Síndrome de Brugada asociado a pericarditis aguda / Brugada syndrome associated to acute pericarditis

Resumen Comunicamos el caso de un hombre de 56 años que ingresó por pericarditis aguda febril, probablemente de causa viral, que durante su evolución presentó una fibrilación auricular paroxística y taquicardia ventricular polimorfa recurrente. El análisis de la historia clínica y serie electrocardiográfica permitió el diagnóstico retrospectivo asociado de un síndrome de Brugada. Hubo buena respuesta inicial al tratamiento antiinflamatorio asociado a colchicina y se implantó un desfibrilador automático intracavitario para prevención de muerte súbita. Se discuten aspectos clínicos del síndrome de Brugada, la importancia de la fiebre y de la pericarditis como cuadro clínico asociado.

Abstract A 56-year-old patient was admitted for acute febrile pericarditis, probably viral, who presented with paroxysmal atrial fibrillation and recurrent polymorphic ventricular tachycardia during his clinical course. Analysis of the clinical and electrocardiographic findings allowed the retrospective diagnosis of Brugada syndrome in the context of pericarditis. An initial response to anti-inflammatory treatment associated with colchicine was good. An internal cardioverter defibrillator was implanted to prevent sudden death. Clinical aspects of the Brugada syndrome, the importance of fever and pericarditis as an associated clinical condition are discussed.

Tratamiento quirúrgico de la pericarditis purulenta: reporte de un caso / Surgical treatment of purulent pericarditis: report of a case

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.

Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.

Treatment of pericardial effusion through subxiphoid tube pericardiostomy and computerized tomography- or echocardiography - guided percutaneous catheter drainage methods

Abstract Objective: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. Methods: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. Results: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. Conclusion: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Pericarditis aguda complicada con derrame pericárdico: Caso clínico pediátrico / Acute pericarditis, complicated by pericardial effusion in a pediatric patient: case report

La pericarditis aguda es la enfermedad más común del pericardio en la práctica clínica. Supone el 0,1% de todos los ingresos hospitalarios y hasta un 5% de aquellos por dolor torácico. En países desarrollados, la causa suele ser benigna, y son más frecuentes las idiopáticas e infecciosas que las secundarias a pericardiotomía quirúrgica y neoplasias. La tuberculosis es la causa más importante en países en vías de desarrollo. Los síntomas más comunes son el dolor torácico característico y la fiebre. Debido a su benignidad y buena evolución con reposo y tratamiento médico, se puede controlar de forma ambulatoria, teniendo presentes aquellos signos de alarma para vigilar o pacientes de riesgo para evitar complicaciones (derrames importantes, taponamiento cardíaco, recurrencias, etc.). Presentamos un caso clínico de un niño de 7 años con antecedentes de comunicación interauricular cerrada quirúrgicamente 9 meses antes, con un cuadro de pericarditis aguda de evolución favorable.

Acute pericarditis is the most common disease of the pericardium encountered in clinical practice. It is diagnosed in 0.1% of all admissions and 5% of emergency room admissions for chest pain. In developed countries, it is usually due to a benign cause. Idiopathic and infectious pericarditis are more common than secondary to surgical pericardiotomy or neoplastic causes, whereas tuberculosis is the dominant cause in developing countries. The most common symptoms of pericarditis are characteristic chest pain and fever. Since pericarditis presents a benign outcome because of self-limiting and good response to conventional anti-inflammatory therapy, it can be safely managed on outpatient basis unless a specific cause is suspected or the patient has high-risk features to avoid complications such as pericardial effusion, cardiac tamponade or recurrent pericarditis. We report a case of pericarditis, diagnosed 9 months after surgical closure of an atrial septal defect, in a 7-year-old boy with favorable evolution.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series / Pneumonia por Streptococcus pneumoniae complicada por pericardite purulenta: uma série de casos

AbstractObjective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity.Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis.Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.

ResumoObjetivo:Na era dos antibióticos, a pericardite purulenta é uma entidade rara. Entretanto, ainda há relatos de casos da doença, associados a alta mortalidade, muitos deles atribuídos ao diagnóstico tardio. Aproximadamente 40-50% de todos os casos de pericardite purulenta são causados por bactérias gram-positivas, particularmente Streptococcus pneumoniae.Métodos:Relatamos quatro casos de pneumonia pneumocócica complicada por pericardite, com diferentes características clínicas e níveis de gravidade.Resultados:Em três dos quatro casos, a principal complicação foi tamponamento cardíaco. A pesquisa microbiológica (teste de antígeno urinário e cultura de líquido pleural) confirmou o diagnóstico de pneumonia pneumocócica grave complicada por pericardite purulenta.Conclusões:Em casos de pneumonia pneumocócica complicada por pericardite, o pronto diagnóstico é de extrema importância para evitar comprometimento hemodinâmico grave. As complicações da pericardite aguda aparecem no início do curso clínico da infecção. As complicações mais graves são tamponamento cardíaco e suas consequências. A antibioticoterapia com pericardiocentese reduz sobremaneira a mortalidade associada à pericardite purulenta.

Pericardite com tamponamento por salminella enteritidis / Salmonella enteritidis pericarditis with tamponade

Relata-se o caso de paciente feminina, 22 anos, sem história médica prévia relevante, admitida no Serviço de Urgência por cansaço progressivo e dor precordial aguda, referindo queixa abdominais há 72 horas. Avaliação médica revela presença de derrame pericárdio moderado. Internada, evolui em tamponamento cardíaco, requerendo pericardiocentese. É determinada a presença de Salmonella enteritidis no líquido pericárdico, e então iniciado tratamento com antibiótico. O prognóstico foi satisfatório, com recuperação total clínica e ecocardiográfica.

Report on a 22 year old female with no relevant prior medical history who was admitted to the Ermergency Department complaining of acute chest pain and progressive fadigue, mentioning abdominal complaints 72 hours previously. A medical evaluation showed moderate pericardial effusion. After admission, this developed into pericardial tamponade, requiring pericardiocentecis. Salmonella enteriditis was identified in the pericardial fluid, starting treatment with antibiotics. The prognosis was satisfactory , with complete clinical and echocardiographic recovery.

Pericardite aguda e crônica / Acute and chronic pericarditis

A pericardite é a forma mais comum das doenças do pericárdio e pode se apresentar nas formas aguda e crônica. Frequentemente é idiopática e de evolução benigna. Quando não, as causas mais comuns são tuberculose, neoplasias malignas e doenças autoimunes. O diagnóstico clínico requer a presença de dor precordial típica, atrito pericárdico, elevação difusa do segmento ST e derrame pericárdico. Os exames laboratoriais incluem: ECG, ecocardiograma, RX do tórax e marcadores de inflamação e necrose miocárdica Procedimentos adicionais e internação devem ser considerados para o pacientes de maior risco. Os marcadores de risco são febre >38ºC, evolução subaguda, derrame pericárdico volumoso ou tamponamento cardíaco e ausência de resposta ao tratamento com anti-inflamatórios. O tratamento da pericardite deve ser focar a causa específica, quando identificável. Genericamente, usa-se aspirina ou anti-inflamatórios não hormonais para os casos de etiologia viral ou idiopáticos. A colchicina pode ser útil como droga adicional nos casos recorrentes. A pericardiocentese está indicada nos pacientes com tamponamento cardíaco, quando há chance elevada de tuberculose, pericardite purulenta ou neoplasia. A pericardiectomia fica reservada para os casos de pericardite constrictiva crônica.

Pericarditis is the most common form of pericardial diseases and most of the cases are idiopathic and and follow a benign course. Major nonidiopathic etiologies include tuberculosis, neoplasia and autoimmune diseases.The clinical diagnosis is confirmed when the following criteria are present: typical chest pain, pericardial friction rub, widespread ST-segment elevation, and pericardial effusion. Tests for pericarditis include ECG, echocardiogram, chest radiography and inflammation markers. High-risk patients need tests for etiology search and hospitalization. High-risk patients present fever >38oC, a subacute course, large pericardial effusion or cardiac tamponade and/or failure of antiinflammatory drugs.Treatment should target the specific etiology, if known. Generically, aspirin or a non-steroid anti-inflammatory drug is used for treatment of viral and idiopathic pericarditis. Colchicine is recommended as adjunct therapy for recurrent events. Pericardiocentesis is indicated for cardiac tamponade, high suspicion of tuberculosis, purulent pericarditis or neoplasia. Pericardiectomy is recommended for persistent constriction.

Acute Idiopathic Hemorrhagic Pericarditis with Cardiac Tamponade as the Initial Presentation of Acquired Immune Deficiency Syndrome

This paper presents a case of cardiac tamponade with idiopathic hemorrhagic pericarditis as the initial symptom of human immunodeficiency virus (HIV) infection. A 29-year-old male came to the emergency room with a sudden onset of dizziness. Upon arrival, he was hypotensive although not tachycardic, and his jugular venous pressure was not elevated. His chest X-rays revealed a mild cardiomegaly. Transthoracic echocardiography revealed a large amount of pericardial effusion with a diastolic collapse of the right ventricle, a dilated inferior vena cava with little change in respiration, and exaggerated respiratory variation of mitral inflow velocities, representing echocardiographic evidence of cardiac tamponade. After pericardiocentesis, his blood pressure improved to 110/70 mmHg without inotropics support. Serial 12-lead electrocardiograms during hospitalization revealed upwardly concave diffuse ST-segment elevation followed by a T-wave inversion suggestive of acute pericarditis. Pericardial fluid cytology and cultures for bacteria, mycobacteria, adenovirus, and fungus were all negative. HIV enzyme-linked immunosorbent assay (ELISA) was positive and confirmed by Western blot. The CD4 cell count was 168/mm3. Finally, the diagnosis of cardiac tamponade due to HIV-associated hemorrhagic pericarditis was made. It was concluded that HIV infection should be considered in the diagnosis of unexplained pericardial effusion or cardiac tamponade in Korea.

Evolução de um cisto pericárdico após tratamento de pericardite aguda / Development of a pericardial cyst after treatment of acute pericarditis

Relata-se o caso de uma paciente internada com quadro de pericardite aguda, de provável etiologia viral, em que foi detectada presença de cisto pericárdico. Houve recidiva de sintomas da pericardite uma semana após tratamento com AAS por sete dias. Após uso de AAS por um mês e colchicina por três meses com remissão total dos sintomas, houve redução importante no tamanho do cisto pericárdico.

Mortality in Patients Treated for Tuberculous Pericarditis in Sub-Saharan Africa

Objective: To determine the mortality rate and its predictors in patients with a presumptive diagnosis of tuberculous pericarditis in sub-Saharan Africa. Design: Between 1 March 2004 and 31 October 2004; we enrolled 185 consecutive patients with presumed tuberculous pericarditis from 15 referral hospitals in Cameroon; Nigeria; and South Africa; and observed them during the 6-month course of antituberculosis treatment for the major outcome of mortality. This was an observational study; with the diagnosis and management of each patient left at the discretion of the attending physician. Using Cox regression; we have assessed the effect of clinical and therapeutic characteristics (recorded at baseline) on mortality during follow-up. Results: We obtained the vital status of 174 (94) patients (median age 33; range 14-87 years). The overall mortality rate was 26. Mortality was higher in patients who had clinical features of HIV infection than in those who did not (40versus 17; P=0.001). Independent predictors of death during follow-up were: (1) a proven non-tuberculosis final diagnosis (hazard ratio [HR] 5.35; 95confidence interval 1.76 to 16.25); (2) the presence of clinical signs of HIV infection (HR 2.28; 1.14-4.56); (3) co-existent pulmonary tuberculosis (HR 2.33; 1.20-4.54); and (4) older age (HR 1.02; 1.01-1.05). There was also a trend towards an increase in death rate in patients with haemodynamic instability (HR 1.80; 0.90-3.58) and a decrease in those who underwent pericardiocentesis (HR 0.34; 0.10-1.19). Conclusion : A presumptive diagnosis of tuberculous pericarditis is associated with a high mortality in sub-Saharan Africans. Attention to rapid aetiological diagnosis of pericardial effusion and treatment of concomitant HIV infection may reduce the high mortality associated with the disease

Pericardite aguda pós-influenza ou pós-vacina antiinfluenza: atualização / Acute pericarditis following Influenza infection or vaccine: update

As pericardites com etiologias idiopática e viral se confundem. Nem sempre existem achados clínicos que distinguem uma da outra, e é provável que muitos casos de pericardite idiopática sejam causados por infecções virais não reconhecidas. A influenza, virose que acomete principalmente o trato respiratório, pode também desencadear complicações cardíacas, como miocardites e pericardites. Por sua potencialidade mórbida, tem sido, nos últimos anos, alvo de campanhas nacionais de imunização por vacina. A pericardite pós-influenza e a pericardite pósvacina antiinfluenza são doenças cada vez mais enfrentadas pelo médico. O presente trabalho objetiva revisar a literatura mundial, fazendo uma atualização do tema delimitado

Purulent Pericarditis Caused by Group G Streptococcus as an Initial Presentation of Colon Cancer

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.

Pericarditis purulenta en paciente inmunocompetente con CIA / Purulent pericarditis in immunocompetent patient with interauricular communication

Paciente inmunocompetente quien presenta taponamiento cardíaco por pericarditis purulenta primaria asociado a CIA tipo ostium secundum. El ecocardiograma transesofágico y los hemocultivos fueron negativos para el diagnóstico de endocarditis. Queremos remarcar la utilidad del acceso quirúrgico subxifoideo, para el drenaje pericárdico