DOCSLIB.ORG

Uk-Pericarditis.Pdf

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Uk-Pericarditis.Pdf Pericarditis Authors: Doctor Sabiha Gati BSc (Hons), MBBS and Doctor Sanjay Sharma BSc (Hons), MBChB, MRCP (UK), MD1 Creation Date: March 2005 Scientific Editor: Professor William McKenna 1 University Hospital Lewisham, Lewisham High Street, London SE13 6LH. [email protected] Abstract Keywords Background Definition and Classification Frequency ACUTE PERICARDITIS Clinical manifestation Other investigations Management Complications PERICARDIAL EFFUSION CARDIAC TAMPONADE Clinical Manifestations Investigations Management CONSTRICTIVE PERICARDITIS Clinical manifestations Investigations Management References Abstract Pericarditis is an inflammatory disorder of the serous pericardium resulting from a primary insult to the heart or is secondary to a systemic disorder. Of the many causes, the most frequently encountered include acute idiopathic pericarditis and viral infections. The condition is classically diagnosed by the presence of chest pain, presence of a pericardial friction rub and characteristic changes on ECG. Extensive investigations to elicit a cause are not necessary as they are of low diagnostic yield. Because of its frequently self-limiting nature, non-steroidal anti-inflammatory drugs are normally used as the first line treatment with the aim of dampening the inflammatory process and expediting recovery. Specific therapy should be initiated for an underlying disorder perpetuating pericarditis. Complications of pericarditis include pericardial effusions and subsequent tamponade and long term constrictive pericarditis. Further laboratory evaluation, echocardiography and pericardiocentesis should be considered for individuals likely to have these complications. Keywords Pericarditis, pericardial effusion, pericardial constriction the two layers of the serous pericardium that normally Background contains 15 to 50 mls of plasma fluid (1). The heart is surrounded by a protective pericardium made up of two layers, a serous and a fibrous Definition and Classification component. The serous component is further divided Pericarditis is an inflammatory disorder of the serous into an inner, visceral and outer, parietal layer. A pericardium which may result from either a primary potential space, the pericardial cavity exists between insult directly to the heart or be secondary to a large number of systemic disorders (Table 1). In most Gati S., Sharma S. Pericarditis. Orphanet Encyclopedia, March 2005. 1 http://www.orpha.net/data/patho/GB/uk-Pericarditis.pdf instances the disorder is self-limiting but may be ACUTE PERICARDITIS complicated by pericardial effusion or constriction. Aetiology Table 1: Diseases affecting the pericardium. The cause of pericardial disease in many cases is Adapted from (1). unknown, particularly in young adults. Studies suggest Trauma Myocardial Infarction a viral aetiology (coxsackie B) in most cases. Since Radiotherapy the disease is usually self-limiting the cause is not Aortic dissection investigated as there is a considerable time lag before Blunt or penetrating injury the results of the viral titre are available and the Infection Bacterial – Tuberculosis, initiation of treatment. The diagnosis can be made Streptococcus, Staphylococcus, from the clinical presentation and does not require Pneumococcus, Haemophilus, positive virology titres. Individuals may present with Legionella, Salmonella, Lyme disease, chest pain and flu-like symptoms. Although the Neisseria meningitides & Gonorrhoea, condition is self-limiting, recurrence over the following Chlamydia psittaci & Trachomotis 6 to 12 months may occur with an immunological Viral – HIV, Coxsackie virus A&B, basis. echovirus, EBV, mumps, hepatitis B, influenza, varicella Viral pericarditis Fungal – Histoplasmosis, aspergillosis, Coxsackie virus A & B, echovirus, adenovirus and HIV nocardia, candida, coccidiomycosis are the most commonly implicated viral causes of Parasitic – Echinococcus, amebiasis, acute pericarditis. Seasonal epidemics are known to toxoplasmosis occur with influenza and coxsackie B. Viral pericarditis Neoplasm Primary or secondary is typically self-limiting, lasting 1-3 weeks and is Drugs Hydralazine, Procainamide, Cytotoxics, treated symptomatically. HIV can facilitate infection of Phenytoin, Penicillin, Anticoagulants the pericardium by non-virulent organisms or can Endocrine Hypothyroidism directly infect the pericardium. HIV typically causes small asymptomatic pericardial effusions. Metabolic Uraemia, Amyloidosis Inflammatory Dressler’s syndrome, Postcardiotomy Bacterial pericarditis Connective RA, SLE, SS, PAN, Churg-strass, The most common bacterial causes are Tissue GCA, sarcoidosis, IBD, wegener’s Staphylococcus aureus, Streptococcus pneumonie, disorders granulomatosis Haemophilus influenzae and Mycobacterium Acute tuberculosis. The spread is either haematogenous or Idiopathic directly from the lungs or pleura. Less common HIV= Human immunodeficiency virus, EBV= Ebstein bacterial infections may be seen in the bar virus, RA= Rheumatoid arthritis, SLE= Systemic immunocompromised and in those with altered lupus erythematosus, SS= Systemic sclerosis, PAN= bacterial flora from extensive prolonged antibiotic Polyarteritis nodosa, GCA= giant cell arteritis, IBD= therapy. inflammatory bowel disease. Tuberculosis pericarditis Frequency Tuberculous pericarditis is rare in the western world, Epidemiological data on the incidence of pericarditis however, it is still an important cause of pericardial are scarce, possibly because the condition can be disease in the third world. Both parietal and visceral difficult to identify, and of its self-limiting nature. The layers of pericardium are infected and the frequency of pericarditis can vary in numerous myocardium is involved in most cases. Tuberculous disorders (Table 2). Mortality may vary according to pericarditis can present in the form of acute the aetiology, being low with viral/idiopathic pericarditis, pericardial effusion or with constrictive pericarditis and very high with purulent pericarditis (2). pericarditis. Treatment is with antituberculous drugs. Steroids hasten recovery in the first 11 weeks but Table 2: Frequency of the disorder under should be avoided in tuberculous pericarditis different causes of pericarditis. Adapted from secondary to HIV syndrome. (14) Fungal infection Cause Accountable cases Fungal pericarditis is rare and is usually manifest in Infection immunocompromised patients. Histoplasma is the Bacterial 1-8% most common fungal organism in the immuno- Tuberculosis 4% sufficient individuals and is known to cause Viral 1-10% constriction and calcification. Infections with Autoimmune actinomycosis (Actinomyces), coccidiodomycosis Rheumatoid arthritis 11-50% (Coccidioides), Candida and Aspergillus have also Systemic lupus 25% (after autopsy 62%) been reported. erythematosus Systemic sclerosis 5-10%(after autopsy 70%) Malignancy Chronic Renal failure 12% Neoplastic disorders affecting the pericardium include Hypothyroidism 4% rare primary tumours such as mesotheliomas or Myocardial infarction 7-23% myosarcomas or, more commonly are secondary to Dressler’s syndrome 4% metastases from the lung, breast, gastro-intestinal Postcardiotomy 10-40% tract and haematological malignancies. Malignancy is frequently associated with moderate to large effusions Neoplasm 5-17% (2,3), and may lead to tamponade. Patients with Gati S., Sharma S. Pericarditis. Orphanet Encyclopedia, March 2005. 2 http://www.orpha.net/data/patho/GB/uk-Pericarditis.pdf neoplastic pericardial effusions may also present with pericardium may also be involved in allergic supraventricular arrhythmias, or features of hypersensitivity reactions to penicillins. constrictive pericarditis. Generally, malignant pericardial effusions require drainage. The diagnosis Clinical manifestation of neoplastic pericardial effusion is based on Clinical presentation of acute pericarditis consists of a cytological examination of pericardial fluid or direct triad of chest pain, pericardial friction rub and histological tests on the pericardium (4,5). Recurrent generalised widespread ST segment and T wave effusions are treated by surgical fashioning of a changes on the ECG. continuum window into the pleural cavity. Chest pain Hypothyroidism The onset of the pain is sudden. The pain is Hypothyroidism causes silent pericardial effusion that classically located in the retrosternal area and is rarely of haemodynamic significance. Low voltage characteristically sharp in nature with exacerbation complexes are seen on the ECG. Thyroxine during movement or deep inspiration. The intensity of replacement alone is sufficient to resolve the the pain decreases with sitting forward. Dyspnoea is pericardial effusion. the consequence of the pain aggravated by breathing. Myocardial infarction Pericardial friction rub Acute pericarditis and/or effusion, are manifested in Precordial examination of a patient with acute approximately 15% of patients following an myocardial pericarditis often reveals a scratchy superficial sound infarct (MI) (5,6,7,8). The overall incidence of MI audible over the precordium, in any position termed a induced pericardial disease is reduced by 50% with “pericardial rub”. The rub can be fleeting and may vary thrombolytic therapy (7). Infarct size and early with posture and is best heard with the diaphragm of initiation of thrombolytic therapy determines the the stethoscope at the left sternal border. A pericardial incidence and extent of pericardial involvement (7). rub can be distinguished from a pleural rub by
Load more

Recommended publications
  • Guidelines on the Diagnosis and Management of Pericardial
    European Heart Journal (2004) Ã, 1–28 ESC Guidelines Guidelines on the Diagnosis and Management of Pericardial Diseases Full Text The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Task Force members, Bernhard Maisch, Chairperson* (Germany), Petar M. Seferovic (Serbia and Montenegro), Arsen D. Ristic (Serbia and Montenegro), Raimund Erbel (Germany), Reiner Rienmuller€ (Austria), Yehuda Adler (Israel), Witold Z. Tomkowski (Poland), Gaetano Thiene (Italy), Magdi H. Yacoub (UK) ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Maria Angeles Alonso Garcia (Spain), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), Martin Cowie (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Enrique Fernandez Burgos (Spain), John Lekakis (Greece), Bertil Lindahl (Sweden), Gianfranco Mazzotta (Italy), Joa~o Morais (Portugal), Ali Oto (Turkey), Otto A. Smiseth (Norway) Document Reviewers, Gianfranco Mazzotta, CPG Review Coordinator (Italy), Jean Acar (France), Eloisa Arbustini (Italy), Anton E. Becker (The Netherlands), Giacomo Chiaranda (Italy), Yonathan Hasin (Israel), Rolf Jenni (Switzerland), Werner Klein (Austria), Irene Lang (Austria), Thomas F. Luscher€ (Switzerland), Fausto J. Pinto (Portugal), Ralph Shabetai (USA), Maarten L. Simoons (The Netherlands), Jordi Soler Soler (Spain), David H. Spodick (USA) Table of contents Constrictive pericarditis . 9 Pericardial cysts . 13 Preamble . 2 Specific forms of pericarditis . 13 Introduction. 2 Viral pericarditis . 13 Aetiology and classification of pericardial disease. 2 Bacterial pericarditis . 14 Pericardial syndromes . ..................... 2 Tuberculous pericarditis . 14 Congenital defects of the pericardium . 2 Pericarditis in renal failure . 16 Acute pericarditis . 2 Autoreactive pericarditis and pericardial Chronic pericarditis . 6 involvement in systemic autoimmune Recurrent pericarditis . 6 diseases . 16 Pericardial effusion and cardiac tamponade .
    [Show full text]
  • Myocarditis, Pericarditis and Other Pericardial Diseases
    Heart 2000;84:449–454 Diagnosis is easiest during epidemics of cox- GENERAL CARDIOLOGY sackie infections but diYcult in isolated cases. Heart: first published as 10.1136/heart.84.4.449 on 1 October 2000. Downloaded from These are not seen by cardiologists unless they develop arrhythmia, collapse or suVer chest Myocarditis, pericarditis and other pain, the majority being dealt with in the primary care system. pericardial diseases Acute onset of chest pain is usual and may mimic myocardial infarction or be associated 449 Celia M Oakley with pericarditis. Arrhythmias or conduction Imperial College School of Medicine, Hammersmith Hospital, disturbances may be life threatening despite London, UK only mild focal injury, whereas more wide- spread inflammation is necessary before car- diac dysfunction is suYcient to cause symp- his article discusses the diagnosis and toms. management of myocarditis and peri- Tcarditis (both acute and recurrent), as Investigations well as other pericardial diseases. The ECG may show sinus tachycardia, focal or generalised abnormality, ST segment eleva- tion, fascicular blocks or atrioventricular con- Myocarditis duction disturbances. Although the ECG abnormalities are non-specific, the ECG has Myocarditis is the term used to indicate acute the virtue of drawing attention to the heart and infective, toxic or autoimmune inflammation of leading to echocardiographic and other investi- the heart. Reversible toxic myocarditis occurs gations. Echocardiography may reveal segmen- in diphtheria and sometimes in infective endo-
    [Show full text]
  • Pericardial Disease and Other Acquired Heart Diseases
    Royal Brompton & Harefield NHS Foundation Trust Pericardial disease and other acquired heart diseases Sylvia Krupickova Exam oriented Echocardiography course, 4th November 2016 Normal Pericardium: 2 layers – fibrous - serous – visceral and parietal layer 2 pericardial sinuses – (not continuous with one another): • Transverse sinus – between in front aorta and pulmonary artery and posterior vena cava superior • Oblique sinus - posterior to the heart, with the vena cava inferior on the right side and left pulmonary veins on the left side Normal pericardium is not seen usually on normal echocardiogram, neither the pericardial fluid Acute Pericarditis: • How big is the effusion? (always measure in diastole) • Where is it? (appears first behind the LV) • Is it causing haemodynamic compromise? Small effusion – <10mm, black space posterior to the heart in parasternal short and long axis views, seen only in systole Moderate – 10-20 mm, more than 25 ml in adult, echo free space is all around the heart throughout the cardiac cycle Large – >20 mm, swinging motion of the heart in the pericardial cavity Pericardiocentesis Constrictive pericarditis Constriction of LV filling by pericardium Restriction versus Constriction: Restrictive cardiomyopathy Impaired relaxation of LV Constriction versus Restriction Both have affected left ventricular filling Constriction E´ velocity is normal as there is no impediment to relaxation of the left ventricle. Restriction E´ velocity is low (less than 5 cm/s) due to impaired filling of the ventricle (impaired relaxation)
    [Show full text]
  • Constriction Versus Restriction Anurag Bajaj. MD Regional Health
    10/21/2019 Constriction versus Restriction Anurag Bajaj. MD Regional Health Recognizing constrictive pericarditis and restrictive cardiomyopathy as a reversible cause of heart failure. Understand the pathophysiology of constrictive pericarditis and restrictive cardiomyopathy. Echocardiographic findings differentiating between constrictive pericarditis and restrictive cardiomyopathy. Invasive hemodynamics findings differentiating between constrictive pericarditis and restrictive cardiomyopathy. 1 10/21/2019 A 45-year-old man is evaluated for a 6-month history of progressive dyspnea on exertion and lower- extremity edema. He can now walk only one block before needing to rest. He reports orthostatic dizziness in the last 2 weeks. He was diagnosed 15 years ago with non-Hodgkin lymphoma, which was treated with chest irradiation and chemotherapy and is now in remission. He also has type 2 diabetes mellitus. He takes furosemide (80 mg, 3 times daily), glyburide, and low-dose aspirin. Physical examination Afebrile. Blood pressure of 125/60 mm Hg supine and 100/50 mm Hg standing; pulse is 90/min supine and 110/min standing. Respiration rate is 23/min. BMI is 28. Presence of jugular venous distention and jugular venous engorgement with inspiration. CVP of 15 cm H2O. Cardiac examination discloses diminished heart sounds and a prominent early diastolic sound but no gallops or murmurs. Pulmonary auscultation discloses normal breath sounds and no crackles. Abdominal examination shows shifting dullness Lower extremities show 3+ pitting edema to the level of the knees. Remainder of the physical examination is normal. BUN 40 mg/dL, Cr 2.0 mg/dL, ALT 130 U/L, AST 112 U/L, Albumin 3.0 g/dL, UA negative for protein, 2 10/21/2019 70 year old female presented with dyspnea caused by minor stress.
    [Show full text]
  • Case Report: Cytarabine-Induced Pericarditis and Pericardial Effusion Rino Sato, MD and Robert Park, MD
    HEMATOLOGY & ONCOLOGY Case Report: Cytarabine-Induced Pericarditis and Pericardial Effusion Rino Sato, MD and Robert Park, MD INTRODUCTION for inpatient chemotherapy, and demonstrated mild global left ventricular dysfunction with ejection fraction Cytarabine (cytosine arabinoside, Ara-C) is an antime- of 40%. The cardiomyopathy was attributed to his tabolite analogue of cytidine that is used as a chemo- underlying hypertension or sleep apnea, and not therapeutic agent for the treatment of acute myelogenous coronary artery disease based on a normal coronary leukemia and lymphocytic leukemias1 . The most computed tomography (CT) angiogram. The patient common side effects of this therapy include myelosup- was started on induction therapy with high-dose pression, pancytopenia, hepatotoxicity, gastrointestinal cytarabine therapy at 3g/m2 every twelve hours without ulceration with bleeding, and pulmonary infiltrates2. an anthracycline agent such as doxorubicin. Cardio-pulmonary complications of cytarabine therapy are uncommon, but include supraventricular and On day 5 of cytarabine therapy, the patient developed ventricular arrhythmias, sinus bradycardia, and recurrent non-radiating sharp chest pain that worsened with heart failure2, 3. Occasionally, patients may develop inspiration and palpation. He had no cough or sputum pericarditis leading to pericardial tamponade, which can production. His cardiac exam revealed a tri-phasic, be fatal. We report a case of cytarabine-induced high-pitched friction rub best heard over the left lower pericarditis and pericardial effusion to increase awareness sternal border. He was normotensive, did not have pulsus about this serious side effect of cytarabine and review paradoxus, and had minimally distended jugular veins. the current literature. An electrocardiogram revealed widespread concave ST-elevation and PR-depression in the limb leads (I, II, III, CASE PRESENTATION avF) and precordial leads (V5-V6) concerning for acute pericarditis (Figure 1).
    [Show full text]
  • Acute Non-Specific Pericarditis R
    Postgrad Med J: first published as 10.1136/pgmj.43.502.534 on 1 August 1967. Downloaded from Postgrad. med. J. (August 1967) 43, 534-538. CURRENT SURVEY Acute non-specific pericarditis R. G. GOLD * M.B., B.S., M.RA.C.P., M.R.C.P. Senior Registrar, Cardiac Department, Brompton Hospital, London, S.W.3 Incidence neck, to either flank and frequently through to the Acute non-specific pericarditis (acute benign back. Occasionally pain is experienced on swallow- pericarditis; acute idiopathic pericarditis) has been ing (McGuire et al., 1954) and this was the pre- recognized for over 100 years (Christian, 1951). In senting symptom in one of our own patients. Mild 1942 Barnes & Burchell described fourteen cases attacks of premonitory chest pain may occur up to of the condition and since then several series of 4 weeks before the main onset of symptoms cases have been published (Krook, 1954; Scherl, (Martin, 1966). Malaise is very common, and is 1956; Swan, 1960; Martin, 1966; Logue & often severe and accompanied by listlessness and Wendkos, 1948). depression. The latter symptom is especially com- Until recently Swan's (1960) series of fourteen mon in patients suffering multiple relapses or patients was the largest collection of cases in this prolonged attacks, but is only partly related to the country. In 1966 Martin was able to collect most length of the illness and fluctuates markedly from of his nineteen cases within 1 year in a 550-bed day to day with the patient's general condition. hospital. The disease is thus by no means rare and Tachycardia occurs in almost every patient at warrants greater attention than has previously some stage of the illness.
    [Show full text]
  • Case Report Acute Pericarditis
    Case Report Acute Pericarditis Urgent message: This case underscores the importance of not “anchoring” to a previous provider’s diagnosis and always remem- bering that medical conditions are dynamic. JOHN J. KOEHLER, MD, and DANIEL MURAUSKI, DO Introduction cute pericarditis is defined as inflammation of the Apericardium that surrounds the heart and the base of the great vessels. The classical presentation con- sists of chest pain, a pericardial friction rub, and seri- al changes on electrocardiogram (EKG). Although data on the incidence of pericarditis are lacking, estimates indicate that it is the cause of at least 1% of emergency room (ER) visits among patients with ST-segment ele- vation and up to 5% of ER visits for nonischemic chest pain.1,2 Case Presentation A 57-year-old woman presented with persistent “chest congestion” starting 4 days prior. One day after onset of symptoms, she had seen her primary care physi- cian, who diagnosed an upper respiratory tract infec- © Corbis.com tion (URI) and provided a “Z pack.” The patient reported no past medical or surgical history and takes Further evaluation of the patient revealed the fol- no medications other than the recently prescribed lowing vital signs: antibiotic. T 99.2°F On further questioning, the woman reported expe- BP 90/60 mmHg riencing sharp sub-sternal chest pain that radiated into P 106 bpm her back. It was made worse with deep breathing and RR 16 lying flat. She noted mild relief after taking acetamin- O2 Sat 97% ophen, which she took 4 hours before presentation. On review of systems, the patient reported fever, chills, She did not appear toxic and her exam was normal malaise, and a headache.
    [Show full text]
  • ECG in Pericarditis Pericardial Effusion Pericardium the Pericardium Is a Double Sheet Made up by Two Layers of Not So Distensible Fibrous Tissue That Wraps the Heart
    Pericardial effusion with emphasis on the electrocardiographic aspects By Andrés Ricardo Pérez-Riera MDPhD ECG In pericarditis Pericardial effusion Pericardium The pericardium is a double sheet made up by two layers of not so distensible fibrous tissue that wraps the heart. The internal or visceral layer is adhered to the heart. The external or parietal layer is wrapped by the visceral one. Between both there is a space with a small amount of serofibrinous liquid (ö20 to 50 ml). The parietal layer fixes the heart in its place within the chest and prevents direct contact between the organ and neighboring structures. Functions of the pericardium The pericardium has three main functions: mechanical, membranous and ligamentous. Mechanical function: it restricts cardiac dilatation increasing the efficiency of the heart, maintaining ventricular compliance and distributing hydrostatic forces. Additionally, it creates a closed chamber with subatmospheric pressure, aiding atrial filling and reducing parietal transmural pressures. Membranous function: it protects the heart, reducing its external friction and acting as a barrier against propagation of infections and neoplasia’s. Ligamentous function: it anatomically fixes the heart, preventing the latter from balancing. Other functions: Barrier against infections; barrier against dissemination of neoplasias; preventing excessive movements of the organ; preventing direct contact of the heart with neighboring structures; conditioning less friction between the heart and other organs; allowing diastolic distention of the chambers due to negative atmospheric pressure. Pericarditis Concept of pericarditis: syndrome caused by inflammation of the pericardium, a sack made up by two sheets (parietal and visceral) that wrap the heart and the great vessels. Etiological classification of pericarditis • Idiopathic (unknown): 26-86% of cases.
    [Show full text]
  • Pericardial Diseases Radhika Prabhakar 12.12.2018 and 12.19.2018 MKSAP Question 1
    Pericardial Diseases Radhika Prabhakar 12.12.2018 and 12.19.2018 MKSAP Question 1 A 45-year-old woman is evaluated for severe chest pain. Which of the following conditions is demonstrated on this patient's electrocardiogram? A Anteroseptal myocardial infarction B Inferior myocardial infarction C Pericarditis D Posterior myocardial infarction MKSAP Question 1 Continued Educational Objective: Identify electrocardiographic manifestations of pericarditis. Pericarditis is demonstrated on this patient's electrocardiogram. Electrocardiographic changes characteristic of acute pericarditis include diffuse ST-segment elevations and a depressed PR interval, both of which are present in this electrocardiogram. As pericarditis evolves, the electrocardiographic manifestations change and are classified into stages: stage 1 is characterized by diffuse ST- segment elevations; stage 2 is characterized by “pseudonormalization,” in which the ST segments normalize; stage 3 is characterized by diffuse T-wave inversion and possible slightly depressed ST segments; and in stage 4, the electrocardiogram returns to normal. Definitions & Anatomy Pericarditis: Inflammation of the pericardium Function of pericardium is to protect the heart and reduce friction between heart and adjacent structures Mechanical barrier to infection Influences ventricular pressures Figure 1. A: Anterior view of the anatomy of the pericardium after section of the large vessels at their cardiac origin and removal of the heart. PCR = post caval recess. RPVR = right pulmonary vein recess.
    [Show full text]
  • What You Should Know About Acute Pericarditis
    Information O from Your Family Doctor What You Should Know About Acute Pericarditis What is acute pericarditis? How is it treated? Acute pericarditis (PAIR-ih-kar-DI-tiss) is an It is treated with nonsteroidal anti-inflammatory inflammation of the sac around the heart, drugs (NSAIDs), such as aspirin or ibuprofen which is called the pericardium (PAIR-ih-KAR- (one brand: Motrin), or another medicine called dee-um). It usually happens in men 20 to 50 colchicine. Colchicine can help if you have years of age, but it can happen in anyone. already been diagnosed with acute pericarditis, or if your symptoms do not get better with How do you get it? NSAIDs. This medicine should be taken until Usually it is caused by a virus. It can also be your symptoms go away. caused by a heart attack, a tear in the heart, or another disease. Other possible causes are What can I expect? cancer or a reaction to a medicine you have Most patients get better in two to six weeks. taken. Many times the cause is not known. You may need to be treated in the hospital if you have a fever higher than 100.4°F, a high What are the symptoms? white blood cell count, or a lot of fluid in the Most patients have chest pain. The pain can sac around your heart. You may also be at risk spread to your jaw and arm, which may feel like of getting very sick if you take blood thinner a heart attack. This pain may get worse when medicine, have a weak immune system, have you lie on your back, cough, or take a deep hurt your chest before, or do not get better with breath.
    [Show full text]
  • Acute Pericarditis, Myocarditis, and Worse!
    Emergency Files Acute pericarditis, myocarditis, and worse! Nadder Sharif MSc MD CCFP(EM) Payam Dehghani MD FRCPC Case descriptions arm) (Figure 2). Bloodwork results reveal a tropo- Case 1. A 21-year-old man presents to your emer- nin level of 1.64 µg/L. He tells you his pain is almost gency department at 2:50 AM with 8-out-of-10 pleurit- completely gone and he wants to go home. ic, retrosternal chest pain that radiates to his back. He admits to drinking a few beers the previous night but A patient presenting to the emergency department denies drug use. With the exception of a recent upper with sudden-onset chest pain, ST-segment elevation on respiratory tract infection, he has been healthy and his or her ECG, and elevated cardiac biomarkers should his past medical history is unremarkable. On exami- alert any clinician to the possibility of acute myocardial nation you find him to be a fit-looking young man infarction (AMI). However, acute pericarditis, myocarditis, who is in obvious discomfort. He has an axial tem- or myopericarditis are also associated with these findings. perature of 37.9° and he is diaphoretic, but findings The lack of a true criterion standard for diagnosing peri- of his examination are otherwise normal. A 12-lead carditis and myocarditis makes it challenging to differen- electrocardiogram (ECG) reveals 2 mm of ST-segment tiate these diseases from AMI.1,2 Early recognition of AMI elevation in multiple leads (Figure 1). About an is crucial for timely initiation of revascularization proto- hour later you learn that his serum troponin level is cols.
    [Show full text]
  • Development of Diagnostic Score for Acute Pericarditis in Patients Admitted for Chest Pain
    medRxiv preprint doi: https://doi.org/10.1101/2020.08.19.20176750; this version posted August 31, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 1 Development of Diagnostic Score for Acute Pericarditis in Patients Admitted for Chest Pain Authors André Costa Meireles1; João Vitor Miranda Porto Oliveira1; Bruna de Sá Barreto Pontes1; Alexandre Costa Souza2; Laila Caroline Oliveira Souza Barbosa Gomes2; Thomaz Emanoel Azevedo Silva1; Milton Henrique Vitoria de Melo1; Gabriela Oliveira Bagano1; Márcia Maria Noya Rabelo2; Luis Claudio Lemos Correia1,3,4,5 Afilliations 1Bahiana School of Medicine and Public Health, Salvador, Brazil 2Department of Cardiology, Hospital São Rafael, Salvador, Brazil 3Department of Cardiology, Hospital Aliança, Salvador, Brazil 4Director, Center of Evidence Based Medicine – Bahiana, Salvador, Brazil 5Editor-in-chief, Journal of Evidence-based Healthcare NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.08.19.20176750; this version posted August 31, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission. 2 ABSTRACT Background: Despite the presence of clinical, laboratory and electrocardiographic characteristics suggestive of acute pericarditis, there is no multivariate diagnostic score developed for this condition.
    [Show full text]