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Acute Pericarditis


Presentation

  • Chest pain was present in 96%, and fever was present in 56%. All children had electrocardiographic changes comprising ST and T-wave abnormalities.[ncbi.nlm.nih.gov]
  • Hs-CRP was determined at presentation and then every week until normalization. Hs-CRP elevation was recorded in 156 of 200 cases (78%) at presentation.[ncbi.nlm.nih.gov]
  • Abstract A woman of 23 presented with a painful, swollen left knee. A thick yellow fluid aspirated from the joint cavity grew Neisseria gonorrhoeae. Central pleuritic chest pain and ST segment elevation developed 48 hours after presentation.[ncbi.nlm.nih.gov]
  • RESULTS: 179 presentations were included, with 73.9% men and a mean age of 38.8 years.[ncbi.nlm.nih.gov]
  • The following characteristics were more frequently associated with a positive cTnI test: younger age (p 0.001), male gender (p 0.007), ST-segment elevation (p 0.001), and pericardial effusion (p 0.007) at presentation.[ncbi.nlm.nih.gov]
Fever
  • Echocardiography, cardiac MR-scan, biological examinations and coronary angiogram were normal except positive dengue fever serologies. She had suffered from dengue fever recently. Clinical and ECG outcomes were good under treatment.[ncbi.nlm.nih.gov]
  • A mutation analysis revealed the heterozygote of the familial Mediterranean fever (FMF) gene (E84K, G304R). This finding confirmed our diagnosis, and we treated the patient with colchicine.[ncbi.nlm.nih.gov]
  • Compared with those without genetic mutations, patients with TRAPS mutations had more frequently a positive family history for pericarditis and periodic fever syndromes (p 0.001), a higher mean number of recurrences after the first year (p 0.001), on[ncbi.nlm.nih.gov]
  • Acute pericarditis developed 36 hours after PCI procedure with fever and severe chest pain. Electrocardiogram showed ST elevation in inferior-lateral leads.[ncbi.nlm.nih.gov]
  • The patient presented with complaints of fever, chest pain, fatigue, and shortness of breath. On physical examination, she had tachycardia, hepatomegaly, and muffled heart sounds.[ncbi.nlm.nih.gov]
Chills
  • […] in the neck, shoulder, back, or abdomen Often increases with deep breathing and lying flat, and may increase with coughing and swallowing Can feel sharp and stabbing Is often relieved by sitting up and leaning or bending forward You may have fever, chills[nlm.nih.gov]
  • Other symptoms suggestive of a recent or concomitant viral illness, such as fatigue, fever, chills, or respiratory or gastrointestinal symptoms, might also be present in either pericarditis or myocarditis.[cfp.ca]
  • Clinical features include fever, chills, and spiking temperatures. Constrictive pericarditis is a serious potential complication.[emedicine.com]
  • Other symptoms may include fevers and chills, sweats, shortness of breath, and difficulty swallowing. When pericarditis is due to infection, the symptoms tend to arise quickly while inflammation due to chronic diseases is more gradual in onset.[medicinenet.com]
Malaise
  • The pain is relieved by leaning forward and is made worse by lying supine. [1,2] Fever, malaise, and myalgia On going inflammation with release of cytokines responsible for these symptoms.[1,2] Shortness of breath Will be prominent in cardiac tamponade[explainmedicine.com]
  • Symptoms Exercise intolerance Fatigue Prodrome (if infectious) Fever Malaise Myalgias VI.[fpnotebook.com]
  • Signs and Symptoms Clinical Symptoms Symptoms are often vague and their onset is insidious; they include malaise, fatigue, and decreased exercise tolerance.[clevelandclinicmeded.com]
Dyspnea
  • Abstract A 65-year-old female patient was admitted to our hospital with the symptoms of chest pain, dyspnea and fatigue. She had undergone a tooth extraction three months before. She took no medication.[ncbi.nlm.nih.gov]
  • He had developed shortness of breath 7 days prior to hospitalization and was admitted with severe dyspnea.[ncbi.nlm.nih.gov]
  • Consequently, patients often develop dyspnea because of discomfort associated with breathing.[pathwaymedicine.org]
  • People with pericarditis may also develop dyspnea (shortness of breath) and fever.[verywell.com]
  • References: [3] [4] [2] Clinical features Acute pericarditis Low-grade intermittent fever, tachypnea, dyspnea, nonproductive cough Chest pain : often sharp, pleuritic ; improves on sitting and leaning forward Pericardial friction rub : high-pitched scratching[amboss.com]
Subacute Clinical Course
  • Hospital admission should be reserved for patients with high fever, subacute clinical course, cardiac tamponade, severe effusion, myocardial involvement, and for immunodepressed patients or those who are receiving anticoagulant treatment. 20 Pharmacological[revespcardiol.org]
Chest Pain
  • Chest pain subsided within the day of admission followed by T-wave inversion on electrocardiogram.[ncbi.nlm.nih.gov]
  • Abstract A 58-year old woman had felt some chest pains on effort for several days. She was admitted to the emergency room with severe and refractory chest pain after exercise.[ncbi.nlm.nih.gov]
  • Recent-onset chest pain in the presence of (sinus) bradycardia is considered to be associated with an acute ischemic syndrome rather than acute pericarditis.[ncbi.nlm.nih.gov]
  • Chest pain appearing in connection with or soon after the symptoms of infection is the characteristic symptom.[ncbi.nlm.nih.gov]
  • Radiologists should be attentive to pericardial thickening or enhancement on CT studies done for chest pain, as they may be able to suggest pericarditis as an alternative diagnosis for the chest pain.[ncbi.nlm.nih.gov]
Pericardial Friction Rub
  • Diagnosis is based on the recognition of two characteristic findings (pericardial chest pain, pericardial friction rub, new ECG changes or new pericardial effusion).[ncbi.nlm.nih.gov]
  • The pathognomonic physical finding of acute pericarditis is the pericardial friction rub, which is usually auscultated along the lower left sternal border.[ncbi.nlm.nih.gov]
  • Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers.[ncbi.nlm.nih.gov]
  • A pericardial friction rub is found in up to 85% of patients. Classic electrocardiographic changes include widespread concave upward ST-segment elevation without reciprocal T-wave inversions or Q waves.[ncbi.nlm.nih.gov]
  • friction rub 0 references Identifiers Freebase ID /m/0c9kg4 1 reference stated in Freebase Data Dumps publication date 28 October 2013 UMLS CUI C0155679 0 references Sitelinks Wikipedia (8 entries) edit arwiki التهاب التامور الحاد cawiki Pericarditis[wikidata.org]
Tachycardia
  • Abstract Acute pericarditis is almost invariably associated with sinus tachycardia. Recent-onset chest pain in the presence of (sinus) bradycardia is considered to be associated with an acute ischemic syndrome rather than acute pericarditis.[ncbi.nlm.nih.gov]
  • On physical examination, she had tachycardia, hepatomegaly, and muffled heart sounds. Teleradiography exhibited cardiomegaly and echocardiography showed a pericardial effusion of 25 mm. Serum anti-PVB19 IgM and PVB19 DNA were positive.[ncbi.nlm.nih.gov]
  • Paroxysmal tachycardia and the effect of stimulation of the vagus nerves by pressure. Heart 1913:5:93 2. Wolff L, Parkinson J, White PD. Bundle branch block with short PR interval in healthy young people prone to paroxysmal tachycardia.[books.google.com]
  • The most common presentation of symptomatic pericarditis consisted of chest pain, dyspnea, tachycardia, and tachypnea. Electrocardiogram (EKG) findings included diffuse ST elevation (15 percent) and sinus tachycardia (41 percent).[cureus.com]
  • Sinus tachycardia and low-grade fever are also common.[blogs.nejm.org]
Retrosternal Chest Pain
  • After 90 hours of 5-fluorouracil infusion, he developed severe retrosternal chest pain. Electrocardiography showed signs of acute pericarditis and was managed with ibuprofen and 5-fluorouracil was discontinued.[ncbi.nlm.nih.gov]
  • The presenting symptom is retrosternal chest pain. A pericardial rub is characteristic. Diffuse upward sloping ST segments are found with electrocardiogram. Pericardial effusions may be demonstrated with an echocardiogram.[ncbi.nlm.nih.gov]
  • Patients with acute pericarditis commonly present with acute, sharp, retrosternal chest pain that is relieved by sitting or leaning forward. A pericardial friction rub is found in up to 85% of patients.[ncbi.nlm.nih.gov]
  • HPI: A 22 year-old male presented to the emergency department with a chief complaint of retrosternal chest pain that started yesterday. He described the pain as a constant, sharp and pleuritic.[jetem.org]
  • Symptomology The prototypical symptom of acute pericarditis is retrosternal chest pain which may also refer to the back and shoulders.[pathwaymedicine.org]
Pericardial Disorder
  • Pericardial Disorders The pericardium is a membrane, or sac, that surrounds your heart. It holds the heart in place and helps it work properly. Problems with the pericardium include Pericarditis - an inflammation of the sac.[icdlist.com]
Increased Sweating
  • Side effects of corticosteroids include: weight gain mood swings increased sweating Other treatments and measures Treatment for pericarditis is different if it is not caused by a viral infection.[your.md]
Night Sweats
  • Immunocompromised or human immunodeficiency virus (HIV)‑positive patients are at increased risk. 4 Nonspecific symptoms such as dyspnea, fever, chills, and night sweats develop slowly, and a friction rub or chest pain is often absent.[clevelandclinicmeded.com]

Workup

  • However, data regarding manifestations, workup, and the management of acute pericarditis in the African American population is lacking.[cureus.com]
Pericardial Effusion
  • The aim of this study was to identify clinical indicators for SIDs in patients admitted for acute pericarditis with pericardial effusion.[ncbi.nlm.nih.gov]
  • One month later, the pericardial effusion and related symptoms had disappeared.[ncbi.nlm.nih.gov]
  • KEYWORDS: Dressler syndrome; Friction rub; Pericardial effusion; Post-cardiac injury syndrome [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • At the end of three months, pericardial effusion resolved, hemoglobin and hematocrit levels were normal, and serum anti-PVB19 IgM was negative.[ncbi.nlm.nih.gov]
  • The second course of chemotherapy with cytarabine and amsacrine was started after clinical improvement; 3 days later an acute pericarditis with a large pericardial effusion accompanied by a left pleural effusion developed.[ncbi.nlm.nih.gov]
Toxoplasma Gondii
  • Abstract Infection due to protozoan parasite Toxoplasma gondii is highly prevalent among humans throughout the world. Acquired primary infection is seldom severe in immunocompetent people while it can be life-threatening in immunodeficient ones.[ncbi.nlm.nih.gov]
ST Elevation
  • Nevertheless, chest pain and ST-elevation reappeared late on the third hospital day, accompanied by fever and small amounts of pericardial and pleural effusions.[ncbi.nlm.nih.gov]
  • Electrocardiogram showed ST elevation in inferior-lateral leads. However, the follow-up coronary angiography showed negative result and the symptom improved dramatically with the treatment of nonsteroidal anti-inflammatory drug treatment.[ncbi.nlm.nih.gov]
  • Significant findings: The ECG shows diffuse ST- elevation. The patient also has mild PR-depression, most notably in the inferior and lateral leads. The patient also has minimal PR elevation in lead aVR.[jetem.org]
  • Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers.[ncbi.nlm.nih.gov]
  • On electrocardiography (ECG), there was ST elevation on V2-6, D1, D2, and AVL. The patient was immediately transported to the cardiac catheterization laboratory for primary percutaneous coronary intervention.[ncbi.nlm.nih.gov]
ST Elevation in All Leads
  • In pericarditis four stages can be distinguished on the ECG: stage I: ST elevation in all leads.[en.ecgpedia.org]
Flattened T Wave
  • Stages 2, 3, and 4 ECG findings consist of ST-segment normalization and T wave flattening, T wave inversion, and normalization of T waves, respectively.[cfp.ca]
  • Stage 1 – widespread STE and PR depression with reciprocal changes in aVR (occurs during the first two weeks) Stage 2 – normalisation of ST changes; generalised T wave flattening (1 to 3 weeks) Stage 3 – flattened T waves become inverted (3 to several[lifeinthefastlane.com]
Electrocardiogram Change
  • Patients were eligible if they were 18 years of age presenting with their first episode of acute pericarditis (diagnosed by observing two of typical chest pain, friction rub, suggestive electrocardiogram changes, new/worsening pericardial effusion).[2minutemedicine.com]
  • A widespread T wave inversion is observed on the electrocardiogram, without the appearance of Q waves Stage 4 Acute Pericarditis, Stage 4 Electrocardiogram changes return to normal.[en.my-ekg.com]

Treatment

  • Colchicine is effective and safe for the treatment and prevention of recurrent pericarditis and might ultimately serve as the initial mode of treatment, especially in idiopathic cases.[ncbi.nlm.nih.gov]
  • BACKGROUND: Acute pericarditis is common, yet uncertainty persists on its treatment. We thus aimed to conduct a comprehensive systematic review on pharmacologic treatments for acute or recurrent pericarditis.[ncbi.nlm.nih.gov]
  • The pegylated interferon treatment was sustained for 24 weeks and HCV-RNA was found negative at the 3rd and 6th months of the treatment and six months after the end of treatment.[ncbi.nlm.nih.gov]
  • Pharmacological treatment should include anti-inflammatory drugs in combination with treatment for hyperthyroidism. The specific pathophysiological link between the two conditions is still to be elucidated.[ncbi.nlm.nih.gov]
  • Use of colchicine for treatment in ED is infrequent.[ncbi.nlm.nih.gov]

Prognosis

  • The prognosis is highly dependent on a correct and precocious diagnosis (etiology included) and therapy.[ncbi.nlm.nih.gov]
  • Thus, the infection by Toxoplasma gondii should be taken into account in the aetiology of either acute pericarditis or myocarditis, because a specific treatment is available, which can improve on the prognosis of the disease.[ncbi.nlm.nih.gov]
  • This prospective, bicentric study is aimed at describing a myopericarditis population, the clinical and MRI follow-up, and search for prognosis markers.[ncbi.nlm.nih.gov]
  • The aim of this study is to prospectively evaluate the frequency of high-sensitivity C-reactive protein (hs-CRP) elevation in patients with acute pericarditis, its time course of normalization, and the possible importance for diagnosis, therapy, and prognosis[ncbi.nlm.nih.gov]
  • Twenty children, aged 6 months to 13 years, with acute pericarditis admitted between 1987 and 1997 to a university hospital were analyzed retrospectively for their etiology, presentation, management, and prognosis.[link.springer.com]

Etiology

  • The etiology is also heterogeneous, often without a suggestive symptomatology.[ncbi.nlm.nih.gov]
  • Cardiology consultation is recommended for patients with severe disease, those with pericarditis refractory to empiric treatment, and those with unclear etiologies.[ncbi.nlm.nih.gov]
  • Nevertheless, there is a lack of prospective studies that have evaluated the specific risk according to different etiologies.[ncbi.nlm.nih.gov]
  • Overview Pericarditis can be caused by both infectious and noninfectious etiologies.[pathwaymedicine.org]
  • The main etiology are viral infections, although it can also be secondary to systemic diseases and infections. The main complication of acute pericarditis is pericardial effusion, triggering a cardiac tamponade.[ncbi.nlm.nih.gov]

Epidemiology

  • BACKGROUND AND OBJECTIVES: Epidemiologic data on hospitalizations for acute pericarditis are scarce. We sought to study the trends in these hospitalizations and outcomes in the USA over a 10-year period.[ncbi.nlm.nih.gov]
  • Though epidemiologic studies are lacking, acute pericarditis is recorded in 0.1 to 0.2 percent of hospitalized patients and in five percent of the patients admitted to the emergency department with non-ischemic chest pain [1].[cureus.com]
  • Pagina 340 - The Framingham Study: an epidemiological investigation of cardiovascular disease. National Institutes of Health publication, 1974:74-599. ‎[books.google.ro]
  • Epidemiology Accounts for 5% of Emergency Department Chest Pain cases Most typical patient is a male aged 20 to 50 years old However occurs in both genders and at all ages III.[fpnotebook.com]
  • Knowledge of this basic epidemiologic fact is essential for the development of a rational management protocol that, on the one hand, avoids the unnecessary use of invasive pericardial diagnostic procedures in patients with idiopathic pericarditis and[revespcardiol.org]
Sex distribution
Age distribution

Pathophysiology

  • The specific pathophysiological link between the two conditions is still to be elucidated.[ncbi.nlm.nih.gov]
  • BACKGROUND: The pathophysiology of acute pericarditis remains largely unknown, and biomarkers are needed to identify patients susceptible to complications.[ncbi.nlm.nih.gov]
  • Pathophysiology The pericardium is a fibrous sac surrounding the heart consisting of two layers: a thin visceral layer attached to the pericardium and a thicker parietal layer.[unboundmedicine.com]
  • […] the heart such as after a heart attack such as Dressler's syndrome. [1] Familial mediterranean fever and TNF receptor associated periodic syndrome are rare inherited autoimmune diseases capable of causing recurring episodes of acute pericarditis. [1] Pathophysiology[en.wikipedia.org]
  • However, the pathophysiologic process leading to cTnI release in myopericarditis is distinctly different from that in patients with acute coronary syndromes, and it is uncertain whether a cTnI elevation carries the same prognostic value.[onlinejacc.org]

Prevention

  • A longer course of colchicine is recommended for the prevention of recurrence of the disease. The use of glucocorticoids should be avoided due to the associated risk of recurrence. Exercise and physical activity are harmful during pericarditis.[ncbi.nlm.nih.gov]
  • The best method to prevent recurrent pericarditis induced by DCF is to use an alternate chemotherapeutic regimen.[ncbi.nlm.nih.gov]
  • However, conclusive data are lacking regarding the use of colchicine during a first attack of acute pericarditis and in the prevention of recurrent symptoms.[ncbi.nlm.nih.gov]
  • Usefulness of colchicine in preventing recurrences of pericarditis. Am J Cardiol . 1994 ; 73 : 916–917. Crossref Medline Google Scholar 10 Millaire A, de Groote P, Decoulx E, Goullard L, Ducloux G.[doi.org]
  • Colchicine is effective and safe for the treatment and prevention of recurrent pericarditis and might ultimately serve as the initial mode of treatment, especially in idiopathic cases.[ncbi.nlm.nih.gov]

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