Akute und chronisch-konstriktive Perikarditis

Acute pericarditis is an inflammatory disease of the pericardium of variable etiology. A viral infection may sometimes preceede symptoms but frequently the etiology remains unknown (idiopathic pericarditis). The disease is typically associated with left-sided chest pain and ECG abnormalities mimicking acute myocardial infarction. At physical examination the characteristic finding is a pericardial friction rub. A pericardial effusion of varying extent may be present or develop in the course of the disease. Pericardial tamponade, which may develop insidiously, represents a life-threatening complication. Pathophysiologically, filling of the cardiac chambers is impeded resulting in orthopnea, tachycardia, and eventually shock. Emergency pericardiocentesis is the treatment of choice. Constrictive pericarditis is the result of a chronic inflammation of the pericardium. Clinically it is characterized by dyspnea during exercise, symptoms of right heart failure and typical hemodynamic findings. Treatment primarily includes surgical removal of the thickened pericardium.     

Massive Pericardial Effusion in a Case of Acute Pericarditis with Slight ST-Segment Elevation of Short Duration

We present the case of a 77-year-old woman who suffered from chest pain. Her white blood cell count was 10,200/μL and C-reactive protein level was 5.5 mg/dL. There was no electrocardiogram abnormality up to 5 hours after admission. At 15 hours, slight ST-segment elevation occurred, but this disappeared on day 4. Imaging revealed slight pericardial effusion. Nonsteroidal anti-inflammatory drugs and antibiotics were administered. However, the pericardial effusion, inflammatory response, and bilateral heart failure worsened. Pericardiotomy on day 6 released 350 mL of fluid, and symptoms improved. Viral pericarditis was assumed. Massive pericardial effusion is rare in cases of acute viral pericarditis, as is slight, short-duration ST-segment elevation.     

Acute and chronic-constrictive pericarditis

Acute pericarditis is an inflammatory disease of the pericardium of variable etiology. A viral infection may sometimes precede symptoms but frequently the etiology re-mains unknown (idiopathic pericarditis). The disease is typically associated with left-sided chest pain and ECG abnormalities mimicking acute myocardial infarction. At physical examination the characteristic finding is a pericardial friction rub. A pericardial effusion of varying extent may be present or develop in the course of the disease. Pericardial tamponade, which may develop insidiously, represents a life-threatening complication. Pathophysiologically, filling of the cardiac chambers is impeded resulting in orthopnea, tachycardia, and eventually shock. Emergency pericardiocentesis is the treatment of choice. Constrictive pericarditis is the result of a chronic inflammation of the pericardium. Clinically it is characterized by dyspnea during exercise, symptoms of right heart failure and typical hemodynamic findings. Treatment primarily includes surgical removal of the thickened pericardium.     

Acute pericarditis presenting with sinus bradycardia: A case report

Acute pericarditis is almost invariably associated with sinus tachycardia. Recent-onset chest pain in the presence of (sinus) bradycardia is considered to be associated with an acute ischemic syndrome rather than acute pericarditis. This report describes a patient with acute pericarditis initially presenting with sinus bradycardia, probably due to a vasovagal response to (chest) pain.     

The role of echocardiography in diagnosis and management of isolated meningococcal pericarditis

Although pericarditis may complicate the course of meningococcemia, it is distinctly unusual as a presenting sign. Herein we report a case of a previously healthy 16-year-old male with isolated meningococcal pericarditis, in which transthoracic echocardiography was of great importance for the initial diagnosis and for guiding the therapeutic approach during the hospitalization period. The patient presented with symptoms of chest pain and fever that deteriorated into cardiac tamponade. Pericardiocentesis was successful and Neisseria meningitidis was identified as the causative agent in the pericardial fluid. Because of failure of clinical resolution, echocardiogram was repeated and showed evidence of maintenance of large echo dense content in pericardial space. The presence of purulent content was confirmed during open-chest surgery. The role of echocardiography for the correct management of this rare form of pericarditis is discussed.     

An unusual case of cardiac tamponade

A 29-year-old woman with Ebstein's anomaly on anticoagulant therapy presented with chest pain. A diagnosis of pericarditis was made once a myocardial infarction and pulmonary embolus had been excluded. She was discharged but returned shortly thereafter with fever, tachypnea and tachycardia. A repeat chest film disclosed that the cardiac silhouette had enlarged greatly since prior admission. Despite the absence of pulsus paradoxus, right heart catheterization confirmed the clinical suspicion of pericardial tamponade.     

Chronic Pericarditis and Pericardial Tamponade Associated with Ulcerative Colitis

Unlike other extraintestinal inflammatory manifestations of ulcerative colitis, cardiac involvement is infrequently reported and inadequately characterized, with only 9 previously reported cases of pericardial tamponade associated with inflammatory bowel disease. A 32 year old male with ulcerative colitis, treated with orally administered mesalamine for ten years, developed chronic pericarditis. Extensive clinical and laboratory evaluation failed to find any cause of the pericarditis other than the ulcerative colitis. Although the pericarditis remitted with indomethacin therapy, this medicine had to be discontinued because of a reactivation of ulcerative colitis attributed to this nosteroidal antiinflammatory drug (NSAID). The pericarditis then responded well to high-dose corticosteroid therapy, but the patient represented with chest pain, dyspnea, tachypnea, and engorged neck veins after tapering the corticosteroid therapy. Angiography revealed near equalization of end diastolic pressures in both ventricles, a finding consistent with pericardial tamponade. The patient underwent subtotal pericardiectomy. Thoracotomy revealed a thickened pericardial wall and a large pericardial effusion. The patient's symptoms resolved postpericardiectomy. This case extends the clinical spectrum of pericarditis associated with ulcerative colitis, by describing a case of pericarditis that was chronic, refractory to maintenance medical therapy, caused pericardial tamponade, and was successfully treated by pericardiectomy.     

Frequency of pericardial effusion as determined by M-mode echocardiography in acute myocardial infarction

A pericardial friction rub occurs in 6 to 16% of patients after acute myocardial infarction (AMI), but the incidence of pericardial effusion (PE) is not known. M-mode echocardiography was done 1, 3 and 5 days after AMI in 43 consecutive patients admitted within 24 hours of AMI, and PE was detected in 16 (37%). The PE was small in 7 patients, moderate in 6 and large in 3. A pericardial friction rub developed in 8 (19%), of whom only 4 had PE. Pleuritic chest pain diminished by sitting up and relieved by antiinflammatory agents developed in 12 (28%), of whom only 5 had PE. The peak creatine kinase level was significantly higher in patients with PE (1,769 +/- 1,003 U) than in those without (1,181 +/- 838 units). More patients with PE were in Killip classification II, III or IV (11 of 16 [69%] vs 9 of 27 [33%]). The presence of PE was not associated with age, site of AMI, development of Q waves, use of heparin or previous AMI. In conclusion, PE as detected by M-mode echocardiography is frequently present after AMI, and its presence is not closely associated with the occurrence of a pericardial friction rub or typical pericardial pain.     

Transesophageal echocardiography in pericardial disease and tamponade

While most pericardial disorders can be imaged by transthoracic echocardiography, transesophageal echocardiography may be required in those cases where pericardial pathology is clinically suspected, but cannot be imaged adequately with transthoracic echocardiography. Transesophageal echocardiography is especially helpful in patients after heart or chest surgery, with cardiac compression by a loculated pericardial hematoma, in patients with dissection, endocarditis, or interatrial shunting associated with pericardial effusion, in patients with pericardial tumors, and in the differential diagnosis between constrictive pericarditis and restrictive cardiomyopathy.     

Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review

Pericarditis refers to the inflammation of the pericardial layers, resulting from a variety of stimuli triggering a stereotyped immune response, and characterized by chest pain associated often with peculiar electrocardiographic changes and, at times, accompanied by pericardial effusion. Acute pericarditis is generally self-limited and not life-threatening; yet, it may cause significant short-term disability, be complicated by either a large pericardial effusion or tamponade, and carry a significant risk of recurrence. The mainstay of treatment of pericarditis is represented by anti-inflammatory drugs. Anti-inflammatory treatments vary, however, in both effectiveness and side-effect profile. The objective of this review is to summarize the up-to-date management of acute and recurrent pericarditis.     

Pericardial involvement in acute myocardial infarction

The incidence of both early postinfarction pericarditis and post-myocardial infarction (Dressler's syndrome) appears to be declining. Pericardial pain and pericardial friction rub define early postinfarction pericarditis and usually develop on day 2 or 3 after a transmural myocardial infarction. The clinical course is benign, and the prognosis of the patient is not altered by development of this complication. Pericardial effusions have been found in as many as 28% of patients after acute MI. 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. Avoidance of corticosteroids and NSAIDs must be considered carefully because of the reported complications of these agents. The post-myocardial infarction syndrome develops usually during the second or third week after acute MI but may be seen as early as 24 hours and as late as several months after the MI. Whether this syndrome is the result of autosensitization to myocardial antigens released into the circulation during infarction remains uncertain. Alternative hypotheses for the causation of the syndrome include the release of blood in the pericardial space and simply that the syndrome represents a prolonged and exaggerated form of early postinfarction pericarditis. Clinically, post-myocardial infarction syndrome is manifested by fever, malaise, chest pain, and the presence of a pericardial and possibly pleuropericardial friction rub. Pericardial effusion is frequently large, and, rarely, cardiac tamponade may develop and require pericardiocentesis. Treatment consists of aspirin, NSAIDs, or corticosteroids.(ABSTRACT TRUNCATED AT 250 WORDS)     

A Rare Case of Aspergillus Pericarditis with Associated Myocardial Abscess and Echocardiographic Response to Therapy

Myocardial abscess is an extremely rare entity and is often deadly in nature. We present a case of a patient with recent orthotopic liver transplant, on immunosuppression, who presented with cardiac tamponade due to Aspergillus fumigatus pericarditis and associated myocardial abscess. The diagnosis was made based on computed tomography imaging, culture of pericardial fluid for Aspergillus, and transthoracic echocardiography. The patient received antifungal therapy with clinical improvement and documented reduction in abscess size based on repeat echocardiogram. Aspergillus myocardial abscess is an extremely rare diagnosis but should be considered in an immunosuppressed patient presenting with pericardial effusion or ventricular mass.     

A rare case of Actinomyces israelii presenting as pericarditis in a 75-year-old man

Actinomyces israelii is a gram-positive bacillus that is rarely associated with infections in the general population. A. israelii belongs to the normal flora of the body and it rarely becomes pathogenic. Cardiac involvement is rare and in most cases involves the pericardium. Fewer than 20 cases of pericardial actinomycosis have been reported in the literature since 1950. We report the case of a 75-year-old man with a history of coronary artery disease with recent myocardial infarction and stent placement, atrial fibrillation, and recent colonic perforation with subsequent colectomy/colostomy who presented to our hospital with a 2-week history of left-sided chest pain. Workup revealed the presence of a pericardial effusion and pericarditis. Pericardial fluid analysis demonstrated A. israelii. An examination and discussion of the literature is performed regarding this rare manifestation of human actinomycosis.     

Pericardial effusion in the course of myocardial infarction: incidence, natural history, and clinical relevance

Incidence and significance of pericardial effusion in patients with acute myocardial infarction (AMI) have not been established. To evaluate these issues, we studied prospectively 138 consecutive patients with AMI. An echocardiogram was obtained in each 1, 3, and 10 days and 3 and 6 months after admission. Fifty four patients with unstable angina and 57 without heart disease were studied as controls. Echocardiographic diagnostic criteria of pericardial effusion were established from 33 additional patients undergoing surgery. Pericardial effusion was found in 28% of patients with AMI. Twenty-five percent of patients with AMI had pericardial effusion on the third day, vs 8% of patients with unstable angina (p less than .02) and 5% of patients without heart disease (p less than .01). At 1, 3, and 10 days and 3 and 6 months prevalence of pericardial effusion was 17%, 25%, 21%, 11%, and 8%, respectively. There was no case of tamponade. Pericardial effusion was more common in anterior AMI (p less than .02) and in patients with heart failure (p less than .05) but it was not significantly associated with early pericarditis, peak creatine kinase-MB, the level of anticoagulation, or mortality. Thus, pericardial effusion is a common event in patients with AMI (incidence of 28%), but does not result in specific complications. The reabsorption rate of pericardial effusion is slow and, in our experience, mild or moderate pericardial effusion does not preclude heparin therapy.     

Post-myocardial infarction pericarditis

Opinion statement Post-myocardial infarction pericarditis occurs in approximately 5% to 6% of patients who receive thrombolytic agents. It should be suspected in any patient with pleuropericardial pain. A pericardial friction rub may or may not be present. Differentiation of pericarditis from recurrent angina may be difficult, but a careful history and evaluation of serial electrocardiograms can help distinguish the two entities. Dressler’s syndrome, pericarditis that occurs at least 1 week following myocardial infarction, is now exceedingly rare. Most cases of pericarditis have a benign course; however, because pericarditis is associ-ated with larger infarcts, overall long-term mortality rate is increased. Rare complications include hemopericardium, cardiac tamponade, and constrictive pericarditis. Therapy is directed toward relief of pain, which usually responds well to nonsteroidal anti-inflammatory agents (eg, aspirin or ibuprofen).     

不同指标诊断心肌梗死后心包炎的差异

目的　观察不同指标对诊断梗死后心包炎发生率的差异以及溶栓与 PTCA对梗死后心包炎发生率的影响。方法　 1 60例急性心肌梗死病人分为常规药物治疗组 75例、溶栓组 5 2例、 PTCA组 3 3例。于梗死后一周内每日常规检查病人且每 1 -2日记录心电图一次 ,部分常规药物治疗及溶栓的病人于梗死后 5 -7天行心脏超声检查。结果　以心包摩擦音、胸膜炎样胸痛、典型心包炎心电图、心电图不典型 T波演变、心包积液作为诊断标准 :梗塞后心包炎发生率在常规组分别为 8%、 2 9.3 %、 1 .3 %、 3 2 %、 2 0 % ;在溶栓组分别为 3 .8%、 1 5 .3 %、 0 %、 2 3 %、 1 7% ;在 PTCA组分别为 0 %、 6.7%、 0 %、 1 0 %。结论　不同指标诊断梗死后心包炎的发生率明显不同 ,其中以心电图不典型 T波改变最高。溶栓与 PTCA治疗可明显降低梗死后心包炎的发生率。     

Cardiac troponin I in acute pericarditis

OBJECTIVES: This study was designed to investigate the prognostic value of cardiac troponin I (cTnI) in viral or idiopathic pericarditis. BACKGROUND: Idiopathic acute pericarditis has been recently reported as a possible cause of nonischemic release of cTnI. The prognostic value of this observation remains unknown. METHODS: We enrolled 118 consecutive cases (age 49.2 +/- 18.4 years; 61 men) within 24 h of symptoms onset. A highly sensitive enzymoimmunofluorometric method was used to measure cTnI (acute myocardial infarction [AMI] threshold was 1.5 ng/ml). RESULTS: A cTnI rise was detectable in 38 patients (32.2%). The following characteristics were more frequently associated with a positive cTnI test: younger age (p < 0.001), male gender (p = 0.007), ST-segment elevation (p < 0.001), and pericardial effusion (p = 0.007) at presentation. An increase beyond AMI threshold was present in nine cases (7.6%), with an associated creatine kinase-MB elevation, a release pattern similar to AMI, and echocardiographic diffuse or localized abnormal left ventricular wall motion without detectable coronary artery disease. After a mean follow-up of 24 months a similar rate of complications was found in patients with a positive or a negative cTnI test (recurrent pericarditis: 18.4 vs. 18.8%; constrictive pericarditis: 0 vs. 1.3%, for all p = NS; no cases of cardiac tamponade or residual left ventricular dysfunction were detected). CONCLUSIONS: In viral or idiopathic acute pericarditis cTnI elevation is frequently observed and commonly associated with young age, male gender, ST-segment elevation, and pericardial effusion at presentation. cTnI increase is roughly related to the extent of myocardial inflammatory involvement and, unlike acute coronary syndromes, is not a negative prognostic marker.     

Ambulance despatchers' estimation of intensity of pain and presence of associated symptoms in relation to outcome in patients who call for an ambulance because of acute chest pain

BACKGROUND: A large number of patients who call for an ambulance becauseof acute chest pain have an acute ischaemic event, but somedo not. AIM: To relate the ambulance despatcher's estimated severity of painand presence of associated symptoms, in patients who call foran ambulance because of acute chest pain, to whether they developacute myocardial infarction (AMI) and to the risk of early death. PATIENTS: All those with acute chest pain who contacted the despatch centrein Göteborg over a 2-month period. RESULTS: In all, 503 patients fulfilled the inclusion criteria. Patientsjudged as having severe chest pain (68%) developed AMI duringthe first 3 days in hospital on 26% of occasions as comparedwith 13% among patients judged as having only vague chest pain(P=0·0004). The difference was less marked among theelderly and women. The presence of any of the following associatedsymptoms, dyspnoea, nausea, vertigo, cold sweat or syncope,tended to be associated with a higher infarction rate (24%)than if none of these symptoms was present (1 7%, P=0·06).Mortality during the pre-hospital and the hospital phase wasnot associated with the estimated severity of pain or the presenceof associated symptoms. CONCLUSIONS: The despatcher's estimation of the severity of pain and thepresence of associated symptoms appears to be associated withthe development of AMI but not with early mortality.     

Contribution of electrocardiograms, serum enzymes and history of chest pain to the diagnosis of acute myocardial infarction -- A community-based register study in North Karelia, Finland, 1972-1981

The contribution of electrocardiograms, serum enzymes and historyof chest pain to the diagnosis of acute myocardial infarction(AMI) was examined in a series of 3123 persons with a definiteacute myocardial infarction registered in a community-basedmyocardial infarction register study in North Karelia, easternFinland in 1972–1981. Criteria for chest pain history,serum enzyme and electrocardiographic findings were those usedin the WHO co-ordinated myocardial infarction register studies.The history of chest pain typical of AMI was obtained in approximately90% of both men and women in all age groups. Among persons withfirst AMI, the proportion of unequivocal ECG changes was higheramong men than in women and declined with age in both sexes(81.8% in men 20–44 years of age, 47.8% in men 75 yearsof age or more; 61.7% in women 20–54 years of age and45.6% in women 75 years of age or more) and lower among personswith recurrent AMI, but even among them it decreased with age.The proportion of serum enzyme elevations was approximately90% in all subgroups. The results of the present study reconfirmthat the contribution of elevated serum enzymes is particularlyimportant in patients with recurrent acute myocardial infarctionand old age. Elevated serum enzymes should receive greater attentionin surveillance studies aiming to detect trends in AMI incidencein populations.     

Rapid progression of pericardial calcification in a patient with end-stage renal disease.

Dialysis pericarditis is a relatively uncommon cause of pericardial constriction and may be found in patients with end-stage renal disease receiving adequate renal replacement therapy. We present a patient with end-stage renal disease maintained on chronic peritoneal dialysis who developed severe myopericardial calcification over a 2-month period demonstrated by sequential chest computed tomographic scanning. The characteristic hemodynamic findings of constrictive-effusive pericarditis, obtained during cardiac catheterization, are presented and discussed.