Presentation
Presents 70 fully illustrated case presentations with teaching points that make information easy to understand and digest. [books.google.de]
Fulminant clinical tamponade presents with symptoms that depend on its etiology. [textbookofcardiology.org]
There may also be PR interval depression – and if both of these are present it is pretty much diagnostic for pericarditis Later there may also be T wave inversion – especially if myocarditis is also present. [almostadoctor.co.uk]
Also, peaked, tall, symmetric T waves are present in V 2 –V 4. PR-segment depression is present in several leads and lateral leads (I, aVL). Fig. 1. [anesthesiology.pubs.asahq.org]
Entire Body System
- Weakness
Heart sounds in general may be weak or sound far away. A buildup of fluid in the covering of the heart or space around the lungs (pericardial effusion) is not common after a heart attack. [medlineplus.gov]
It may produce fever and symptoms of heart failure, such as weakness, fatigue, and difficulty breathing. Cardiac tamponade may occur. Pericarditis can be misdiagnosed as myocardial infarction, and vice versa. [healthguidance.org]
The drop in blood pressure can cause blurred vision, nausea, confusion, and weakness. These indications can establish CT rapidly, and sometimes, even within a minute. Since it is a life-threatening condition, it requires immediate treatment. [news-medical.net]
Cardiomyoplasty : currently an experimental treatment where skeletal muscles are wrapped around the patient body over a weak heart. This will improve the heart's pumping motion when stimulated byb a pacemaker type of device. [physio-pedia.com]
- Acutely Ill Patient
However, this may be due to a severe bias because acutely ill patients may be sent to surgery more often. [circ.ahajournals.org]
Respiratoric
- Pleuritic Pain
The disease consists of a persistent low-grade fever, chest pain (usually pleuritic in nature), pericarditis (usually evidenced by a pericardial friction rub ), and/or a pericardial effusion. [en.wikipedia.org]
Gastrointestinal
- Abdominal Pain
The common symptoms of constrictive pericarditis are: Swelling in the legs and abdomen Shortness of breath Nausea and vomiting Fatigue Abdominal pain In a survey of 10 people with a history of acute pericarditis, it was reported that only one person among [news-medical.net]
Be aware that individuals with pericarditis may also present with a primary symptom of acute abdominal pain. Fevers usually are low grade, but they occasionally reach 104F. [ceufast.com]
Cardiovascular
- Chest Pain
However, acute pericarditis is more likely if inspiration and supine position worsens the chest pain, and sitting upright and leaning forward alleviates the chest pain; the pain in STEMI is unaffected by position. [ecgwaves.com]
Of note, the patient states that after the surgery, he had resolution of his chest pain, but he has started experiencing chest pain again. [medbullets.com]
It is characterized by chest pain, fever, pericarditis with a friction rub, pleurisy, pleural effusion, joint pain, and elevated white blood cell count and sedimentation rate. [medical-dictionary.thefreedictionary.com]
He describes the pain as bilateral, radiating to the left arm, worsening over time, and associated with mild SOB and also some pleuritic chest pain. [hqmeded-ecg.blogspot.com]
- Pericardial Friction Rub
> 95% of cases sudden onset, anterior aspect sharp and pleuritic in nature **increase pain with inspiration or cough *** decreased pain with sitting up or leaning forward May have hx of viral infection Pericardial friction rub in acute pericarditis highly [quizlet.com]
Pericardial pain and pericardial friction rub define early postinfarction pericarditis and usually develop on day 2 or 3 after a transmural myocardial infarction. [ncbi.nlm.nih.gov]
There may be a rubbing sound (called a pericardial friction rub, not to be confused with a heart murmur). Heart sounds in general may be weak or sound far away. [medlineplus.gov]
Typical symptoms include: pleuritic chest pain fever general malaise Typical signs comprise: leukocytosis and raised inflammatory markers pericardial friction rub (murmurs by auscultation) It is common for pericardial effusion to develop but tamponade [radiopaedia.org]
Further, pericardial friction rub, when present, is often evanescent and can be overlooked. [anesthesiology.pubs.asahq.org]
- Heart Disease
diseases I24.0 Acute coronary thrombosis not resulting in myocardial infarction I24.1 Dressler's syndrome I24.8 Other forms of acute ischemic heart disease I24.9 Acute ischemic heart disease, unspecified I25 Chronic ischemic heart disease I25.1 Atherosclerotic [icd10data.com]
Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Pericardial Disease, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD [acc.org]
Code Classification Diseases of the circulatory system ( I00–I99 ) Ischemic heart diseases ( I20-I25 ) Other acute ischemic heart diseases ( I24 ) Version 2019 Billable Code Information for Medical Professionals Diagnostic Related Groups The diagnosis [icdlist.com]
Pericardial diseases. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 83. Little WC, Oh JK. [medlineplus.gov]
Waller BF, Taliercio CP, Howard J, et al. : Morphologic aspects of pericardial heart disease: part II. Clin Cardiol 1992, 15 :291–298. PubMed CrossRef Google Scholar 13. [link.springer.com]
- Retrosternal Chest Pain
Nevertheless, the retrosternal chest pain in acute pericarditis is very similar to that in STEMI. The combination of retrosternal chest pain and ST elevation on ECG explains why clinicians often confuse acute pericarditis and STEMI. [ecgwaves.com]
The most common symptom of acute pericarditis is precordial or retrosternal chest pain, usually described as sharp or stabbing. [ceufast.com]
- Cyanosis
This is accompanied by severe cyanosis of the neck and face and intense jugular ingurgitation. Less clear, however, is the definition of the subacute form, term coined by O'Rourke some years ago in a report of 3 cases (42). [fac.org.ar]
[…] gallop, rales < halfway up lung fields or elevated jugular venous pressure (mortality 17%) Class III: Pulmonary edema (mortality 38%) Class IV: Cardiogenic shock defined as systolic blood pressure < 90 mm Hg and signs of hypoperfusion such as oliguria, cyanosis [healio.com]
Musculoskeletal
- Arthritis
On further review, she endorses a polyarticular arthritis and has had two first-trimester spontaneous abortions. Her vitals are as follows: T 100.9 F, HR 101, BP 115/70, RR 14, SpO2 96% on room air. [medbullets.com]
Post-infarction syndrome is a complex of nonspecific inflammatory lesions of the number of bodies (effusion, pleural effusion, pneumonia, arthritis and other)arising on 2-12 weeks, rarely at a later date, after the onset of myocardial infarction regardless [medicalency.com]
Uncommon causes include collagen vascular diseases (systemic lupus erythematosus, rheumatoid arthritis, scleroderma), radiation, post-myocardial infarction, uremia, aortic dissection, bacterial infection, and pneumopericardium. [acc.org]
Cytomegalovirus Coxsackieviruses Echoviruses HIV Other conditions that can cause these effusions include: Cancer Injury to the sac or heart from a medical procedure Heart attack Severe kidney failure, also called uremia Autoimmune disease ( lupus, rheumatoid arthritis [webmd.com]
Inflammatory pericarditis Only symptomatic rheumatoid arthritis (RA) pericarditis should be treated. However, treat lupus pericarditis with anti-inflammatory agents and optimize systemic lupus erythematosus (SLE) treatment. [emedicine.medscape.com]
- Myalgia
Symptoms Exercise intolerance Fatigue Prodrome (if infectious) Fever Malaise Myalgias VI. [fpnotebook.com]
The ultimate manifestation may be constrictive pericarditis. 4 Diagnosis HISTORY AND PHYSICAL EXAMINATION Patients with acute pericarditis commonly report a prodrome of fever, malaise, and myalgias. [aafp.org]
Workup
Multimodality cardiovascular imaging and diagnostic work-up 4.1 Multimodality imaging 4.1.1 Chest X-ray 4.1.2 Echocardiography 4.1.6 Cardiac catheterization 4.1.7 Multimodality imaging 4.2 Proposal for a general diagnostic workup 5. [escardio.org]
However, a thorough diagnostic workup ruled out myocardial injury, and further evaluation suggested that the patient’s electrocardiographic pattern was caused by a regional or localized pericarditis. [anesthesiology.pubs.asahq.org]
QT, RR, ST Intervals
- ST Elevation
Characteristics of ST elevations in STEMI ST elevation myocardial infarction (STEMI) causes localized ST elevations, meaning that there are ST elevations in a few leads which are anatomically neighbouring (so called contiguous leads ). [ecgwaves.com]
This can lead to ST elevation in all leads. Therefore, it is important to distinguish pericarditis from a myocardial infarction, which has more acute complaints and ST-elevations are limited to the infarct area. [en.ecgpedia.org]
Pericarditis can cause localised ST elevation but there should be no reciprocal ST depression (except in AVR and V1). STEMI, like pericarditis, can also cause concave up ST elevation. Only STEMI causes convex up or horizontal ST elevation. [lifeinthefastlane.com]
Here I have magnified II, III, aVF, and aVL for better comparison: Now the difference in ST segments become more evident: new ST elevation in II, III, and aVF, with reciprocal ST depression in aVL. [hqmeded-ecg.blogspot.com]
[…] doi: 10.1097/01.CCN.0000436381.67253.30 Department: Heart Beats In Brief Author Information Authors Article Metrics Metrics Know the difference between pericarditis and ST elevation myocardial infarction. [journals.lww.com]
T Wave
- Flattened T Wave
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]
Other ECG Findings
- Abnormal ECG
It's the perfect book to turn to for clear and clinically relevant guidance on all of today’s ECG applications. Comprehensively and expertly describes how to capture and interpret all normal and abnormal ECG findings in adults and children. [books.google.com]
Treatment
The goal of treatment is to make the heart work better and reduce pain and other symptoms. [stlukes-stl.com]
Treatment is with aspirin or NSAIDs. [emedicine.medscape.com]
The condition may come back, even in people who get treatment. Untreated pericarditis can be life threatening in some cases. [medlineplus.gov]
Serum cardiac troponin I levels also have been shown to be elevated in some patients. 3 Treatment Overview The treatment of acute pericarditis should be guided by the underlying cause. [uspharmacist.com]
while in severe cases it requires treatment like that of papiilary ms rupture. [slideshare.net]
Prognosis
Pericardial syndromes 3.1 Acute pericarditis 3.1.1 Clinical management and therapy 3.1.2 Prognosis 3.2 Incessant and chronic pericarditis 3.3 Recurrent pericarditis 3.3.1 Therapy 3.3.2 Prognosis 3.4 Pericarditis associated with myocardial involvement [escardio.org]
The prognosis for timely initiation of treatment generally favourable. Without treatment, the possible outcome in adhesive pericarditis. Post-infarction syndrome is not always detected correctly. [medicalency.com]
Prognosis of the disease is excellent, as severe complications are rare. [textbookofcardiology.org]
Supraventricular tachycardias, although less common (less than 10% of post-MI patients) portend a poorer prognosis (in contradistinction to SVT in a non-ischemic setting). Bradydysrythmias in turn carry a poor prognosis after MI. [mededmasters.com]
Etiology
[…] efficiency-limits dilation protect from infection and malignancy autonomically fixes heart Most common disorder involving pericardium Acute pericarditis: 5% of pts presenting in ER with non-ischemic chest pain pathophys: inflammation of pericardial tissue Etiology [quizlet.com]
Pericarditis with an infectious etiology may be preceded by signs and symptoms of infection; by flulike symptoms, for a viral etiology; or, for an autoimmune or malignancy etiology, by exacerbation of symptoms of the underlying disorder. [uspharmacist.com]
Fulminant clinical tamponade presents with symptoms that depend on its etiology. [textbookofcardiology.org]
Needle pericardiocentesis is often best when the etiology is known or the presence of tamponade is in question. Surgical drainage is best when the presence of tamponade is certain but the etiology is unclear. [merckmanuals.com]
The etiology is not well understood, and several possible pathomechanisms have been proposed, including local inflammation, autoimmune response and latent viruses. [radiopaedia.org]
Epidemiology
Epidemiology, aetiology and classification of pericardial diseases 2.1 Epidemiology 2.2 Aetiology 3. [escardio.org]
"Epidemiology and Causes of Heart Failure." Retrieve April 4, 2014 from UpToDate.com [ceufast.com]
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]
Pathophysiology
Chapter topics in the Coronary Care Manual, 2nd Edition include pathophysiology, drug and non-drug therapies and postcoronary management, with chapters organised into subsections. [books.google.de]
This paper reviews the pathophysiology and difficulties in diagnosis of post-myocardial infarction pericarditis and discusses long-term outcome. PubMed Google Scholar 6. [link.springer.com]
Thus, incomplete recanalization of infarct-related coronary artery appears to be a pathophysiological link to hemorrhagic PE and threatening rupture. [circ.ahajournals.org]
Pathophysiology: Pericardial Layers Parietal Pericardium Surrounds heart and limits end diastolic heart volume Closely adhered to the Great Vessel s and has minimal elasticity Pericardial sac Between the two pericardial layers Typically contains less [fpnotebook.com]
Pathophysiology | Physical Examination | Diagnosis | Treatment – Revascularization • Medical Therapy | Complications Introduction ST segment elevation myocardial infarction most commonly occurs when thrombus formation results in complete occlusion of [healio.com]
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]
Medical therapy for specific conditions (e.g., tuberculous pericarditis) is recommended to prevent the progression of constriction. Multimodality imaging. [acc.org]
Early intervention with dialysis may prevent the development of uremic pericarditis. Maintenance of adequate dialysis therapy lessens the likelihood of a patient developing dialysis-associated pericarditis. [emedicine.medscape.com]
Guidelines for prevention of NSAID-related ulcer complications. Am J Gastroenterol. 2009;104:728-738. 30. Grossman JM, Gordon R, Ranganath VK, et al. [uspharmacist.com]
These professionals can also communicate with your primary care doctor or cardiologist. [10] Prevention - Dietary Modification There are alternative/holistic options that can be employed to prevent an MI or additional MIs, which focus around diet and [physio-pedia.com]