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Postcardiac Injury Syndrome


Presentation

  • The data presented document that pleuropulmonary involvement is a common manifestation of postcardiac injury syndrome.[ncbi.nlm.nih.gov]
  • Moreover, it has never been reported that PCIS presenting as mediastinitis occurs after an AMI. Our case is the first case of PCIS presenting as acute mediastinitis.[synapse.koreamed.org]
Surgical Procedure
  • In modern practice, however, most cases of mediastinitis are complications of cardiovascular or thoracic surgical procedures. 11 - 13) The radiologic hallmark of non-postoperative mediastinitis is mediastinal widening on chest X-ray.[synapse.koreamed.org]
  • Therefore, early identification of these patients could allow medical treatment and might help avoid the need for a surgical procedure. Cardiologists should remember that this uncommon syndrome can occur after routine endovascular procedures.[ncbi.nlm.nih.gov]
  • procedures within the preceding weeks. [ citation needed ] Treatment [ edit ] Dressler syndrome is best treated with high dose aspirin.[en.wikipedia.org]
  • procedure (on) T81.9 ICD-10-CM Diagnosis Code T81.9 Unspecified complication of procedure 2016 2017 2018 2019 Non-Billable/Non-Specific Code postcardiotomy syndrome I97.0 postcommissurotomy syndrome I97.0 postvalvulotomy syndrome I97.0 Injury T14.90[icd10data.com]
  • PCIS occurs several days to several months after the surgical procedure. The syndrome manifests itself as exudative pericardial or pleural effusion with low-grade temperature and elevated inflammatory parameters.[termedia.pl]
Candidiasis
  • […] in the ICU 311 Management of Invasive Candidiasis in the Critically Ill 324 Use of Antifungal Drugs during Continuous Hemofiltration Therapies 337 IX Hemodynamic Optimization 345 Guytonian Approach to the Circulation 347 A Way to Individual Goals 357[books.google.com]
Hemophilia A
  • Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious[books.google.com]
Pleural Effusion
  • RECENT FINDINGS: In acute idiopathic pericarditis, pleural effusions tend to be left-sided and, if bilateral, they are usually larger on the left. Less than 5% are unilateral right-sided.[ncbi.nlm.nih.gov]
  • Effusions 230 15 Differentiating Between Benign and Malignant Pleural Effusions 245 16 Clinical Evaluation of the Patient with a Pleural Effusion 258 17 Transudative Pleural Effusions 277 18 Interventional Radiology of Pleural Disease 294 19 DrugInduced[books.google.com]
Pleuritic Pain
  • It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion. Dressler syndrome is also known as postmyocardial infarction syndrome [1] and the term is sometimes used to refer to post-pericardiotomy pericarditis.[en.wikipedia.org]
  • Symptoms include: chest pain that’s worse when lying down chest pain that worsens with deep breathing or coughing (pleuritic pain) fever difficult or labored breathing fatigue decreased appetite Dressler syndrome is difficult to diagnose because its symptoms[healthline.com]
  • Introduction Post pericardiotomy syndrome (PPS) was first described in 1953 in patients who developed fever and pleuritic pain after undergoing mitral valve surgery 1.[acc.org]
  • pain, friction rubs, pleural effusions, pneumonitis, and abnormal ECG and radiography findings (see Workup).[emedicine.medscape.com]
Malignant Pleural Effusion
  • Empyema 342 21 Postsurgical Pleural Infection 380 22 Surgical Management of Empyema 388 23 Malignant Pleural Effusions 399 24 Pleural Effusion in Lung Carcinoma 426 25 Benign Tumors of the Pleura 443 26 Pleurodesis 468 27 Pleuroperitoneal Shunts in Malignant[books.google.com]
Respiratory Distress
  • Inside, you’ll find totally updated coverage of vital topics, such as coagulation and apoptosis in certain critical care illnesses, such as acute lung injury and adult respiratory distress syndrome; sepsis and other serious infectious diseases; specific[books.google.com]
  • distress syndrome 615 CHAPTER 65 Pulmonary hypertension 626 CHAPTER 66 Pulmonary embolism 634 CHAPTER 67 Stroke 645 CHAPTER 68 Acute kidney injury 657 CHAPTER 69 Hyperglycaemia diabetes and other endocrine emergencies 668 CHAPTER 70 Bleeding and haemostasis[books.google.es]
Rales
  • The major clinical findings were pleurisy (91 percent; 32/35), fever (66 percent; 23/35), pericardial rub (63 percent; 22/35), dyspnea (57 percent; 20/35), rales (51 percent; 18/35), pleural rub (46 percent; 16/35), elevated erythrocyte sedimentation[ncbi.nlm.nih.gov]
  • Findings Symptoms typically appear 2-3 weeks following infarct/surgery–sometimes years May last for weeks or months Pleuritic chest pain (91%) Fever Pericardial and pleural effusion Pericardial friction rub Effusions can be bloody and cause tamponade Also rales[learningradiology.com]
Vomiting
  • She returned to hospital a day later with vomiting and fever. She was found to have new atrial fibrillation in addition to right-sided weakness and dysarthria.[ncbi.nlm.nih.gov]
  • The basic symptoms of a syndrome are revealed upon the direct observation of an afflicted individual; these symptoms may include stomach pain, vomiting, muscular tension in the anterior abdominal wall, and Blumberg’s sign, which indicates peritoneal irritation[encyclopedia2.thefreedictionary.com]
Chest Pain
  • The case adds a differential diagnosis to chest pain and malaise following PTCA.[ncbi.nlm.nih.gov]
  • Four hours after the procedure, the patient developed pleuritic chest pain, with a low-grade fever.[amjmed.org]
  • At the time of onset of the chest pain, he was isolated on an island and unable to access transportation for transfer to the hospital.[synapse.koreamed.org]
Heart Disease
  • Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pericardial Disease, Genetic Arrhythmic Conditions, Cardiac Surgery and Arrhythmias[acc.org]
  • Other NSAIDs though once used to treat Dressler syndrome, are less advocated and should be avoided in patients with ischemic heart disease.[en.wikipedia.org]
  • Postpericardiotomy syndrome following surgery for nonrheumatic heart disease. Circulation. 1958;17(4, Part 1):549–56. PubMed CrossRef Google Scholar 6. Kaye D, Frankl W, Arditi LI.[link.springer.com]
  • Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier Saunders; 2019:chap 83. Little WC, Oh JK. Pericardial diseases. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed.[medlineplus.gov]
  • Do you have a history of heart disease? What prescription or over-the-counter medications are you taking? 1998-2019 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. Terms of use[drugs.com]
Retrosternal Chest Pain
Angioedema
  • Blood Transfusion 391 The Meaning of Fluid Responsiveness 393 Respiratory Variation in the Perioperative and Critical Care Settings 402 Think Microcirculation 412 Human Albumin in the Management of Complications of Liver Cirrhosis 421 Bradykininmediated Angioedema[books.google.com]
Dysarthria
  • She was found to have new atrial fibrillation in addition to right-sided weakness and dysarthria. An infarct in the left anterior inferior cerebellar artery territory was later confirmed on CT.[ncbi.nlm.nih.gov]
Akinesia
  • An echocardiographic examination revealed akinesia of the left ventricular septum and severe left ventricular dysfunction.[synapse.koreamed.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]
  • He had extensive testing, including workup for ischemic heart disease. A left heart catheterization was done, revealing non-obstructive coronary artery disease.[cureus.com]
  • […] or late postoperative cardiac tamponade [15] and even recurrent cardiac tamponade. [16] The syndrome is also characterized by pericardial or pleuritic pain, friction rubs, pleural effusions, pneumonitis, and abnormal ECG and radiography findings (see Workup[emedicine.medscape.com]
Pericardial Effusion
  • CONCLUSIONS: More than 25% of patients with small cardiac perforation during catheter ablation may develop PCIS which can be masked by pericardial effusion/tamponade.[ncbi.nlm.nih.gov]
  • Conclusion More than one forth of patients with cardiac perforation during catheter ablation may develop PCIS which can be masked by pericardial effusion/tamponade.[circ.ahajournals.org]
Pulmonary Infiltrate
  • The post cardiac injury syndrome is characterized by the development of a fever, pleuropericarditis, and parenchymal pulmonary infiltrates in the weeks following trauma to the pericardium or myocardium.[ncbi.nlm.nih.gov]
  • Pericardial effusion is common, and there may be pleural effusion with or without pulmonary infiltrates. There is often a latent period of days to weeks between injury and symptom onset.[amjmed.org]
  • infiltrates are occasionally seen.[immunologyresearchjournal.com]
  • It is characterized by chest pain, pericardial rub, fever, high sedimentation rate, pleuritis, pulmonary infiltrates, pericardial effusion and pleural effusion.[brown.edu]
  • Pleural effusions or pulmonary infiltrates may be seen. 9 Malignancy Pericarditis associated with malignancy is caused mainly by metastatic disease.[clevelandclinicmeded.com]
Left Pleural Effusion
  • We report 2 cases of exudative left pleural effusion following radiofrequency catheter ablation of cardiac arrhythmias complicated by cardiac perforation.[ncbi.nlm.nih.gov]
  • Right:Three weeks later, there is a moderately large left pleural effusion (white arrow). There are no other signs of conge st ive heart failure.[learningradiology.com]
ST Elevation
  • Postcardiac injury syndrome Acute Pericarditis After Percutaneous Coronary Intervention Mimicking Inferolateral ST-Elevation Myocardial Infarction January 29, 2013 The authors describe a rare case of postcardiac injury syndrome manifesting as acute pericarditis[invasivecardiology.com]
  • ECG demonstrating global ‘saddle shaped’ ST elevation consistent with pericarditis (C). Chest radiography showing bilateral pleural effusion (D).[amjmed.org]
  • […] for hemodynamically or electrically unstable patients without ST elevation for whom a cardiovascular lesion is suspected.[eccguidelines.heart.org]
  • elevation Diffuse in I, II, and III Originating from S wave Concave upwards Lead V 6 : ST-T amplitude 0.24 mm Focal—vascular territory Originating from R wave Convex upwards ST depression Lead aV R only Present; reciprocal changes to ST elevation according[clevelandclinicmeded.com]
  • "Primary percutaneous coronary intervention and mild induced hypothermia in comatose survivors of ventricular fibrillation with ST-elevation acute myocardial infarction." Resuscitation 74.2 (2007): 227-234. Menegazzi, James J.[derangedphysiology.com]
Pleural Effusion
  • RECENT FINDINGS: In acute idiopathic pericarditis, pleural effusions tend to be left-sided and, if bilateral, they are usually larger on the left. Less than 5% are unilateral right-sided.[ncbi.nlm.nih.gov]
  • Effusions 230 15 Differentiating Between Benign and Malignant Pleural Effusions 245 16 Clinical Evaluation of the Patient with a Pleural Effusion 258 17 Transudative Pleural Effusions 277 18 Interventional Radiology of Pleural Disease 294 19 DrugInduced[books.google.com]

Treatment

  • In spite of receiving anti-inflammatory treatment, the patient developed relapsing PCIS.[ncbi.nlm.nih.gov]
  • Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual.[books.google.com]

Prognosis

  • Although PCIS can follow a relapsing course, it does carry a favorable prognosis.[ncbi.nlm.nih.gov]
  • The prognosis of the PCIS is relatively good for most patients; however, 10 to 15% of cases will experience a recurrence 5 .[immunologyresearchjournal.com]
  • Overall, the prognosis is favorable, although potentially fatal cardiac tamponade has been reported occasionally, and there is an intermediate risk of pericardial constriction (2%-5%) during long-term follow-up.[amjmed.org]
  • 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]
  • Advances in cardiopulmonary resuscitation enable progress in management of post-cardiac arrest syndrome, but the overall prognosis after cardiac arrest has not improved.[e-jnc.org]

Etiology

  • BACKGROUND: Postcardiac injury syndrome (PCIS) is a complication of a variety of cardiac injuries, of which small heart perforation is the etiology that is often unrecognized.[ncbi.nlm.nih.gov]
  • Abstract Background Postcardiac injury syndrome (PCIS) is a complication of a variety of cardiac injuries, of which minor perforation of the heart with a cardiac catheter is a rare, under-recognized etiology.[circ.ahajournals.org]
  • Other tests are performed based on clinical suspicion of a specific etiology or to exclude certain etiologies.[brown.edu]
  • Magnetic resonance imaging (MRI) may be useful when trying to establish the etiology of post-myocardial infarction pericardial effusion. 2.[file.scirp.org]
  • Etiology The most common form of acute pericarditis is idiopathic, which accounts for about 90% of cases ( Box 1 ).[clevelandclinicmeded.com]

Epidemiology

  • The epidemiology of the postpericardiotomy syndrome: A common complication of surgery. American Heart Journal, 116 , 1323–1329. PubMed CrossRef Google Scholar 5. Hargreaves, M., & Bashir, Y. (1994).[link.springer.com]
  • Epidemiology, aetiology and classification of pericardial diseases 2.1 Epidemiology 2.2 Aetiology 3.[escardio.org]
  • Risk Factors for PPS The earliest epidemiologic study aimed at identifying those at risk of PPS included 994 patients who underwent cardiothoracic surgery at Johns Hopkins between November of 1984-1985 12.[acc.org]
  • CHAPTER 48 Coronary artery bypass graft surgery 430 CHAPTER 49 Cardiogenic shock in patients with acute coronary syndromes 441 CHAPTER 50 Gender considerations in acute coronary syndromes 449 SECTION VII Acute heart failure 457 epidemiology classification[books.google.es]
  • Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication.[cambridge.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of PCIS involves auto-antibodies that target antigens exposed after damage to cardiac tissue. The treatment of PCIS includes the use of nonsteroidal anti-inflammatory drugs and corticosteroids.[ncbi.nlm.nih.gov]
  • Postcardiac injury syndrome is presumed to have autoimmune pathophysiology, triggered by the damage of pericardial or pleural mesothelial cells. 2 The syndrome is characterized by an acute pleuropericarditis consisting of fever, pleuritic chest pain,[amjmed.org]
  • Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation. Circulation. 2008 Dec 2;118(23):2452-83.[lifeinthefastlane.com]
  • Although this matter is not recent, the pathophysiology of post-arrest adrenal insufficiency has not been elucidated.[wjgnet.com]
  • Post-cardiac arrest syndrome, a new term proposed by the authors of the statement, “is a unique and complex combination of pathophysiological processes,” they said.[mdedge.com]

Prevention

  • Prophylactic use of corticosteroids before cardiac surgery has not been effective in preventing PCIS. The widespread use of reperfusion therapy and cardiac medications with anti-inflammatory properties may have reduced the incidence of PCIS.[ncbi.nlm.nih.gov]
  • Several strategies (aspirin, corticosteroids, colchicine) have beenexamined in clinical trials for primary prevention of post-pericardiotomy syndrome 22 .In the COlchicine for the Prevention of the Post-pericardiotomy Syndrome (COPPS) trial colchicine[immunologyresearchjournal.com]
  • The postoperative use of colchicine is also a reasonable option for preventing PCIS in patients who have undergone cardiac surgery. Summary Pleural effusions because of pericardial diseases remain a clinical diagnosis.[ingentaconnect.com]
  • Adjunctive use of colchicine may prevent recurrences.[amjmed.org]

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