[Differential characteristics of primary acute pericarditis and severe pericardial effusion without tamponade]. / Características diferenciales de las pericarditis agudas primarias con derrame pericárdico severo sin taponamiento.

The aim or our study was to evaluate the main clinical and etiological features or primary acute pericarditis with severe pericardial effusion without cardiac tamponade. Our experience included 35 patients with this problem diagnosed in the last 5 years. Patients with a previous potential etiology for acute pericarditis were excluded. The diagnostic protocol identified a specific etiology in 20% of patients, the most frequent being idiopathic forms. Patients with severe pericardial effusion without cardiac tamponade who had a favourable clinical outcome on nonsteroidal antiinflammatory drugs therapy presented a lower proportion of specific etiology than those with a poor response to this therapy (8% versus 45%; p = 0.03). An exhaustive etiological investigation, including diagnostic pericardiocentesis should be reserved for these patients with unfavourable response to antiinflammatory drug therapy.

Características diferenciales de las pericarditis agudas primarias con derrame pericárdico severo sin taponamiento / Differential characteristics of primary acute pericarditis and severe pericardial effusion without tamponade

El objetivo de este trabajo es evaluar las principales características clínicas y etiológicas de las pericarditis agudas primarias que se inician con derrame severo sin taponamiento. Presentamos nuestra experiencia en 35 pacientes en los últimos 5 años. Todos los pacientes en los que hubiese una causa potencial de pericarditis en la primera valoración clínica fueron descartados. El protocolo diagnóstico encaminado a la búsqueda de una etiología específica ha obtenido un rendimiento global del 20%, siendo, por tanto, las formas idiopáticas las más frecuentes. Los casos con derrame severo y respuesta favorable al tratamiento presentaron menor proporción de etiologías específicas que los que no respondieron al tratamiento con antiinflamatorios no esteroideos (el 8% frente al 45%; p = 0,03). Es, por tanto,en estos últimos en los que se justificaría una investigación etiológica exhaustiva, incluyendo una pericardiocentesis diagnóstica dada la mayor probabilidad de hallar una causa específica de la enfermedad

The aim or our study was to evaluate the main clinical and etiological features or primary acute pericarditis with severe pericardial effusion without cardiac tamponade. Our experience included 35 patients with this problem diagnosed in the last 5 years. Patients with a previous potential etiology for acute pericarditis were excluded. The diagnostic protocol identified a specific etiology in 20% of patients, the most frequent being idiopathic forms. Patients with severe pericardial effusion without cardiac tamponade who had a favourable clinical outcome on nonsteroidal antiinflammatory drugs therapy presented a lower proportion of specific etiology than those with a poor response to this therapy (8% versus 45%; p = 0.03). An exhaustive etiological investigation, including diagnostic pericardiocentesis should be reserved for these patients with unfavourable response to antiinflammatory drug therapy

[Unknown etiology cardiac tamponade. Could some characteristics of the disease define higher probability of specific etiologies?]. / Taponamiento cardíaco sin causa aparente. Existen características de la enfermedad que definan una mayor probabilidad de etiología específica?

INTRODUCTION: Cardiac tamponade without definite cause (one of the forms of primary pericardial disease), always puts the clinician on the alert for the possibility of a specific etiology of disease. PATIENTS AND METHODS: The objectives of this prospective study on 50 patients with primary pericardial disease and cardiac tamponade have been to establish the real incidence of specific etiologies in our environment, as well as the principal clinical manifestations of these patients. All patients were evaluated through an exhaustive diagnostic protocol (including non-invasive diagnostic tests, analysis of the pericardial fluid and in some cases pericardial biopsy) for the search of a specific cardiac tamponade etiology. RESULTS: In our experience it has been most frequent to find a definite etiology in a slightly superior proportion (54%), without differences among the idiopathic and specific forms of cardiac tamponade with regard to the most relevant clinical manifestations, including the aspect and amount of the pericardial fluid and the recurrences of cardiac tamponade. CONCLUSIONS: The disease has no clinical manifestations that establish its etiology: this justifies in-depth etiological research in this group of patients.

Taponamiento cardíaco sin causa aparente. ¿Existen características de la enfermedad que definan una mayor probabilidad de etiología específica? / Unknown etiology cardiac tamponade. Could some characteristics of the disease define higher probability of specific etiologies?

Introducción. El taponamiento cardíaco sin causa aparente (una de las formas de enfermedad pericárdica primaria), siempre alerta al clínico ante la posibilidad de una causa específica de enfermedad. Pacientes y métodos. Los objetivos de este estudio prospectivo de 50 pacientes con enfermedad pericárdica primaria y taponamiento cardíaco han sido conocer la incidencia real de etiologías específicas en nuestro medio, así como las principales características clínicas de estos enfermos. Todos los pacientes han sido sometidos a un exhaustivo protocolo diagnóstico (incluyendo pruebas diagnósticas incruentas, análisis del líquido pericárdico y en algunos casos biopsia pericárdica) encaminado a la búsqueda de una etiología específica de taponamiento. Resultados. En nuestra experiencia ha sido más frecuente encontrar una causa definida en una proporción levemente superior (54%), no existiendo diferencias entre las formas idiopáticas y específicas de taponamiento cardíaco en cuanto a las características clínicas más relevantes, incluyendo el aspecto y cuantía del líquido pericárdico y las recidivas del taponamiento. Conclusiones. No existen características clínicas de la enfermedad que definan la etiología de la misma, justificando una profunda investigación etiológica en este grupo de pacientes

Introduction. Cardiac tamponade without definite cause (one of the forms of primary pericardial disease), always puts the clinician on the alert for the possibility of a specific etiology of disease. Patients and methods. The objectives of this prospective study on 50 patients with primary pericardial disease and cardiac tamponade have been to establish the real incidence of specific etiologies in our environment, as well as the principal clinical manifestations of these patients. All patients were evaluated through an exhaustive diagnostic protocol (including non-invasive diagnostic tests, analysis of the pericardial fluid and in some cases pericardial biopsy) for the search of a specific cardiac tamponade etiology. Results. In our experience it has been most frequent to find a definite etiology in a slightly superior proportion (54%), without differences among the idiopathic and specific forms of cardiac tamponade with regard to the most relevant clinical manifestations, including the aspect and amount of the pericardial fluid and the recurrences of cardiac tamponade. Conclusions. The disease has no clinical manifestations that establish its etiology: this justifyies in-depth etiological research in this group of patients

[Clinical features and prognosis of infective endocarditis in the elderly]. / Características clínicas y pronósticas de la endocarditis infecciosa en el anciano.

INTRODUCTION AND OBJECTIVES: In recent decades the mean age of patients with infective endocarditis has progressively increased. The objective of the present study was to describe the clinical features and prognoses of infective endocarditis in the elderly. METHODS: A prospective study was performed of 125 non drug abuser patients over the age of 14 years and admitted from 1987 until 1997 in a single institution. Twenty-one patients were older than 65 years. RESULTS: No significant differences were observed among the age groups with respect to delay in diagnosis, clinical signs, site of the infection and the rate of negative blood cultures. Prosthetic valve endocarditis was more frequent in elderly than in younger adults (41 and 33%, respectively). S. viridans and enterococcus were more frequent (47 compared with 29% in younger adults, p < 0.05). Elderly patients underwent surgery less frequently (46 versus 56%) and most surgery was performed on an emergency basis. The in hospital mortality was higher in the elderly (50 versus 15%), p < 0.05. CONCLUSIONS: Prosthetic valve endocarditis and severe complications during the active phase are more frequent in the elderly and this is related to a worse prognosis in the short and intermediate term. A higher rate of elective surgery during the active phase could improve the prognosis of infective endocarditis in the elderly.

[Short and long-term prognosis of prosthetic valve endocarditis in non-drug addicts]. / Pronóstico a corto y largo plazo de la endocarditis sobre prótesis en pacientes no drogadictos.

INTRODUCTION AND OBJECTIVES: Prosthetic valve infective endocarditis is a complication of valvular replacement surgery with a high morbimortality during the in-hospital phase and an important risk of complications during follow-up. The objective of the present study is to assess the clinical features and the short and long-term prognosis of this disease. PATIENTS AND METHODS: A prospective study of 43 consecutive cases of prosthetic valve endocarditis in non-addict patients from January 1987 to March 1997. RESULTS: The mean age was 51 +/-16 years. Eight patients (19%) had early prosthetic valve endocarditis (two months following heart surgery), fourteen patients (32%) had intermediate (between 2 and 12 months post surgery) and twenty-one (49%) had late prosthetic valve endocarditis (more than one year after heart surgery). Transesophageal echocardiography was performed in 32 patients with a sensibility of 81%. Complications occurred in 86% of patients and 53% of patients underwent surgery during the active phase (25% was emergency surgery). Inpatient mortality was 23% (50% in early prosthetic valve endocarditis). After a mean follow-up of 56 months there were 5 cases of recurrence, four patients required late surgery and 5 patients died. Survival (excluding early mortality) was 82% at 5 years with no significant differences among patients who received only medical treatment and those who underwent surgery in the active phase. CONCLUSIONS: Early mortality of prosthetic valve endocarditis is, according to our experience of 20%. The prognosis of survivors to the active phase is favourable in the majority. Early prosthetic valve endocarditis still causes a high mortality rate despite the use of combined medical surgical treatment in most cases.

[The general characteristics and short- and long-term results of infective endocarditis in non-drug addicts]. / Características generales y resultados a corto y largo plazo de la endocarditis infecciosa en pacientes no drogadictos.

INTRODUCTION AND OBJECTIVES: Infective endocarditis is a disease with a high morbimortality during the active phase and a considerable risk of complications during follow-up. The aim of our study is to describe the clinical and prognostic features of infective endocarditis in non-drug addict patients in short and long terms. PATIENTS AND METHODS: A prospective study of 138 cases of infective endocarditis in non-drug addict patients through the parenteral pathway treated in our institution from 1987 to 1997. RESULTS: The mean age was 44 +/- 20 years. Ninety-five patients (69%) had native valve infective endocarditis and forty-three (31%) had prosthetic valve endocarditis. Streptococci were the causal microorganism in 34% and staphylococci in 33%. 83% of patients developed some type of complications during hospital stay. 51% of patients were operated on during the active phase (22% were urgent). The in-hospital mortality rate was 21%. 10 patients (9%) needed late cardiac surgery and seven patients (5%) died during follow-up. Global survival at 10 years was 71%. There were no statistical differences in survival in as much as the type of treatment received during the hospital stay in the active phase (medical alone or combined medical-surgical). CONCLUSIONS: A high early surgery rate in the active phase related to good long-term results and does not increase early in-hospital mortality. Medical treatment also offers good long-term results in cases of infectious endocarditis with absence of bad prognostic factors and good clinical outcome.