ABSTRACT
Thirty-one patients with recurrent pericarditis were observed for periods of 2 to 19 years. Twenty-four had idiopathic pericarditis; four had postoperative or posttraumatic pericarditis, two had postinfarction pericarditis and one had recurrent pericarditis after anticoagulant-induced intrapericardial bleeding. In 24 patients (Group I), recurrences were documented by electrocardiographic changes, echocardiographic evidence of pericardial fluid or a pericardial rub as well as chest pain. In seven patients (Group II), recurrences were documented only by increased white blood cell count, increased erythrocyte sedimentation rate or fever in addition to pain. In 19 patients, the duration of the active or recurrent process was 5 years or more; in 7, it was 8 years or more. Three patients had cardiac tamponade in the initial attack; none had tamponade during recurrences. No patient developed congestive heart failure, constrictive pericarditis or cardiac arrhythmias with recurrences. Immunoelectrophoresis showed normal findings or minor deviations in 11 patients studied; B cell and T cell lymphocyte counts were normal in 10 patients and showed minor deviations in 3. Antinuclear antibody studies were normal in 19 of 22 patients and positive in low titer in 2. Most patients required adrenal steroid therapy for pain relief; steroid withdrawal was often difficult. Pericardiectomy was done in nine patients; in only two was this followed by clear-cut relief. In this group of 31 patients, 22 of whom were observed for 5 years or more, recurrent attacks of chest pain were the only major disabling feature of their pericarditis.
Subject(s)
Pericarditis , Acute Disease , Adolescent , Adult , Anti-Inflammatory Agents/therapeutic use , Arrhythmias, Cardiac/etiology , Blood Proteins/analysis , Echocardiography , Female , Follow-Up Studies , Glucocorticoids/adverse effects , Glucocorticoids/therapeutic use , Humans , Male , Middle Aged , Pericarditis/blood , Pericarditis/complications , Pericarditis/immunology , Pericarditis/therapy , Pericardium/surgery , Prognosis , RecurrenceABSTRACT
Methysergide ( Sansert ) has been associated with numerous fibrotic disorders. In particular, multiple cardiac lesions have been described in cases where methysergide was thought to have played a causative role. A patient is described who presented with cardiac findings suggestive of acute myopericarditis . An inflammatory myocarditis was subsequently excluded by endomyocardial biopsy. Hemodynamic findings suggested the presence of constrictive pericarditis or restrictive cardiomyopathy, or both. Radiographic evidence of constrictive pericarditis and biopsy evidence of endocardial fibrosis were documented in this patient with a long history of interrupted methysergide therapy.
Subject(s)
Endomyocardial Fibrosis/chemically induced , Methysergide/adverse effects , Myocarditis/diagnosis , Pericarditis, Constrictive/diagnosis , Acute Disease , Diagnosis, Differential , Endomyocardial Fibrosis/diagnosis , Endomyocardial Fibrosis/diagnostic imaging , Endomyocardial Fibrosis/pathology , Hemodynamics , Humans , Male , Middle Aged , Myocardium/pathology , Pericarditis, Constrictive/diagnostic imaging , Pericarditis, Constrictive/pathology , Pericardium/pathology , Tomography, X-Ray Computed , Virus Diseases/diagnosisABSTRACT
M-mode echocardiograms from 40 patients with proven constrictive pericarditis and 40 subjects without evidence of cardiac disease were reviewed for features previously described in constrictive pericarditis. In this large series, no single feature of the M-mode echocardiogram could be considered diagnostic, although a pattern of normal left ventricular size and systolic function, mild left atrial dilation, flattened diastolic left ventricular posterior wall motion and abnormal septal motion was found in most patients. It is concluded that the M-mode echocardiogram can provide findings suggestive of constrictive pericarditis but must be used in conjunction with hemodynamic and other studies to establish the diagnosis.