Edit concept Question Editor Create issue ticket

Suppurative Pericarditis

Purulent Pericarditis


Presentation

  • We present a case of a previously healthy 31-year-old Hispanic man with bicuspid aortic valve who developed severe bivalvular pneumococcal endocarditis complicated by suppurative pericarditis that was promptly treated with antimicrobial therapy and subsequent[ncbi.nlm.nih.gov]
  • A systematized diagnostic approach to moderate pericardial effusion is presented, together with a review of purulent pericarditis.[semanticscholar.org]
  • The patient presented no constrictive pattern on TTE at 12-month follow-up.[revportcardiol.org]
  • Infections in various body systems are considered, with emphasis on differing presentations and diagnostic difficulties, ways of improving diagnostic skills as well as management and treatment.[books.google.com]
Fatigue
  • Cardiac tamponade Patients may present subacutely with symptoms of anxiety, dyspnea, fatigue, or altered mental status.[odlarmed.com]
  • Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety. Due to its similarity to the pain of myocardial infarction (heart attack), pericarditis can be misdiagnosed as a heart attack.[en.wikipedia.org]
  • During recovery, rest periods are planned and the person is urged to avoid fatigue and exposure to upper respiratory infections. The patient is told to report symptoms of recurrence, including fever, chest pain, and dyspnea.[medical-dictionary.thefreedictionary.com]
  • Pericardial tamponade Patients may present subacutely with symptoms of anxiety, dyspnea, fatigue, or altered mental status.[emjournal.net]
  • Many patients note undue fatigue. The chest discomfort noted with acute pericarditis, as well as orthopnea and paroxysmal nocturnal dyspnea, does not usually occur in individuals with constrictive pericarditis. Physical examination.[tele.med.ru]
Tachypnea
  • The patient exhibited tachypnea (34 breaths/min) and tachycardia (134 bpm). Auscultation revealed decreased breath sounds in both lung bases, with crackles on the left.[ncbi.nlm.nih.gov]
  • On examination the patient was diaphoretic and pale, with jugular venous distention, distant heart tones, tachypnea, tachycardia and hypotension.[ispub.com]
  • Tachypnea and dyspnea: Dyspnea is a frequent complaint and may be severe with myocarditis, pericarditis, and tamponade.[odlarmed.com]
  • If left heart is unable to receive the blood, it can lead to congestion of vessels in the lungs, causing the dyspnea, cough, orthopnea and tachypnea etc.[drnajeeblectures.com]
  • Fever Cardiac arrhythmias Tachypnea Distended jugular neck veins (DJV) Cyanosis Relative or absolute hypotension Ewart's sign (dullness and bronchial breathing between the tip of the left scapula and the vertebral column) Varying degrees of consciousness[emjournal.net]
Orthopnea
  • If left heart is unable to receive the blood, it can lead to congestion of vessels in the lungs, causing the dyspnea, cough, orthopnea and tachypnea etc.[drnajeeblectures.com]
  • In severe cases, patients may complain of dyspnea, mild-to-moderate chest discomfort, pleuritic chest pain, edema, cough, or orthopnea.[atsu.edu]
  • The chest discomfort noted with acute pericarditis, as well as orthopnea and paroxysmal nocturnal dyspnea, does not usually occur in individuals with constrictive pericarditis. Physical examination.[tele.med.ru]
Painful Cough
  • Case 4 A 57-year-old male presented with fever (38.9 C), chest pain, cough, and progressive dyspnea. The patient exhibited tachypnea (34 breaths/min) and tachycardia (134 bpm).[ncbi.nlm.nih.gov]
Decreased Breath Sounds
  • Auscultation of the thorax showed decreased breath sounds in the right lung and crackles in the left lung base.[ncbi.nlm.nih.gov]
Recurrent Chest Pain
  • Early complaints of constrictive pericarditis are shortness of breath on exertion, recurrent chest pain and or symptoms of right-sided heart failure with venous congestion, hepatomegaly, ascites and oedema [ 2 ].[biomedsearch.com]
Chest Pain
  • Early complaints of constrictive pericarditis are shortness of breath on exertion, recurrent chest pain and or symptoms of right-sided heart failure with venous congestion, hepatomegaly, ascites and oedema [ 2 ].[biomedsearch.com]
  • […] pleuritic chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back) is the characteristic pain of pericarditis.[en.wikipedia.org]
  • The classic history is positional, pleuritic chest pain radiating to the trapezius muscles. The pain is worsened by lying flat and relieved sitting forward.[thesgem.com]
  • Pericardial effusion - the buildup of fluid in the sac Cardiac tamponade - a serious problem in which buildup of fluid in the sac causes problems with the function of the heart Symptoms of pericardial problems include chest pain, rapid heartbeat, and[icdlist.com]
  • Case 4 A 57-year-old male presented with fever (38.9 C), chest pain, cough, and progressive dyspnea. The patient exhibited tachypnea (34 breaths/min) and tachycardia (134 bpm).[ncbi.nlm.nih.gov]
Tachycardia
  • Pain also results in an increase in sympathetic nervous system activities, which is manifested by tachycardia, hypertension, and increased oxygen consumption; this latter condition predisposes the patient to myocardial ischemia.[biomedsearch.com]
  • Upon admission, the patient presented with respiratory distress, fever, tachycardia and increased oxygen requirements, which was explained by a septic pattern of pulmonary origin and pericarditis.[revistas.unal.edu.co]
  • The patient exhibited tachypnea (34 breaths/min) and tachycardia (134 bpm). Auscultation revealed decreased breath sounds in both lung bases, with crackles on the left.[ncbi.nlm.nih.gov]
  • On examination the patient was diaphoretic and pale, with jugular venous distention, distant heart tones, tachypnea, tachycardia and hypotension.[ispub.com]
  • (Tachycardia tires heart muscle causing cardiomegaly BAD) Not too slow.[ceufast.com]
Pericardial Friction Rub
  • On exam there are two important diagnostic findings: a pericardial friction rub, and a pericardial effusion on bedside U/S.[thesgem.com]
  • The physical exam may demonstrate: a pericardial friction rub classically triphasic, two components in diastole and one in systole may be transient signs of tamponade classically Beck's triad, with jugular venous distension, hypotension, and muffled heart[radiopaedia.org]
  • Physical Pericarditis Pericardial friction rub: The most common and important physical finding is a pericardial friction rub, which is best heard at the lower left sternal border or apex when the patient is positioned sitting forward or on hands and knees[odlarmed.com]
  • There is often a pericardial friction rub with serial changes on the electrocardiogram. In dry pericarditis the friction rub is distinct, caused by deposits of fibrin, and may be heard through a stethoscope.[medical-dictionary.thefreedictionary.com]
  • Clinically, most striking feature is loud pericardial friction rub. c) Suppurative pericarditis - almost invariably denotes invasion by infective organisms which reach the pericardial cavity by several routes: direct extension from neighboring inflammation[medpreponline.com]
Retrosternal Chest Pain
  • The common clinical presentation involves; pyrexia, retrosternal chest pain and breathlessness.[jstcr.org]
  • chest pain, usually described as sharp or stabbing.[odlarmed.com]
  • Case Scenario: 33 year-old woman presents to emergency department with sharp retrosternal chest pain which is pleuritic in nature. Well’s low and PERC negative. ECG consistent with acute pericarditis. Other lab investigations normal.[thesgem.com]
  • Sex : Pericarditis, Male Female Age : Pericarditis, predominant in adolescents and young adults CLINICAL History: Pericarditis The most common symptom of acute pericarditis is precordial or retrosternal chest pain, usually described as sharp or stabbing[emjournal.net]
  • The most common symptom of acute pericarditis is precordial or retrosternal chest pain, usually described as sharp or stabbing.[ceufast.com]
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]
  • Although most pericardial disorders in pregnant women with Pericarditis during pregnancy are managed throughout the 9 months, a follow up is highly recommended to ensure the disorder has been taken care of.[pericarditispain.info]
Responsiveness Decreasing
  • On the third day after admission, the clinical condition of the patient worsened and treatment was therefore started with methylprednisolone (1 mg/kg per day), which initially produced a promising response (decrease in the serum C-reactive protein level[ncbi.nlm.nih.gov]

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]
  • INTRODUCTION CLINICAL WORKUP TREATMENT MEDICATION FOLLOW-UP MISCELLANEOUS BIBLIOGRAPHY. INTRODUCTION Background : Pericarditis and cardiac tamponade are clinical problems involving the potential space surrounding the heart or pericardium.[emjournal.net]
Pericardial Effusion
  • A systematized diagnostic approach to moderate pericardial effusion is presented, together with a review of purulent pericarditis.[semanticscholar.org]
  • Cytological and biochemical evaluation of pericardial effusion can help to obtain a diagnosis.[revistas.unal.edu.co]
  • Echocardiogram showed a large pericardial effusion, CT scan ruled out lung and mediastinal infection.[researchers.unab.cl]
Right Pleural Effusion
  • At admission, a chest X-ray revealed right pleural effusion and a CT scan showed right pleural effusion with collapse of the right lower and middle lobes associated with extensive effusion.[ncbi.nlm.nih.gov]
  • Thoracic CT following pericardiocentesis showed a moderate PE, a small right pleural effusion and an area of parenchymal condensation in the superior and posterior segments of the left lower lobe, with air bronchograms, highly suggestive of inflammation[revportcardiol.org]
Air Bronchogram
  • Thoracic CT following pericardiocentesis showed a moderate PE, a small right pleural effusion and an area of parenchymal condensation in the superior and posterior segments of the left lower lobe, with air bronchograms, highly suggestive of inflammation[revportcardiol.org]
Bilateral Pulmonary Opacities
  • A chest X-ray showed an enlarged cardiac silhouette and bilateral pulmonary opacities ( Figure 3 A). An echocardiogram revealed massive pericardial effusion with signs of cardiac tamponade.[ncbi.nlm.nih.gov]
Cardiomegaly on Chest X-ray
  • From the signs of heart failure and cardiomegaly on chest X-ray the differential diagnosis of myocardial disease or pericardial effusion was made.[ncbi.nlm.nih.gov]
Gram-Positive Bacteria
  • Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.[ncbi.nlm.nih.gov]
ST Elevation
  • Initial electrocardiogram (ECG) revealed a sinus tachycardia and subtle saddle shaped ST elevation in V3 to V6. Chest radiograph (CXR) was unremarkable and a troponin level was Analgesia was given and he was observed overnight.[jstcr.org]
  • For investigations, the ECG is the diagnostic test of choice, which should show widespread ST elevation, and PR depression inferiorly and PR elevation in aVR.[thesgem.com]
  • Note the ST elevation in multiple leads with slight reciprocal ST depression in aVR.[en.wikipedia.org]
  • However, no signs of pulmonary hyperflow, cardiac failure or tamponade or pulmonary or systemic congestion were observed which, added to electrocardiographic changes (Figure 2) that showed repolarization and supra-ST elevation disorder in V2 to V6, DI[revistas.unal.edu.co]
Non Specific ST-T Changes
  • The most frequent are: Excessive water and salt retention in subjects with a higher mean weight gain Bacteria Virus infection Hypertension Slightly elevated blood pressure and/or non-specific ST-T changes in association with pericardial effusion Renal[pericarditispain.info]
Decreased Lung Compliance
  • On the seventh day, she showed impaired ventilation, caused by decreased lung compliance and difficulties in maintaining oxygenation. Consequently, extracorporeal membrane oxygenation was started.[ncbi.nlm.nih.gov]

Treatment

  • Conclusion: Primary purulent pericarditis is uncommon, so early detection and treatment of this life-threatening condition may lead to a good outcome.[researchers.unab.cl]
  • The prognosis depends on the timeliness of surgical intervention and treatment.[clinicaladvisor.com]
  • The treatment of purulent pericarditis includes pericardiocentesis, which is indicated for diagnosis and treatment, especially in the presence of significant effusion. (2-4) In this case, the septic status and the presence of pericardial effusion together[revistas.unal.edu.co]
  • Prompt diagnosis of purulent pericarditis and initiation of appropriate treatment are the mainstays of successful management of this rare but potentially lethal entity. Conflicts of interest The authors have no conflicts of interest to declare.[revportcardiol.org]

Prognosis

  • Prognosis Patients with mediastinitis, empyema and purulent pericaditis should be treated with broad spectrum antibiotics, supportive care and surgical drainage. The prognosis depends on the timeliness of surgical intervention and treatment.[clinicaladvisor.com]
  • 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]
  • Making a timely diagnosis and administering early treatment are related to a better prognosis of this pathology. Resumen I ntroducción. La pericarditis purulenta es un proceso inflamatorio del pericardio producto de una infección bacteriana.[revistas.unal.edu.co]
  • FOLLOW-UP Complications: Recurrence of pericarditis Noncompressive effusion Chronic, constrictive pericarditis Cardiac perforation at time of pericardiocentesis Prognosis: The prognosis for patients with pericarditis depends upon the etiology of the pericardial[emjournal.net]
  • Prognosis Prognosis is good. Most people recover within three weeks to several months and do not need any additional treatment. Key terms Computed tomography (CT) scan — A CT scan uses x rays to scan the body from many angles.[medical-dictionary.thefreedictionary.com]

Etiology

  • The etiology of moderate PE is idiopathic in 29% of cases, but can be iatrogenic (16%), or due to neoplasms (13%), myocardial infarction (8%), uremia (6%), connective tissue or thyroid disease (5%) or infection (2%). 2 The etiological distribution of[revportcardiol.org]
  • The presence of pericardial effusion with persistent fever with or without known etiology, particularly in the immunocompromised but also in the apparently healthy patient, should always raise… CONTINUE READING[semanticscholar.org]
  • Etiological diagnosis of pericardial effusion. Future Microbiol. 2006;1(2):229-39. . 17. E wer K, Deeks J, Alvarez L, Bryant G, Waller S, Anderson P, et al.[revistas.unal.edu.co]

Epidemiology

  • Epidemiology, aetiology and classification of pericardial diseases 2.1 Epidemiology 2.2 Aetiology 3.[escardio.org]
  • The microbiology and epidemiology of purulent pericarditis have changed dramatically in the last thirty years (2).[ispub.com]
  • Epidemiology Approximately 60,000 patients develop pleural infections in the United States each year. Between 40-60% of pneumonias will be associated with parapneumonic effusions.[clinicaladvisor.com]
  • Epidemiology Forced exercise, pregnancy, use of steroids or nonsteroidal anti-inflammatory agents, use of ethanol, and nutritional deficiencies are factors that predispose a patient to symptomatic myocarditis.[atsu.edu]
  • "Epidemiology and Causes of Heart Failure." Retrieve April 4, 2014 from UpToDate.com[ceufast.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Empyema The potential space between the parietal pleura and visceral pleura normally contains small amounts of circulating, sterile fluid that can become infected by an adjacent pneumonia or bronchopleural fistula, or seeded by bacteremia[clinicaladvisor.com]
  • Pathophysiology The pericardium (pericardial complex) consists of an outer fibrous layer and an inner serous layer. The fibrous pericardium is a flask-shaped, tough outer sac with attachments to the diaphragm, sternum, and costal cartilage.[odlarmed.com]
  • Pathophysiology of cardiac tamponade. Chest 1998;113:1372–1378. A thoughtful review of the pathophysiology of cardiac tamponade. Tsang TSM, Oh JK, Seward JB. Diagnosis and management of cardiac tamponade in the era of echocardiography.[tele.med.ru]
  • Pathophysiology: The pericardium consists of two layers, an outer fibrous layer and an inner serous layer. The potential space produced by these layers contains approximately 20 cc of fluid with similar electrolyte and protein profiles to plasma.[emjournal.net]

Prevention

  • Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization[books.google.com]
  • Página 487 - Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures. Recommendations of the Immunization Practices Advisory Committee (ACIP). ‎[books.google.es]
  • An additional medicine called colchicine has been shown to prevent prolonged symptoms. Colchicine has also been shown to prevent pericarditis from happening again.[thesgem.com]
  • Prevention There is no way to prevent pericarditis, but a healthy lifestyle with proper nutrition and exercise will help keep the body's immune system strong and more likely to fight off invading microorganisms.[medical-dictionary.thefreedictionary.com]
  • This increase in pericardial pressure can prevent the lower chambers of the heart from filling properly with blood. This can cause decreases in cardiac output followed by hypotension.[atsu.edu]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!