high frequency in their study would be related to their source population which consisted only of the subjects having performed an echocardiography contrary to ours which included all the cardiovascular pathologies which necessitated a hospitalization during the period of study. Although not considered a major sign of pericarditis, dyspnoea was the most common reason for consultation in our population [5,11,12]. This atypical clinical presentation could explain the high frequency of pericardial effusion which is usually a sign long lasting pericarditis (found in more than 90% of patients) and ...
... Pericardial effusion is the abnormal accumulation of fluid in the peri- cardial space which may occur as a result of a variety of clinical condi- tions [11]. The mortality and morbidity of pericardial effusion depends on the underlying etiology and comorbid conditions [11].Although often asymptomatic, presence of small pericardial effusion (SPE) is shown to be associated with increased mortality in patients with human immunodeficiency virus infection [12], in a cohort of patients undergoing transthoracic echocardiography [13], in patients with lung cancer [14] and acute ischemic stroke [15]. ...
... Pericardial effusion is the abnormal accumulation of fluid in the peri- cardial space which may occur as a result of a variety of clinical condi- tions [11]. The mortality and morbidity of pericardial effusion depends on the underlying etiology and comorbid conditions [11].Although often asymptomatic, presence of small pericardial effusion (SPE) is shown to be associated with increased mortality in patients with human immunodeficiency virus infection [12], in a cohort of patients undergoing transthoracic echocardiography [13], in patients with lung cancer [14] and acute ischemic stroke [15]. However, there is no data in the literature regarding the prevalence and importance of pericardial effusion in patients with CAP. ...
Objective:
Although often asymptomatic, presence of small pericardial effusion (SPE) is shown to be associated with adverse events and increased mortality in various conditions. This study aimed to evaluate the frequency and prognostic importance of SPE in a cohort of patients hospitalized for community-acquired pneumonia (CAP).
Methods:
We prospectively followed 154 consecutive adult patients hospitalized with CAP. The severity of CAP was evaluated with the pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. All patients underwent transthoracic echocardiography within the first 48h of admission. Patients were followed-up until hospital discharge or death. The outcomes of interest were length of stay in hospital and complicated hospitalization (CH) which is defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855.
Results:
A total 34 episodes of CHs occurred in 21 (13.6%) patients. Older patients and those with more co-morbid conditions such as diabetes, coronary artery diseases, cerebrovascular diseases, and chronic obstructive pulmonary diseases tended to have a higher rate of CH. Patients with CH had higher N-terminal pro-brain natriuretic peptide, troponin and creatinine levels on admission compared to patients without CH. Patients with CH had also higher CURB-65 and PSI scores and had longer durations of stay compared to patients with uncomplicated course. SPE was noted in 24 (15.6%) of the patients in our study cohort. Incidence of CH was greater for patients with a SPE (26 CHs occurred in 14 of the 24 patients) compared to those without an effusion (8 CHs occurred in 7 of the 130 patients, p<0.001). Logistic multivariate analysis revealed that the presence of SPE was an independent predictor of CH (OR: 3.26; 95% CI: 2.19-8.71; p=0.008).
Conclusion:
This study is the first to demonstrate that the presence of SPE is associated with increased adverse events in patients with CAP.
... Current guidelines advocate for diagnostic pericardiocentesis when suspecting a print & web 4C=FPO 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 neoplastic, purulent, or tuberculous underlying cause. [20][21][22] Electrocardiographic Finding A normal electrocardiography (ECG) does not exclude the presence of a pericardial effusion. The typical ECG findings are (1) sinus tachycardia, even though new-onset atrial fibrillation can be present; (2) low-voltage, defined as maximum QRS amplitude less than 0.5 mV in limb leads and less than 1 mV in the precordial leads; and (3) electrical alternans, characterized by beat-tobeat alteration in the QRS voltage. ...
... Pericardiocentesis (Figs. 12.6 and 12.7) should be performed for diagnostic purposes in cases of suspected neoplastic effusion. [20][21][22] In emergency cases with cardiac tamponade or significant effusion, initial relief can be obtained with percutaneous pericardiocentesis, sometimes followed by drainage with an indwelling catheter, which can, in reverse, prevent pericardial fluid accumulation. Prolonged drainage with an indwelling catheter may be required for several days, and the catheter should not be removed until drainage is less than 20 to 30 mL/24 hour. ...
... Pericarditis is the cause of 5% of emergency room visits for chest pain and, in the Western hemisphere, idiopathic pericarditis (IP) is the most common form of pericarditis, where it accounts for upwards of 90% of cases [1]. Most of the evidence regarding pharmacotherapy for the treatment of pericarditis is for idiopathic (viral) pericarditis (IP) [4][5][6][7][8]. Currently, the 2015 European Society of Cardiology (ESC) Guidelines for the diagnosis and management of pericarditis, recommends inflammatory disease states [20]. ...
... It should be noted that much of the literature characterizing ASA and NSAID use in pericarditis is circumvented around the benefit of colchicine in the treatment of IP and has been previously reviewed [21]. Since there are no data directly comparing one agent to another in terms of efficacy or safety, the choice of ASA/NSAID should be dictated by the following: tolerability, cost, route of administration, pharmacokinetic/pharmacodynamic considerations, adverse effect profile, and drug-disease interactions [4][5][6][7][8]. These principles will be discussed for each agent in their respective sections throughout this review. ...
... More data are available surrounding the use of ASA in the treatment of IRP, relative to NSAIDs. Shortly after the COPE trial was published in 2005, the Colchicine for Recurrent pericarditis (CORE) trial was published the same year [5]. The CORE trial was a prospective, randomized, open-label, parallel-group study to investigate the safety and efficacy of colchicine therapy as adjunct to conventional therapy (ASA only), for treatment of the first episode of recurrent pericarditis. ...
Aspirin (ASA) and non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of therapy for the treatment of idiopathic pericarditis (IP). A comprehensive review consisting of pertinent clinical literature, pharmacokinetic, and pharmacodynamic considerations, has not been released in recent years. This review will facilitate the clinician's understanding of pharmacotherapeutic considerations for using ASA/NSAIDs to treat IP. Data were compiled using clinical literature consisting of case reports, cohort data, retrospective and prospective studies, and manufacturer package inserts. ASA, ibuprofen, indometacin, and ketorolac relatively have the most evidence in the treatment of IP, provide symptomatic relief of IP, and should be tapered accordingly. ASA is the drug of choice in patients with coronary artery disease (CAD), heart failure (HF), or renal disease, but should be avoided in patients with asthma and nasal polyps, who are naïve to ASA therapy. Ibuprofen is an inexpensive and relatively accessible option in patients who do not have concomitant CAD, HF, or renal disease. Indometacin is not available over-the-counter in the USA, and has a relatively higher incidence of central nervous system (CNS) adverse effects. Ketorolac is an intravenous option; however, clinicians must be mindful of the maximum dose that can be administered. While ASA/NSAIDs do not ameliorate the disease process of IP, they are part of first-line therapy (along with colchicine), for preventing recurrence of IP. ASA/NSAID choice should be dictated by comorbid conditions, tolerability, and adverse effects. Additionally, the clinician should be mindful of considerations such as tapering, high-sensitivity CRP monitoring, bleeding risk, and contraindications to ASA/NSAID therapy.
... Surgery is the accepted standard treatment for patients with chronic CP who have persistent and prominent symptoms. 1 However, outcomes after pericardiectomy are variable for reasons that are not well understood. 2 Diastolic dysfunction and septal bounce often persist after surgery, and there are no parameters to evaluate whether the pericardial encasement was adequately released. ...
Pericardiectomy is an effective intervention for constrictive pericarditis. Speckle-tracking echocardiography can provide quantitative information not only about longitudinal strain (LS) but about longitudinal displacement (LD) and septal-to-lateral rotational displacement (SLRD). The aim of this study was to investigate whether pericardiectomy improves myocardial mechanics using speckle-tracking analysis.
Eighty-three patients with constrictive pericarditis who underwent echocardiography were retrospectively assessed (mean age, 58 ± 12 years; 72 men; 50 idiopathic, 20 postoperative, four viral, three radiation, and six others) and compared with 20 healthy volunteers. LD and SLRD were measured from the apical four-chamber view and global LS from three apical views.
LD was less in the constrictive pericarditis group compared with control subjects (P < .001). Only lateral LS was significantly less than that of control subjects (P < .001), but septal LS was similar (P = .48). In pre- and post-pericardial surgery comparisons (n = 27), values of septal and lateral LD were almost identical (mean, 13.6 ± 4.7 vs 13.3 ± 5.4 mm; P = .70) before pericardiectomy, but septal LD decreased (mean, 9.3 ± 3.5 mm; P < .001) and lateral LD increased (mean, 16.8 ± 4.7 mm; P = .0106) after the surgery, even though the difference in LS between the septal and lateral walls decreased (from 5.6 ± 5.3% to 2.5 ± 4.2%, P = .008). Systolic whole-heart swinging motion significantly increased to a counterclockwise direction after surgery (mean SLRD, -0.8 ± 3.3° vs 2.1 ± 3.0°; P = .001). Although the change in SLRD after pericardiectomy was not different between patients with decreases and increases in New York Heart Association class, SLRD change was significantly greater in patients who received fewer diuretics after surgery (mean, 4.00 ± 0.91 vs 0.27 ± 1.47; P = .027).
After surgical removal of the pericardium, LD of the septal and lateral walls became significantly different, and counterclockwise SLRD increased, reflecting loss of pericardial support.
Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
