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3.
Isr Med Assoc J ; 21(7): 487-490, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507126

RESUMO

BACKGROUND: Recurrent pericarditis is a state of repetitive inflammation of the pericardium with intervals of remission. The etiology of recurrent pericarditis is still largely unknown, yet most causes are presumed to be immune mediated. Genetic factors, including human leukocyte antigen (HLA) haplotypes, can be involved in dysregulation of the immune system and as a predisposition to several autoimmune conditions, including recurrent pericarditis. Several diseases are frequently associated with such manifestations. They include systemic lupus erythematosus, familial Mediterranean fever, and tumor necrosis factor receptor-associated periodic syndrome. However, idiopathic recurrent pericarditis remains the most frequently observed clinical condition and the conundrum of this disease still needs to be solved.


Assuntos
Doenças Autoimunes/genética , Predisposição Genética para Doença , Pericardite/fisiopatologia , Febre Familiar do Mediterrâneo/genética , Febre Familiar do Mediterrâneo/imunologia , Antígenos HLA/genética , Haplótipos , Humanos , Lúpus Eritematoso Sistêmico/genética , Lúpus Eritematoso Sistêmico/imunologia , Pericardite/genética , Pericardite/imunologia , Recidiva
5.
Intern Emerg Med ; 14(5): 745-751, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30868443

RESUMO

The clinical significance of pleural effusions (PLEs) in the setting of acute pericarditis remains poorly investigated. We sought to identify predictive factors for PLEs and their association with the short- and long-term prognosis of patients with acute pericarditis. We enrolled 177 patients hospitalized with a first episode of acute pericarditis. In all cases an extensive clinical, biochemical, and diagnostic work-up to detect PLEs and establish etiological diagnosis was performed. All patients included were prospectively followed for a maximum of 18 months (median 12, range 1-18) and complications were recorded. PLEs were detected in n = 94 cases (53.1% of the cohort; bilateral 53.2%, left-sided 28.7%, right-sided 18.1%) and were strongly associated with c-reactive protein (CRP) levels at admission (rho = 0.328, p < 0.001). In multivariate logistic regression, independent predictors for PLEs were female gender (OR = 2.46, 95% CI 1.03-5.83), age (per 1-year increment OR = 1.030, 95% CI 1.005-1.056), CRP levels (per 1 mg/L increment OR = 1.012, 95% CI 1.006-1.019) and size of pericardial effusion (per 1 cm increment, OR = 1.899, 95% CI 1.228-2.935). Bilateral PLEs were associated with increased risk for in-hospital cardiac tamponade (OR = 7.52, 95% CI 2.16-26.21). There was no association of PLEs with new onset atrial fibrillation or pericarditis recurrence during long-term follow-up (χ2 = 0.003, p = 0.958). We conclude that PLEs are common in patients hospitalized with a first episode of acute pericarditis. They are related to the intensity of inflammatory reaction, and they should not be considered necessarily as a marker of secondary etiology. Bilateral PLEs are associated with increased risk of in-hospital cardiac tamponade, but do not affect the long-term risk of pericarditis recurrence.


Assuntos
Pericardite/complicações , Derrame Pleural/etiologia , Adulto , Análise de Variância , Ecocardiografia/métodos , Feminino , Grécia , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pericardite/fisiopatologia , Derrame Pleural/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Resultado do Tratamento
6.
Neurology ; 92(13): e1416-e1426, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30824556

RESUMO

OBJECTIVE: To define the clinical phenotype of patients with myositis with anti-U1-ribonucleoprotein (RNP) autoantibodies. METHODS: In this longitudinal cohort study, the prevalence and severity of clinical features at disease onset and during follow-up in patients with anti-U1-RNP-positive myositis were compared to those with dermatomyositis (DM), immune-mediated necrotizing myopathy (IMNM), and the antisynthetase syndrome (AS). RESULTS: Twenty anti-U1-RNP-positive patients, 178 patients with DM, 135 patients with IMNM, and 132 patients with AS were included. Anti-U1-RNP-positive patients were younger (∼37 years) and more likely to be black (60%) than patients with AS, DM, or IMNM. Muscle weakness was a presenting feature in 15% of anti-U1-RNP-positive patients; 80% eventually developed weakness. Four of 7 anti-U1-RNP-positive patients had necrotizing muscle biopsies. Arthritis occurred in 60% of anti-U1-RNP-positive patients; this was increased compared to DM (18%) or IMNM (6%) (all p < 0.01). DM-specific skin features developed in 60% of anti-U1-RNP-positive patients. Interstitial lung disease (ILD) occurred in 45% of anti-U1-RNP-positive patients; fewer patients with DM (13%) and IMNM (6%) and more patients with AS (80%) developed ILD (all p < 0.01). Glomerulonephritis and pericarditis occurred in 25% and 40% of anti-U1-RNP-positive patients, respectively, but rarely in the other groups; these features occurred only in those with coexisting anti-Ro52 autoantibodies. No anti-U1-RNP patient had cancer-associated myositis or died during the study period. CONCLUSIONS: Patients with anti-U1-RNP myositis typically present with proximal weakness and necrotizing muscle biopsies. Arthritis, dermatitis, and ILD are the most common extramuscular clinical features. Pericarditis and glomerulonephritis are uniquely found in patients with anti-U1-RNP-positive myositis.


Assuntos
Artrite/fisiopatologia , Doenças Autoimunes/fisiopatologia , Glomerulonefrite/fisiopatologia , Debilidade Muscular/fisiopatologia , Miosite/fisiopatologia , Pericardite/fisiopatologia , Adulto , Afro-Americanos , Idade de Início , Idoso , Artrite/etiologia , Autoanticorpos/imunologia , Doenças Autoimunes/complicações , Doenças Autoimunes/etnologia , Estudos de Casos e Controles , Estudos de Coortes , Dermatomiosite/etnologia , Dermatomiosite/fisiopatologia , Grupo com Ancestrais do Continente Europeu , Feminino , Glomerulonefrite/etiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/etiologia , Músculo Esquelético/patologia , Miosite/complicações , Miosite/etnologia , Miosite/imunologia , Necrose , Pericardite/etiologia , Ribonucleoproteína Nuclear Pequena U1/imunologia , Adulto Jovem
8.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 126-129, Jan.-Mar. 2019. graf
Artigo em Português | LILACS | ID: biblio-985129

RESUMO

RESUMO Objetivo: Relatar um caso raro de uma criança com meningite associada a pericardite na doença pneumocócica invasiva. Descrição do caso: Este relato descreve uma evolução clínica desfavorável de um lactente feminino de 6 meses de idade, previamente hígido, que apresentou inicialmente sintomas respiratórios e febre. A radiografia de tórax revelou um aumento da área cardíaca sem alterações radiográficas nos pulmões. Após a identificação do derrame pericárdico, o paciente apresentou convulsões e entrou em coma. Pneumonia foi descartada durante a investigação clínica. Contudo, foi identificado Streptococcus pneumoniae nas culturas de líquor e sangue. O exame neurológico inicial foi compatível com morte encefálica, posteriormente confirmada pelo protocolo. Comentários: A pericardite purulenta tornou-se uma complicação rara da doença pneumocócica invasiva desde o advento da terapia antibiótica. Pacientes com pneumonia extensa são primariamente predispostos e, mesmo com tratamento adequado e precoce, estão sujeitos a altas taxas de mortalidade. A associação de meningite pneumocócica e pericardite é incomum e, portanto, de difícil diagnóstico. Por isso, uma alta suspeição diagnóstica é necessária para instituir o tratamento precoce e aumentar a sobrevida.


ABSTRACT Objective: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. Case description: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. Comments: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.


Assuntos
Humanos , Masculino , Feminino , Streptococcus pneumoniae/isolamento & purificação , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico , Pericardite/fisiopatologia , Pericardite/microbiologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/terapia , Ecocardiografia/métodos , Radiografia Torácica/métodos , Líquido Cefalorraquidiano/microbiologia , Evolução Fatal , Hemocultura/métodos , Meningite/diagnóstico , Meningite/fisiopatologia , Meningite/microbiologia , Meningite/terapia , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Exame Neurológico/métodos
9.
Rev Paul Pediatr ; 37(1): 126-129, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30183802

RESUMO

OBJECTIVE: To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis. CASE DESCRIPTION: This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol. COMMENTS: Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.


Assuntos
Antibacterianos , Meningite , Pericardite , Infecções Pneumocócicas , Streptococcus pneumoniae/isolamento & purificação , Antibacterianos/administração & dosagem , Antibacterianos/classificação , Hemocultura/métodos , Líquido Cefalorraquidiano/microbiologia , Ecocardiografia/métodos , Evolução Fatal , Feminino , Humanos , Lactente , Meningite/diagnóstico , Meningite/microbiologia , Meningite/fisiopatologia , Meningite/terapia , Exame Neurológico/métodos , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico , Pericardite/microbiologia , Pericardite/fisiopatologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/fisiopatologia , Infecções Pneumocócicas/terapia , Radiografia Torácica/métodos
11.
J R Army Med Corps ; 165(6): 451-453, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30429297

RESUMO

We present a case of a fit and well British Army officer with sudden-onset chest pain following a viral illness, on a background of arduous skiing over an 8-week period. This resulted in a 6-month downgrade with no clearly defined plan for return to full fitness and deployability. The diagnosis and differentiation of myopericarditis from other causes of chest pain is reviewed. The treatment and management of myopericarditis is summarised and commentary is made on the paucity of evidence underpinning the return to fitness guidelines. The impact of this condition primarily affecting young fit individuals, commonly exacerbated by viral illness and arduous activity, is discussed in the context of individual employability and operational capability in a military setting.


Assuntos
Medicina Militar , Miocardite , Pericardite , Doença Aguda , Adulto , Dor no Peito/etiologia , Diagnóstico Diferencial , Coração/diagnóstico por imagem , Coração/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Militares , Miocardite/diagnóstico , Miocardite/fisiopatologia , Pericardite/diagnóstico , Pericardite/fisiopatologia , Taquicardia Ventricular
13.
BMJ Case Rep ; 20182018 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-30061136

RESUMO

T wave inversion (TWI) has many differential diagnoses with acute myocardial ischaemia being the highest on the list of potential causes. Cardiac T wave memory is a benign, under-recognised and clinically important phenomenon seen after periods of altered ventricular conduction. After normal ventricular conduction is restored, the T wave 'remembers' and mirrors the direction of the wide QRS complex. Therefore, negative T waves are seen in leads that had negative wide QRS complexes. We describe the case of a 60-year-old truck driver with chest pain, deep TWI and traditional cardiovascular risk factors. After ruling out significant myocardial ischaemia, it was crucial to determine the cause of his T wave changes to provide reassurance and provide commercial license medical clearance. While it is currently a diagnosis of exclusion, it remains an important clinical entity for clinicians to recognise to provide an explanation for certain T wave changes to avoid future unnecessary cardiac testing.


Assuntos
Dor no Peito/diagnóstico por imagem , Angiografia Coronária , Sistema de Condução Cardíaco/fisiopatologia , Pericardite/diagnóstico por imagem , Analgesia , Arritmias Cardíacas , Dor no Peito/etiologia , Tratamento Conservador , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica , Pericardite/tratamento farmacológico , Pericardite/fisiopatologia , Resultado do Tratamento
14.
Intern Emerg Med ; 13(6): 839-844, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30022399

RESUMO

In developed countries, more than 80% of cases of acute pericarditis remain without an established diagnosis after a conventional and standard diagnostic approach. These cases are generally labelled as 'idiopathic', i.e. without a known cause. This lack of information is a matter of concern for both patients and clinicians. Some years ago, this term reflected the state of the art of scientific knowledge on the topic. Advances have changed this point of view, in light of available molecular techniques like polymerase chain reaction able to identify viral cardiotropic agents in pericardial fluid and biopsies. Furthermore, the remarkable efficacy of interleukin-1 antagonists, a therapy targeting the innate immune response, suggests clinical and pathogenic similarity between a proportion of patients with idiopathic recurrent pericarditis and classical autoinflammatory diseases. So, it seems useful to discuss the pros and cons of using the term "idiopathic" in light of the new knowledge.


Assuntos
Formação de Conceito , Pericardite/classificação , Recidiva , Humanos , Pericardite/tratamento farmacológico , Pericardite/fisiopatologia
15.
Int J Cardiol ; 270: 197-199, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29891235

RESUMO

BACKGROUND: Myocardial involvement is common in acute idiopathic pericarditis and can, in some cases, lead to life-threatening complications. Acute idiopathic pericarditis is often preceded by various prodromal symptoms, but whether these symptoms can predict myocardial involvement is unclear. The aim of the study was to examine the value of different prodromal symptoms of acute idiopathic pericarditis for predicting myocardial involvement. METHODS AND RESULTS: Patients diagnosed with acute idiopathic pericarditis in 2007-2017 at our hospital were identified by database search. Demographic parameters, levels of plasma cardiac troponin and creatine kinase, and findings on echocardiography, magnetic resonance imaging, cardiac computed tomography and coronary angiography and data on prodromal symptoms were extracted from the medical files. The final cohort included 239 patients (73.2% males) aged 18-89 years. The most common prodromal symptoms were fever, chills, cough, sore throat, abdominal pain, and diarrhea. Myocardial involvement was observed in 83 patients (34.7%), leading to cardiogenic shock in 4 (4.8%). Patients with myocardial involvement more often had prodromal diarrhea, fever, sore throat, vomiting, atypical chest pain, and pharyngitis. On multivariate analysis, diarrhea, sore throat and fever were strong independent predictors of myocardial involvement (OR, 14.257, 95% CI, 3.920-51.782, p < 0.001, OR, 9.6, 95% CI, 2.934-31.982, p < 0.001 and OR, 2.445, 95% CI, 1.077-5.550, p = 0.025). Diarrhea was associated with left ventricular dysfunction as well. CONCLUSIONS: In acute idiopathic pericarditis, prodromal diarrhea, sore throat and fever strongly predict myocardial involvement, resulting in life-threatening hemodynamic compromise in a minority of the patients.


Assuntos
Pericardite/diagnóstico por imagem , Pericardite/fisiopatologia , Sintomas Prodrômicos , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Eletrocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico por imagem , Miocardite/fisiopatologia , Faringite/diagnóstico por imagem , Faringite/fisiopatologia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
16.
Curr Cardiol Rep ; 20(6): 40, 2018 04 19.
Artigo em Inglês | MEDLINE | ID: mdl-29675684

RESUMO

PURPOSE OF REVIEW: Despite the recent advancements in diagnostic modalities and therapeutic options available, the pathophysiology of pericardial syndromes remains poorly understood. In this review article, we explore the possible links between cardiac adiposity and pericardial syndromes. RECENT FINDINGS: Over the last years, the notion of cardiac adipose tissue has radically changed, and its pivotal role in myocardial diseases has been acknowledged. Recent evidence suggests a cross-talk between epicardial fat and the heart. Imaging of epicardial and pericardial adipose tissue has an independent predictive/prognostic value in cardiovascular disease. Recent data suggests that imaging of epicardial adipose tissue may also provide prognostic information on the clinical course of patients with acute pericarditis. Evidence from clinical and translational studies suggests possible links between epicardial fat and pericardial diseases, which need to be further explored. Epicardial adipose tissue could have a role both as a prognostic biomarker in pericardial syndromes and as potential therapeutic target for pericardial diseases. The findings of future research in the field are eagerly anticipated.


Assuntos
Tecido Adiposo/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Pericardite/fisiopatologia , Pericárdio/fisiopatologia , Tecido Adiposo/diagnóstico por imagem , Humanos , Radiografia , Ultrassonografia
17.
Dtsch Arztebl Int ; 115(12): 193-199, 2018 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-29642989

RESUMO

BACKGROUND: Persistent fever of unknown cause is only rarely of cardiac origin, but heart disease must be considered in the differential diagnosis. Aside from endocarditis, pericarditis and various other conditions may be responsible. METHODS: This review is based on pertinent articles retrieved by a selective search in PubMed and Google Scholar employing the term "fever" in combination with "myocardial infarction," "pericarditis," "endocarditis," and "postcardiac injury," with additional consideration of current cardiological guidelines. RESULTS: Endocarditis is associated with fever in 90% of cases, but 25-50% of patients also develop high body temperatures after acute myocardial infarction. In pericarditis, a temperature above 38°C indicates a poorer prognosis; if accompanied by other warning signs, it is an indication for hospitalization and pericardiocentesis. Fever can arise after cardiac surgical procedures as a manifestation of post - cardiotomy syndrome, a special type of perimyocarditis. There may be a latency period of up to 3 months. CONCLUSION: Fever can have both infectious and non-infectious cardiac causes. Its interpretation depends on the clinical context. The evidence base for treatment is sparse, and controlled trials are needed.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Endocardite/complicações , Febre/etiologia , Infarto do Miocárdio/complicações , Pericardite/complicações , Anti-Infecciosos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Citocinas/biossíntese , Endocardite/tratamento farmacológico , Endocardite/fisiopatologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/fisiopatologia , Febre/tratamento farmacológico , Humanos , Mediadores da Inflamação/metabolismo , Infarto do Miocárdio/fisiopatologia , Pericardite/tratamento farmacológico , Pericardite/fisiopatologia , Pirogênios/metabolismo , Fatores de Tempo
18.
Intern Emerg Med ; 13(4): 475-489, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29633070

RESUMO

Recurrent pericarditis is one of the most frequent pericardial diseases, affecting up to 30% of the patients who have experienced acute pericarditis. While the diagnosis of acute pericarditis is sometime straight forward, its etiology and therapeutic management are still a challenge for physicians. In developed countries, the idiopathic form is the most frequent, and the search for an infectious etiology is almost invariably negative. Nevertheless, since standard treatment with nonsteroidal anti-inflammatory drugs and colchicine is not always able to neutralize pericardial inflammation in recurrent pericarditis, anakinra, an IL-1 receptor antagonist, has been proposed as a possible therapeutic alternative for refractory forms. IL-1 is a cytokine that exerts a pivotal role in innate immunity and in the pathogenesis of some autoimmune diseases, such as rheumatoid arthritis, and in autoinflammatory disorders, as familial Mediterranean fever and cryopyrin-associated periodic syndromes. The successful management of patients with acute idiopathic recurrent pericarditis (IRP) needs a teamwork approach, where cardiologists, rheumatologists, clinical immunologists and internists are involved. In this review, we will discuss the clinical and therapeutical challenges of IRP both in adults and children from a clinical practice standpoint. We will also briefly illustrate the main pathogenic mechanisms of IRP to provide internists and cardiologists with the rationale for approaching the use of anakinra in selected clinical cases.


Assuntos
Pericardite/imunologia , Receptores Tipo I de Interleucina-1/antagonistas & inibidores , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Aspirina/uso terapêutico , Biomarcadores/análise , Biomarcadores/sangue , Proteína C-Reativa/análise , Criança , Pré-Escolar , Colchicina/uso terapêutico , Saúde Global/tendências , Humanos , Imunidade Inata , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Pessoa de Meia-Idade , Pericardite/diagnóstico , Pericardite/fisiopatologia , Recidiva , Fatores de Risco
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