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
- Pain
The pain may be sharp, tight or crushing and may move to the neck, shoulder, or abdomen. The pain may also be worse when you breathe and go away when you lean forward, stand, or sit up. [stlukes-stl.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]
Acute pericarditis causes chest pain, which may be very difficult to discern from pain caused by acute myocardial infarction. [ecgwaves.com]
> 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]
- Asymptomatic
If not-asymptomatic Fatigue Dyspnea Edema JVD Chest pain EKG finding in pericardial effusion Low QRS voltage Limb leads < 5mm Chest leads < 10mm May consider amyloidosis, pericardial dx, lung dx or thick chest wall **Also has electrical alternans Electrical [quizlet.com]
Asymptomatic pericardial effusions do not require specific therapy nor do they absolutely contraindicate the use of anticoagulation as was previously thought. The preferred form of therapy for early postinfarction pericarditis is aspirin. [ncbi.nlm.nih.gov]
Asymptomatic mild pericardial effusion ( Chronic pericardial effusion Pericardial effusion is considered chronic when moderate to large effusions persist for at least 3 months. [textbookofcardiology.org]
Never do any thing on a totally asymptomatic and fully functional patient.(Functional, means good exercise capacity of atleast( 10Mets).Just medical treatment with good doses of statins, beta blockers will do. [drsvenkatesan.com]
Most of the time it is asymptomatic, but if it starts to interfere with ventricular filling, then we say constrictive pericarditis is present. [almostadoctor.co.uk]
- Malaise
Symptoms: Chest pain (aggravated by movement of trunk, inspiration, coughing [i.e. pleuritic]; relieved by sitting up [i.e. positional]); fever, malaise, etc. [forums.studentdoctor.net]
Clinically, post-myocardial infarction syndrome is manifested by fever, malaise, chest pain, and the presence of a pericardial and possibly pleuropericardial friction rub. [ncbi.nlm.nih.gov]
[…] post-cardiac injury syndrome, postcardiotomy pericarditis Cardiology A post-MI pericarditis that develops from 2 days to 11 wks after an acute MI in up to 4% of Pts, open heart surgery, stab wounds to the heart, or blunt chest trauma Clinical Severe malaise [medical-dictionary.thefreedictionary.com]
Trouble breathing Dry cough Fast heart rate (tachycardia) Fatigue Fever (common with the second type of pericarditis) Malaise (general ill feeling) Splinting of ribs (bending over or holding the chest) with deep breathing The health care provider will [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]
- 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]
- Atrial Septal Defect
septal defect as current complication following acute myocardial infarction I23.2 Ventricular septal defect as current complication following acute myocardial infarction I23.3 Rupture of cardiac wall without hemopericardium as current complication following [icd10data.com]
Respiratoric
- Dyspnea
[…] postinfarction pericarditis acute pericarditis developing within one week after myocardial infarction, manifested as pericardial pain, dyspnea, and a pericardial rub. Medical dictionary. 2011. [medicine.academic.ru]
If not-asymptomatic Fatigue Dyspnea Edema JVD Chest pain EKG finding in pericardial effusion Low QRS voltage Limb leads < 5mm Chest leads < 10mm May consider amyloidosis, pericardial dx, lung dx or thick chest wall **Also has electrical alternans Electrical [quizlet.com]
On hospital day 3, she developed dyspnea and pulmonary edema and was found to have pericardial effusion on a transthoracic echocardiogram (TTE). [neurology.org]
Revascularisation is non controversial in patients with angina In patients with primary symptoms of dyspnea, it is less effective and documentation of myocardial viabilty per se will not guarantee successful outcome following revascularisation.Out come [drsvenkatesan.com]
Prolonged elevation of pulmonary venous pressure results in dyspnea (particularly during exertion) and orthopnea. Fatigue may be severe. [merckmanuals.com]
- Yawning
By Richard Klasco, M.D Photo Credit Ask Well Photo Credit Why Do We Yawn? Reading about yawning makes people yawn. You are probably yawning right now. By Roni Caryn Rabin Latest Search Latest Articles Search Articles 13845 results for sorted by [nytimes.com]
Gastrointestinal
- Failure to Thrive
Fred Ferri’s popular "5 books in 1" format provides quick guidance on menorrhagia, Failure to Thrive (FTT), Cogan’s syndrome, and much more. [books.google.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]
- Hypertension
The incidence of diabetes is not particularly high in contrast with the increased incidence of arterial hypertension, which is often higher than 50%, (1,5,6,9,18,20). [fac.org.ar]
Risk factors include female gender, hypertension, first MI, and poor coronary collaterals. Cardiac rupture most commonly occurs in the lateral wall. [mededmasters.com]
[…] forms of pericardial disease 5.8.1 Radiation pericarditis 5.8.2 Chylopericardium 5.8.3 Drug-related pericarditis and pericardial effusion 5.8.4 Pericardial effusion in metabolic and endocrine disorders 5.8.5 Pericardial involvement in pulmonary arterial hypertension [escardio.org]
The patient has a history of insulin-controlled diabetes, hypertension, and hyperlipidemia. 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]
Women typically experience other symptoms such as SOA, nausea and vomiting, and neck or jaw pain. [3] Associated Co-morbidities Associated Co-morbidities for Myocardial Infarction include: Hypertension Coronary Artery Disease (CAD) Congestive Heart Failure [physio-pedia.com]
- Thrombosis
ICD-10-CM Diagnosis Code I21 Acute myocardial infarction 2016 2017 2018 - Revised Code 2019 Non-Billable/Non-Specific Code Includes cardiac infarction coronary (artery) embolism coronary (artery) occlusion coronary (artery) rupture coronary (artery) thrombosis [icd10data.com]
Plaque rupture and plaque erosion (ulceration) can result in coronary thrombosis. STEMI is most often from coronary thrombosis after plaque rupture and less often from fixed obstruction. [healio.com]
Thrombosis and embolic complications Deep vein thrombosis and pulmonary embolism are now relatively uncommon after infarction, except in patients kept in bed because of heart failure. [patient.info]
This is especially significant with drug eluting stent (DES) implantation, where adequate inhibition of platelet aggregation is paramount to preventing stent thrombosis. [bmccardiovascdisord.biomedcentral.com]
Simultaneous Very Late Stent Thrombosis in Multiple Coronary Arteries. Texas Heart Institute Journal. (2012, Oct), cited February 15, 2013; 39(5): 630-634. Available from: Academic Search Premier. [physio-pedia.com]
Psychiatrical
- Suggestibility
A ratio of > 0.25 suggests pericarditis A ratio of < 0.25 suggests BER Example 1 Benign Early Repolarisation ST segment height = 1 mm T wave height = 6 mm ST / T wave ratio = 0.16 The ST / T wave ratio < 0.25 is consistent with BER. [lifeinthefastlane.com]
Access full-color images and 65 online-only topics at Expert Consult, as well as online-only contents including EBMs, Suggested Reading, Patient Teaching Guides, and additional algorithms. [books.google.com]
However, the frequency of patients with ECG signs suggestive of pericarditis (60%) was significantly higher in the inflammation group compared with the effusion group (34%), and the normal group (17%). [imaging.onlinejacc.org]
Cardiac catheterization, right and left sided, is done if clinical and echocardiographic findings suggest constrictive pericarditis. [merckmanuals.com]
Returning to our patient: Although acute myocardial infarction (A) is possible her acute change in presentation and previously history are suggestive of something more. [mededmasters.com]
Neurologic
- Stroke
It is, however, listed as a relative exclusion criterion in the current AHA stroke guidelines. [neurology.org]
[…] from scarring and subsequent loss of elasticity of pericardial sac Pathophys of constrictive pericarditis end stage inflammatory state of pericardium rigid pericardium does not allow decrease in intrathoracic pressure during inspiration REDUCTION IN STROKE [quizlet.com]
Embolization of this thrombus can cause a stroke. [healio.com]
This patient developed these life-threatening bleeding complications despite having no contraindication to prasugrel in terms of age, body weight or previous bleeding episodes/stroke. [bmccardiovascdisord.biomedcentral.com]
(AHA Heart Disease and Stroke Statistics Update 2008, 2010). [ceufast.com]
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]
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]