[Cardiotoxicity induced by chemo- and radiotherapy]. / Cardiotossicità da chemio- e radioterapia.

The authors describe the case of a 55-year old patient, with dyslipidemia as single cardiovascular risk factor, who previously underwent chemo and radiotherapy for Hodgkin lymphoma (stage 2b). The patient developed early coronary atherosclerosis followed by aortic and mitral valve disease and initial constrictive pericarditis. The role of chemo and radiotherapy in the development of cardiovascular disease, in particular valvular and pericardial disease, is discussed.

Clozapine-induced effuso-constrictive pericarditis. Case report and review of the literature.

Clozapine is a widely used antipsychotic medication and is effective against both positive and negative symptoms of schizophrenia. However, clozapine use should be monitored closely due to its side effects profile. The main side effects include cardiorespiratory symptoms, seizures and agranulocytosis. We report a case of effuso-constrictive pericarditis soon after being started on clozapine therapy, whose symptoms improved after discontinuation of clozapine. The literature is reviewed and importance of monitoring is discussed.

Diagnosis of constrictive pericarditis by two-dimensional echocardiography: studies in a new experimental model and in patients.

The purpose of this study was to determine the value of two-dimensional echocardiography in detecting constrictive pericarditis. Serial two-dimensional echocardiography was performed in eight closed chest conscious dogs with experimental constrictive pericarditis, using a new model that creates constrictive pericarditis by the introduction of a pericardial irritant mixture. Constrictive pericarditis was confirmed in these dogs by cardiac catheterization and pathologic examination. Four patients with constrictive pericarditis and three patients with restrictive cardiomyopathy (amyloidosis) were also studied. Analysis of short-axis two-dimensional echocardiograms was performed to determine the frame by frame change in left ventricular cavity areas throughout diastole. Curves of diastolic left ventricular cavity area change versus percent duration of diastole were constructed for each animal and human subject. Pericardial thickness was measured at various gain settings on two-dimensional and M-mode echocardiograms and at post-mortem examination. In dogs with constrictive pericarditis, the echocardiograms seriously overestimated and correlated poorly with pathologic measurements of pericardial thickness. In dogs after constrictive pericarditis developed, 69 +/- 11% (mean +/- SD) (range 50 to 84) of cavity area change occurred in the initial 30% of diastole compared with 35 +/- 7% (range 20 to 45) in control two-dimensional echocardiograms (p less than 0.001). Four patients with constrictive pericarditis showed similar accelerated cavity expansion in early diastole, but three patients with cardiac amyloidosis showed more variable left ventricular diastolic expansion rates. It is concluded that two-dimensional echocardiograms can demonstrate characteristic diastolic filling abnormalities in constrictive pericarditis, but cannot accurately measure pericardial thickness.

Cardiac tamponade and constrictive pericarditis complicating endoscopic sclerotherapy.

We report a case of suspected esophageal perforation with injection of a sclerosing agent into the pericardium during endoscopic sclerotherapy of esophageal varices. Immediately after the procedure, the patient developed fever and a pericardial friction rub. Eight months later, he presented with cardiac tamponade and constrictive pericarditis. This complication should be considered whenever a patient presents with inadequate cardiac output, venous congestion, and a pulsus paradoxus following sclerotherapy.

Cholesterol pericarditis terminating as constrictive calcific pericarditis. Follow-up study of patient with 40 year history of disease.

This is a follow-up report of a patient with idiopathic cholesterol pericarditis (previously described in this Journal in 1961). The patient had had recurrent pericardial effusions since 1939, and died with calcific constrictive pericarditis some 40 years later. In the interim, the patient had an extended period (17 years) of symptomatic relief after pericardiotomy in 1958.

Constrictive pericarditis after myocardial revascularization: report of three cases.

Although postoperative constrictive pericarditis is rare, the diagnosis should be considered when unexplained right-sided heart failure develops after cardiac surgery. Within a 6 week interval, evidence of constrictive pericarditis developed in three patients who had recently undergone myocardial revascularization. One patient presented with biventricular failure, pericardial effusion and suspected tamponade. Severe constrictive pericarditis was demonstrated at subsequent operation. An apparent postpericardiotomy syndrome preceded evidence of right heart failure in the other two patients. Etiologic considerations include the possibility that pericardial irrigation with povidone-iodine (Betadine) solution may have contributed to subsequent fibrosis.

Constrictive pericarditis and pleuropulmonary disease linked to ergot dopamine agonist therapy (cabergoline) for Parkinson's disease.

Cabergoline is one of several ergoline dopamine agonist medications used in the treatment of Parkinson's disease (PD). We diagnosed constrictive pericarditis (CP) in a patient with PD receiving cabergoline therapy (10 mg daily), who had symptoms and signs of congestive heart failure (CHF). In the absence of previous reported cases of this condition linked to ergoline drugs, cabergoline was not initially identified as the cause. Shortly thereafter, however, the patient developed of a severe pleuropulmonary inflammatory-fibrotic syndrome, a recognized complication of ergoline medications, thus suggesting a common pathogenesis due to cabergoline therapy. To our knowledge, this is the first case in the English literature, although we speculate that CP may be more common than reported among patients with PD who are treated with an ergoline drug (cabergoline, bromocriptine, pergolide, or lisuride). The diagnosis of CP is difficult and requires a high level of suspicion; symptoms may masquerade as CHF due to common mechanisms such as coronary artery disease. In patients with PD who are taking not only cabergoline but also one of the other ergoline drugs, CP should be suspected if symptoms of CHF develop.

Constrictive pericarditis following cardiac surgery; a complication that does exist.

Constrictive pericarditis as a complication of cardiac surgery does exist. Although the problem is somewhat uncommon, it should be suspected in patients following cardiac surgery who present with deteriorating cardiac function. The clinical spectrum of the disease is wide and may present as true rigid shell constriction or a more subtle form of elastic sero-effusive construction. It is imperative for the physician to consider this entity in the differential of complications following cardiac surgery.

Chemotherapy induced myocardial fibrosis.

Alkylating agents have a well established role in the treatment of malignant disease, with well documented side effects. This case history, however, illustrates the susceptibility to these agents shown by some patients. It is suggested that, when drug induced pneumonitis is noted, careful screening of left ventricular function should be performed in order to diagnose myocardial fibrosis and subsequent cardiac failure.

Transient effusive-constrictive pericarditis due to chemotherapy.

Commonly used chemotherapeutic agents, specifically cytarabine and daunorubicin, can cause effusive-constrictive pericarditis. We describe a case of transient effusive-constrictive pericarditis in a patient with acute myelogenous leukemia. This is the first case report of a patient with transient effusive-constrictive pericarditis due to chemotherapy.

Hydralazine-induced constrictive pericarditis.

A 59-year-old man was diagnosed as having constrictive pericarditis 17 months after a typical hydralazine-induced autoimmune syndrome. This late complication of hydralazine has been reported only once. Ten years later the patient was found to have anti-neutrophil cytoplasmic antibodies directed against myeloperoxidase.

Surgical treatment of constrictive pericarditis due to practolol. A case report.

We report a case of constrictive pericarditis presenting as a late complication of Practolol therapy associated with polyserositis. The patient had a successful result following pericardectomy. This is the first documented case of surgical treatment for Practolol induced constrictive pericarditis.

[Cardiac damage in a young woman with Hodgkin's disease and long term survival after combination therapy and bone marrow transplantation]. / Poskození srdce u mladé zeny s Hodgkinovou chorobou dlouhodobe prezívající po kombinované lécbe a transplantaci kostní drene.

The authors describe the disease of a 22-year-old woman treated from the age of 13 years on account of Hodgkin's lymphoma by irradiation and cytostatic treatment. On account of a relapse of lymphoma at the age of 14 years megachemotherapy with subsequent transplantation of autologous bone marrow. In the course of eight years of the follow up gradual development of constrictive pericarditis with exsudate. Concurrently progression of mitral insufficiency based on valvular prolapse resulting from radiation. During the last two years refractory systemic hypertension resistant to treatment. At the peak of the disease development of cardiac tamponade and cardiac cachexia with anasarca. After anamnestic, clinical and haemodynamic analysis total pericardetomy was indicated and mitral valve replacement performed. The operation led to improvement of the patient's condition, systemic hypertension receded completely. The patient is in permanent remission.

[Constrictive pericarditis caused by carbergoline]. / Konstriktiv perikarditis udløst af cabergolin.

A 72-year-old male with paralysis agitans presented with symptoms and findings of constrictive pericarditis (CP). One year prior, he had a minor lateral MI. The patient had been treated with cabergoline for four years. At pericardiectomy, a thickened pericardium of 1-1,5 cm encased the right side of the heart. The pericardium was normal in the infarction area. Dopamine agonists pergolide and cabergoline for treatment of Parkinson s disease have been associated with development of CP. The absence of pericardial thickening in the infarction area suggests cabergoline as a probable cause.

[Pleural effusion and constrictive pericarditis secondary to bromocriptine treatment]. / Derrame pleural y pericarditis constrictiva secundarios al tratamiento con bromocriptina.

The case of a 60 year old patient with Parkinson's disease is reported, who, following 2 years of treatment with bromocriptine, presented a left pleural effusion in which chronic constrictive pericarditis was demonstrated. Studies aimed at establishing the etiology were negative. Upon withdrawal of bromocriptine, the pleural effusion disappeared and the patient remained asymptomatic, with only pleural thickening persisting in the thoracic radiography. The appearance of polyserositis as an undesirable effect of the use of bromocriptine is discussed. The first case associated to chronic pericarditis is reported.

Chronic pericardial constriction linked to the antiparkinsonian dopamine agonist pergolide.

Constrictive pericarditis is present when a fibrotic, thickened, and adherent pericardium restricts diastolic filling of the heart. Several drugs can cause pericarditis, which can lead to chronic pericardial constriction. A case of constrictive pericarditis in a patient receiving the antiparkinsonian drug pergolide is reported.

Constrictive pericarditis and pleuropulmonary fibrosis secondary to cabergoline treatment for Parkinson's disease.

A 63 year old man with a six year history of Parkinson's disease presented with signs of right heart failure following a knee replacement. Constrictive pericarditis was diagnosed and a radical pericardectomy performed. Six months later, the patient remained unwell with raised inflammatory markers. An inflammatory fibrotic reaction caused by cabergoline was diagnosed. He improved after cessation of cabergoline.