Presentation
Focuses on aspects of pathophysiological processes, clinical presentations, screening tests, prognostic implications and novel therapeutic approaches. [books.google.com]
Typical presentations of the disease include episodes of fever, abdominal pain and joint pains. Chest pain is a less common presentation. [um.edu.mt]
The case Presented by: Alexandros Protonotarios MD, Adalena Tsatsopoulou MD and Aris Anastasakis MD, PhD Case presentation A 43 year-old man presented due to his 14-year-old daughter’s sudden death. Post mortem diagnosis was myocarditis. [escardio.org]
(in 85% of patients) Absent (unless pericarditis is present) Rare; a pleural friction rub is present in 3% of patients S 3 sound, pulmonary congestion Absent May be present Absent Table 4. [aafp.org]
Symptoms usually begin in most patients between preschool and adolescence, but this disease is present throughout the patient's life. [autoinflammatory.org]
Entire Body System
- Pain
[…] spleen, pain, adult onset, chest pain, appendix, appendicitis, amyloid, SAA [autoinflammatory-search.org]
Chest Pain: Chest pain is one of the most common symptoms of peric arditis. This pain is caused by heart rubbing against the inflamed pericardium. Usually the pain starts in the middle of the chest right behind the breast bone. [pericarditispain.info]
Pericarditis, an inflammation of the membrane surrounding the heart, would also be felt as chest pain. Joint pain: About 50 percent of people with FMF experience joint pain during attacks. [healthofchildren.com]
(left chest) pain Crushing, pressure-like, heavy pain. [en.wikipedia.org]
The main symptom is a sharp pain in the center or left side of your chest. The pain may spread to the shoulder blade. For some people, this pain is dull instead of sharp. It may be worse when you lie down or take a deep breath. [northshore.org]
- Severe Pain
Complications include severe pain, fever, infection and atrial dysrhythmias. Success rates are reported as >90% at 30 days. [ 12 ] Resistant neoplastic processes may require intrapericardial treatment. Complications Pericardial tamponade. [patient.info]
For patients intolerant to oral administration, refractory or with severe pain, temporary intravenous administration of an non-steroidal anti-inflammatory drug or corticosteroid may be considered. [revespcardiol.org]
Abdominal pain: Nearly all people with FMF experience abdominal pain at one point or another, and for most it is the most common complaint. The pain can range from mild to severe and can be diffuse or localized. [healthofchildren.com]
- Atrial Septal Defect
[…] hypertrophy (ASH)非対称性心室中隔肥大 asymptomatic無症候性 【形】 asynergy壁運動異常〈心筋の〉、アシナジ asystole収縮停止(心不全) atheromaアテローム、粥腫 atherosclerosis アテローム[性]動脈硬化[症]、粥状硬化[症] atresia閉鎖 atrial心房[性]の 【形】 atrial septal defect 心房中隔欠損症 atrioventricular (AV) block房室ブロック atrioventricular [tokyo-med.ac.jp]
septal defect closure, closure of the atrial appendage, etc). 22 It is secondary to an “attack” of pericardial mesothelial cells and/or bleeding, however small in the pericardial cavity, which would trigger an autoimmunity reaction in susceptible patients [dovepress.com]
- Cushingoid
On physical exam he is cushingoid in appearance, and has no evidence of synovitis. He remains chest pain free as long as he is on prednisone 10 mg daily or higher doses. [acc.org]
- Recurrent Infection
Anakinra may also have a role in patients who have failed NSAIDs and colchicine and have contra-indications to corticosteroid use (history of diabetes, osteoporotic fractures, recurrent infections, etc.). [journal.frontiersin.org]
Cardiovascular
- Chest Pain
The chest pain may feel like pain from a heart attack and, thus, if you have chest pain, you should call 9-1-1 right away. [cormedicalgroup.com]
(left chest) pain Crushing, pressure-like, heavy pain. [en.wikipedia.org]
Chest injury. Recent heart surgery. Certain diseases, such as cancer, lupus, or tuberculosis. In many cases, the cause is not known. What are the symptoms? The main symptom is a sharp pain in the center or left side of your chest. [northshore.org]
Chest Pain: Chest pain is one of the most common symptoms of peric arditis. This pain is caused by heart rubbing against the inflamed pericardium. Usually the pain starts in the middle of the chest right behind the breast bone. [pericarditispain.info]
Pericarditis was diagnosed when patients sustained attacks of pleuritic retrosternal chest pain and had typical findings in the electrocardiogram, echocardiogram or chest radiogram. [ncbi.nlm.nih.gov]
- Pericardial Friction Rub
A pericardial friction rub is audible at some point in about 85% of patients with acute pericarditis, may have up to three components per cardiac cycle, is high-pitched, and is described as rasping, scratching, or grating ( Chap. 267 ). [accessmedicine.mhmedical.com]
[…] a pericardial friction rub and thus allows differentiation from a pleural rub. [aafp.org]
friction rub, typical electrocardiographic changes, and pericardial effusion. [utswim.wordpress.com]
A pulsus paradoxus in patients with a pericardial effusion helps distinguish those with cardiac tamponade from those without. [ 7 ] Pericardial friction rub: the most important physical sign of acute pericarditis. [patient.info]
It was managed with small doses of prednisone ( Discussion RP is a chronic disease characterized by recurrent episodes of fever, chest pain, pericardial friction rubs, electrocardiographic changes, and pericardial effusion. [pediatrics.aappublications.org]
- Retrosternal Chest Pain
Pericarditis was diagnosed when patients sustained attacks of pleuritic retrosternal chest pain and had typical findings in the electrocardiogram, echocardiogram or chest radiogram. [ncbi.nlm.nih.gov]
Features That Differentiate Acute Pericarditis from Myocardial Ischemia or Infarction and Pulmonary Embolism Symptom and clinical finding Acute pericarditis Myocardial ischemia or infarction Pulmonary embolism Chest pain Location Retrosternal Retrosternal [aafp.org]
Psychiatrical
- Fear
Amyloidosis The most severe and feared complication of FMF is the development of amyloidosis. This may occur in the setting of inadequately controlled disease and/or persistently elevated serum inflammatory markers. [clinicaladvisor.com]
Neurologic
- Hyperactivity
[…] to the caspase 1) dependent processing and secretion of the pro-inflammatory cytokines (such as interleukin-18 (IL-18) and IL-1β) is a response to enterotoxins from certain bacteria. [13] The gain-of-function mutations in the MEFV gene render Pyrin hyperactive [en.wikipedia.org]
[…] isolated recurrent pericarditis. 34 The identification of these patients means that their treatment can be adapted specifically: anakinra, a recombinant IL-1 receptor antagonist, is very effective due to the increased secretion of IL-1, secondary to hyperactivity [dovepress.com]
Workup
The objective of this article is to review the etiology, workup, and treatment for this disease, especially new, emerging therapeutic options. [dovepress.com]
X-Ray
- Pericardial Effusion
pericardial effusion in HIV patients. [patient.info]
The pericardial effusion improved gradually, allowing prednisone tapering after 2 weeks. Eleven weeks after surgery, the pericardial effusion was resolved and prednisone was stopped. [pediatrics.aappublications.org]
Therefore, in children presenting with massive pericardial effusion, FMF should be considered as one of the differential diagnoses. [journals.lww.com]
Since echocardiography is a non-invasive and sensitive tool for the detection of pericardial effusion, we undertook an echocardiographic study to assess the exact frequency of pericardial effusions during attacks of FMF. [heart.bmj.com]
Pericardial involvement is frequent in persons with HIV, but is usually an asymptomatic pericardial effusion of small volume. [emedicine.medscape.com]
Microbiology
- Streptococcus Pneumoniae
Pneumonia due to Streptococcus pneumoniae. 2016 2017 Billable/Specific Code. J13 is a billable/specific ICD-10-CM.The two major categories are community acquired pneumonia (CAP) and health care associated pneumonia (HCAP). [tihalipijeweduzemu.xpg.uol.com.br]
Streptococcus pneumoniae (in children) Syphilis Tuberculosis Whipple disease Fungal Aspergillosis Blastomycosis Candida Coccidioidomycosis Histoplasmosis Other Parasitic Protozoal Noninfectious Acute idiopathic* Acute myocardial infarction* Neoplastic [aafp.org]
Organisms that have been isolated include gram-positive species such as Streptococcus pneumoniae and other Streptococcus species and Staphylococcus. [14] Isolated gram-negative species include Proteus, Escherichia coli, Pseudomonas, Klebsiella, Salmonella [emedicine.medscape.com]
- Staphylococcus Aureus
aureus was the responsible agent in four of five cases of purulent pericarditis; all five patients also had concurrent infection of the soft tissue, bone, lung, or other. [emedicine.medscape.com]
QT, RR, ST Intervals
- ST Elevation
Stage II: normalization of the ST and PR segments Stage III: diffuse T-wave inversions Stage IV: normalization of the T-waves ST-elevation MI v Pericarditis ST-segments are concave (as opposed to the convex or dome-shaped ST-elevations seen in MI) Ratio [utswim.wordpress.com]
Note the ST elevation in multiple leads with slight reciprocal ST depression in aVR. [en.wikipedia.org]
Recurrent pericarditis usually presents with symptoms akin to the acute attack, including chest pain, fever, pericardial rub, typical electrocardiographic findings (i.e. diffuse ST elevations and PR depressions), pericardial effusion and, infrequently [clinicalcorrelations.org]
He described positional chest pain, and was found to have diffuse ST elevations on ECG, along with moderate pericardial effusion on echocardiogram and elevated inflammatory markers. He was initially treated with NSAIDs and colchicine with relief. [acc.org]
In the natural evolution, four stages are described: - Stage I (80% of cases): concave up ST with anterior and inferior elevation. [scielo.br]
Treatment
To the Editor: We read with great interest the article by Adler et al regarding colchicine treatment for recurrent pericarditis. 1 The authors described 51 patients from Israel, Spain, and the United States. [circ.ahajournals.org]
During colchicine treatment, only 7 of the 51 patients had recurrences. In addition, the symptom-free period was significantly longer after starting colchicine treatment: 3.1 months vs 43 months. [clevelandclinicmeded.com]
[…] discontinuation of treatment. [dovepress.com]
Prognosis
Prognosis is excellent with treatment. Familial Mediterranean fever (FMF) is a disease of people with genetic origins in the Mediterranean basin, predominantly Sephardic Jews, North African Arabs, Armenians, Turks, Greeks, and Italians. [msdmanuals.com]
The prognosis depends on many factors, such as the severity of the underlying condition; although in most cases with appropriate treatment, it is good Non-Infectious Pericarditis, in some cases, can become a chronic condition. [dovemed.com]
The course of these manifestations varies widely, but it can associate with poor prognosis in some cases such as with pulmonary hypertension. [avicennajmed.com]
One study showed myocardial involvement may portent a better prognosis in terms of recurrence risk. [acc.org]
Indicators of poor prognosis of acute pericarditis. Circulation. 2007;115:2739-2744. [ Links ] Imazio M, Brucato A, Maestroni S, Cumetti D, Dominelli A, Natale G, Trinchero R. [scielo.br]
Etiology
Incidence of specific etiology and role of methods for specific etiologic diagnosis of primary acute pericarditis. Am J Cardiol. 1995;75(5):378–382. 13. Ginzton LE, Laks MM. [aafp.org]
R5 In conclusion, we generally accept that genetic studies of FMF should be carried out in patients with recurrent episodes of pericarditis of unknown etiology, especially patients of Mediterranean origin. [circ.ahajournals.org]
Evidence of Autoimmune Etiology Multiple lines of evidence suggest an immune-mediated etiology to IRP. [acc.org]
Etiology The cause of pericarditis is very often investigated in the acute phase, and among the different publications, it is difficult to distinguish etiological research between acute and recurrent pericarditis. 12 A recent prospective study on 933 [dovepress.com]
Consider rheumatic fever as an etiology in any child with pericarditis. However, this disease is not a demonstrated cause of constrictive pericarditis. [emedicine.medscape.com]
Epidemiology
[…] certificates, autopsies, and the role of the medical examiner Presents 25 case studies from the author’s experience to illustrate concepts, including cardiac trauma, vascular abnormalities, specific cardiopathic disorders, and toxic, physical, technical, epidemiological [books.google.com]
Epidemiology [ 1 ] Small pericardial effusions are often asymptomatic and pericardial effusion has been found in 3.4% of general autopsy studies. [ 1 ] Studies in the pre-highly active antiretroviral therapy (HAART) era reported an incidence of 11% of [patient.info]
Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention [books.google.ro]
[…] with colchicine-resistant FMF and in two additional autoinflammatory recurrent fever syndromes: mevolonate kinase deficiency (hyper- immunoglobulin D syndrome, or HIDS ) and tumor necrosis factor receptor-associated periodic syndrome ( TRAPS ). [19] Epidemiology [en.wikipedia.org]
Pathophysiology
Focuses on aspects of pathophysiological processes, clinical presentations, screening tests, prognostic implications and novel therapeutic approaches. [books.google.com]
In this article, In this article, we will discuss the incidence, pathophysiology, and prognosis of the various cardiac manifestations affecting FMF patients. [avicennajmed.com]
They are most often “idiopathic”, with a still incompletely understood pathophysiology, involving autoimmunity and autoinflammation of various degrees, and usually set off by microbacteriological or postinjury triggers. [dovepress.com]
Van Sickle Pathophysiology of Osteochondrosis Osteochondrosis of the Cervical Intervertebral Joints.Since a large number of organisms can produce pneumonia, a physician can often arrive at a more rapid microbiological diagnosis if the pathogens are grouped [tihalipijeweduzemu.xpg.uol.com.br]
Prevention
Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]
Prevention conference V: Beyond secondary prevention : Identifying the high-risk patient for primary prevention: executive summary. [books.google.ro]
Shortly thereafter colchicine use has been expanded to the primary prevention of recurrences in patients with a first episode of pericarditis depicting similarly good results. [ncbi.nlm.nih.gov]
This in turn prevents intracellular movement and secretion of proinflammatory substances resulting in less inflammation and its sequelae. [clinicalcorrelations.org]
[…] recurrent pericarditis, in view of its ability to prevent polyserositis in familial Mediterranean fever. [clevelandclinicmeded.com]