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3.
JAAPA ; 33(1): 16-22, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31880644

RESUMO

Pericarditis is the most common form of pericardial disease and may be associated with significant morbidity and mortality. Management of idiopathic pericarditis includes pharmacologic therapies, non-pharmacologic therapies, and surgery. This article describes the diagnosis and management of idiopathic causes of pericarditis, incorporating recommendations included in the European Society of Cardiology guidelines.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Colchicina/uso terapêutico , Imunossupressores/uso terapêutico , Técnicas de Janela Pericárdica , Pericardite/terapia , Moduladores de Tubulina/uso terapêutico , Doença Aguda , Aspirina/uso terapêutico , Azatioprina/uso terapêutico , Gerenciamento Clínico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Pericardite/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Recidiva
4.
Expert Rev Cardiovasc Ther ; 17(11): 817-826, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31709840

RESUMO

Introduction: Acute pericarditis is frequently complicated with recurrences, which represent a diagnostic and therapeutic challenge for the physician, a bothersome trouble for patients. An incorrect treatment of pericarditis may cause further recurrence of symptoms, while an incorrect diagnosis may cause either a prolonged symptoms course with a possible risk of chronic constriction, or useless and potentially harmful treatments.Areas covered: This review will focus on the most useful and recent diagnostic tools for recurrent pericarditis. Medline/Pubmed Library were screened with specific key search: 'recurrent AND pericarditis'. The research was restricted to papers published in the last 5 years (2015-2019) and papers in English language, in order to appraise the latest advances in diagnostic assessment.Expert opinion: An accurate diagnosis of recurrent pericarditis is critical to provide timely and appropriate treatment of symptoms and prevention of further episodes. Diagnosis is made in case of recurrent symptoms associated with a documented evidence of pericardial inflammation. Further studies are needed to develop newer diagnostic tools aimed at identification of a predominant auto-inflammatory of auto-immune mechanism, which is essential to tailor the treatment.


Assuntos
Pericardite/terapia , Pericárdio/patologia , Humanos , Pericardite/diagnóstico , Recidiva
6.
Curr Cardiol Rep ; 21(9): 107, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31376028

RESUMO

Identification of the etiology of pericardial disease is challenging because the accessibility to pericardial fluid and tissue is limited and there is a relatively low yield of fluid and tissue analysis. Pericardial disease is associated with various systemic diseases and is frequently a first manifestation of other systemic diseases. Detecting the cause of pericarditis and minimizing the subsequent inflammatory process can possibly prevent long-term complications. PURPOSE OF REVIEW: To review the clinical utility of [18F]-2-deoxy-2-fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG-PET/CT) in the diagnosis and treatment of pericardial disease. RECENT FINDINGS: [18F]FDG-PET/CT can visualize the hypermetabolic tissues of both malignancy and inflammation. Distribution of [18F]FDG-PET/CT uptake can provide information for neoplastic disease. If malignancy is ruled out, high uptake of pericardium is associated with active inflammation of the pericardium, and thus response to anti-inflammatory agents can also be predicted with [18F]FDG-PET/CT imaging. [18F]FDG-PET/CT can be helpful for diagnosing and establishing prognosis and for planning for anti-inflammatory treatment in pericardial disease.


Assuntos
Pericardite/diagnóstico por imagem , Pericardite/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Fluordesoxiglucose F18 , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/secundário , Humanos , Inflamação/diagnóstico por imagem , Inflamação/terapia , Pericardite/etiologia , Prognóstico , Compostos Radiofarmacêuticos
7.
Curr Cardiol Rep ; 21(9): 97, 2019 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352541

RESUMO

PURPOSE OF REVIEW: This review highlights the literature related to pericardial injury following radiation for oncologic diseases. RECENT FINDINGS: Radiation-associated pericardial disease can have devastating consequences. Unfortunately, there is considerably less evidence regarding pericardial syndromes following thoracic radiation as compared to other cardiovascular outcomes. Pericardial complications of radiation may arise acutely or have an insidious onset several decades after treatment. Transthoracic echocardiography is the screening imaging modality of choice, while cardiac magnetic resonance imaging further characterizes the pericardium and guides treatment decision-making. Cardiac CT can be useful for assessing pericardial calcification. Ongoing efforts to lessen inadvertent cardiac injury are directed towards the revision of radiation techniques and protocols. As survival of mediastinal and thoracic malignancies continues to improve, radiation-associated pericardial disease is increasingly relevant. Though advances in radiation oncology demonstrate promise in curtailing cardiotoxicity, the long-term effects pertaining to pericardial complications remain to be seen.


Assuntos
Cardiotoxicidade/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Pericardite/diagnóstico por imagem , Pericárdio/diagnóstico por imagem , Cardiotoxicidade/etiologia , Cardiotoxicidade/prevenção & controle , Cardiotoxicidade/terapia , Relação Dose-Resposta à Radiação , Humanos , Neoplasias/radioterapia , Derrame Pericárdico/etiologia , Derrame Pericárdico/prevenção & controle , Derrame Pericárdico/terapia , Pericardite/etiologia , Pericardite/prevenção & controle , Pericardite/terapia , Pericárdio/lesões , Pericárdio/efeitos da radiação , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Lesões por Radiação/terapia , Fatores de Risco
8.
BMJ Case Rep ; 12(6)2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167769

RESUMO

Petrified pinna refers to the calcification or ossification of the external auricular cartilage. It is an uncommon clinical entity and is most often associated with local trauma, frostbite or inflammation. Auricular calcification may be the exclusive cutaneous marker of underlying endocrinopathy. It has been most commonly associated with adrenal insufficiency and other endocrine conditions like diabetes mellitus, hypothyroidism and acromegaly. We present a 47-year-old Caucasian manwho presented with acute pericarditis with tamponade physiology, who was found to have petrified pinnae as a telltale sign of the underlying autoimmune polyendocrine syndrome type 2.


Assuntos
Calcinose/etiologia , Pavilhão Auricular/patologia , Pericardite/etiologia , Poliendocrinopatias Autoimunes/diagnóstico , Insuficiência Adrenal/tratamento farmacológico , Diagnóstico Diferencial , Síndrome da Sela Vazia/diagnóstico por imagem , Humanos , Hipotireoidismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pericardiocentese/métodos , Pericardite/diagnóstico por imagem , Pericardite/terapia , Poliendocrinopatias Autoimunes/complicações , Poliendocrinopatias Autoimunes/imunologia , Resultado do Tratamento
9.
Am J Emerg Med ; 37(6): 1175-1183, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30987913

RESUMO

INTRODUCTION: Despite the declining incidence of coronary heart disease (CHD) in the United States, acute myocardial infarction (AMI) remains an important clinical entity, with many patients requiring emergency department (ED) management for mechanical, inflammatory, and embolic complications. OBJECTIVE: This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post myocardial infarction mechanical, inflammatory, and embolic complications. DISCUSSION: While 30-day mortality rate after AMI has decreased in the past two decades, it remains significantly elevated at 7.8%, owing to a wide variety of subacute complications evolving over weeks. Mechanical complications such as ventricular free wall rupture, ventricular septal rupture, mitral valve regurgitation, and formation of left ventricular aneurysms carry significant morbidity. Additional complications include ischemic stroke, heart failure, renal failure, and cardiac dysrhythmias. This review provides several guiding principles for management of these complications. Understanding these complications and an approach to the management of various complications is essential to optimizing patient care. CONCLUSIONS: Mechanical, inflammatory, and embolic complications of AMI can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. In addition to understanding the natural progression of disease and performing a focused physical examination, an electrocardiogram and bedside echocardiogram provide quick, noninvasive determinations of the underlying pathophysiology. Management varies by presentation and etiology, but close consultation with cardiology and cardiac surgery is recommended.


Assuntos
Aneurisma Cardíaco/etiologia , Ruptura Cardíaca Pós-Infarto/etiologia , Insuficiência da Valva Mitral/etiologia , Infarto do Miocárdio/complicações , Pericardite/etiologia , Ecocardiografia , Eletrocardiografia , Medicina de Emergência , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/terapia , Ruptura Cardíaca Pós-Infarto/diagnóstico , Ruptura Cardíaca Pós-Infarto/terapia , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/terapia , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Narração , Pericardite/diagnóstico , Pericardite/terapia , Exame Físico , Sistemas Automatizados de Assistência Junto ao Leito , Fatores de Risco
10.
Vet Clin North Am Equine Pract ; 35(1): 139-157, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30871834

RESUMO

Pericardial, myocardial, and great vessel diseases are relatively rare in horses. The clinical signs are often nonspecific and vague, or related to the underlying cause. Physical examination usually reveals tachycardia, fever, venous distension or jugular pulsation, a weak or bounding arterial pulse, ventral edema, and abnormal cardiac auscultation such as arrhythmia, murmur, or muffled heart sounds. The prognosis depends on the underlying cause and the disease progression, and ranges from full recovery to poor prognosis for survival. This article focuses on the etiology, diagnosis, prognosis, and treatment of pericarditis, pericardial mass lesions, myocarditis, cardiomyopathy, and great vessel aneurysm or rupture.


Assuntos
Anormalidades Cardiovasculares/veterinária , Cardiopatias/veterinária , Doenças dos Cavalos/diagnóstico , Animais , Aorta/anormalidades , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Cardiomiopatias/terapia , Cardiomiopatias/veterinária , Anormalidades Cardiovasculares/diagnóstico , Anormalidades Cardiovasculares/etiologia , Anormalidades Cardiovasculares/terapia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/terapia , Doenças dos Cavalos/etiologia , Doenças dos Cavalos/terapia , Cavalos , Miocardite/diagnóstico , Miocardite/etiologia , Miocardite/terapia , Miocardite/veterinária , Pericardite/diagnóstico , Pericardite/etiologia , Pericardite/terapia , Pericardite/veterinária , Prognóstico
11.
Ann Thorac Surg ; 108(4): e261-e263, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30885856

RESUMO

Many cases of immunoglobulin G4 (IgG4)-related disease involving different organ systems have been reported in the literature since the disorder was first described in patients with sclerosing pancreatitis. This report discusses an interesting case of IgG4-related cardiovascular disease that involved the pericardium and resulted in reoccurring chest pain in a 36-year-old man. The challenging diagnosis was made using established diagnostic criteria for other tissue sites and included the presence of elevated serum IgG4, pericardial infiltration by IgG4-positive plasma cells, focal phlebitis, and fibrosis. The patient's symptoms improved with immunosuppressive therapy.


Assuntos
Angina Pectoris/etiologia , Doença Relacionada a Imunoglobulina G4/complicações , Pericardite/etiologia , Pericardite/patologia , Adulto , Humanos , Doença Relacionada a Imunoglobulina G4/patologia , Doença Relacionada a Imunoglobulina G4/terapia , Masculino , Pericardite/terapia
12.
Future Cardiol ; 15(2): 119-126, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30848669

RESUMO

This review examined the relevance of chest pain, pericardial friction rub, pericardial effusion and ECG changes in regard to the diagnosis of acute pericarditis. It also assessed the evidence for the management and therapeutic guidelines, specifically nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids. Overall, there appears to be a lack of research into pericarditis. The bulk of high-quality research seems to have been carried out prior to the publication of the European Society of Cardiology guidelines of 2015. Diagnostically, the current combination of symptoms, clinical signs and investigations offer reasonable criteria for diagnosis, but they are not a gold standard. Research into its therapeutic treatment options is required to address the effects of specific nonsteroidal anti-inflammatory drugs (NSAIDs).


Assuntos
Anti-Inflamatórios/uso terapêutico , Gerenciamento Clínico , Eletrocardiografia/métodos , Imagem Cinética por Ressonância Magnética/métodos , Pericardite/diagnóstico , Pericardite/terapia , Guias de Prática Clínica como Assunto , Doença Aguda , Biomarcadores/sangue , Diagnóstico Diferencial , Humanos , Troponina/sangue
14.
Am J Emerg Med ; 37(5): 1006.e5-1006.e7, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30777376

RESUMO

BACKGROUND: Purulent bacterial pericarditis is a rare and potentially fatal disease. The course may be fulminant, and the presentation may pose a diagnostic challenge. CASE REPORT: An otherwise healthy 75-year-old male was brought to the emergency department in a state of general deterioration, confusion, and shock. Bedside ultrasound showed a significant pericardial effusion. His condition quickly deteriorated and the resuscitation included emergent bedside pericardiocentesis. The drainage was purulent and later cultures grew out Streptococcus pneumoniae. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Purulent pericarditis is extremely rare but should be considered in the patient with a fulminant infectious process (particularly pneumonia) and signs of pericardial effusion. Treatment should include appropriate antibiotics and early drainage.


Assuntos
Pericardite/diagnóstico , Pneumonia Pneumocócica/diagnóstico , Sepse/diagnóstico , Idoso , Reanimação Cardiopulmonar , Drenagem , Evolução Fatal , Humanos , Masculino , Pericardiocentese , Pericardite/etiologia , Pericardite/terapia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/etiologia , Infecções Pneumocócicas/terapia , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/terapia , Sistemas Automatizados de Assistência Junto ao Leito , Sepse/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia
16.
Int J Cardiol ; 282: 60-65, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30773267

RESUMO

BACKGROUND: Data concerning idiopathic recurrent pericarditis in pregnancy are scarce. OBJECTIVES: To evaluate the management and outcome of idiopathic recurrent pericarditis during pregnancy. METHODS AND RESULTS: Twenty-one pregnancies were evaluated in fourteen women with a history of recurrent idiopathic pericarditis (mean maternal age 31.5 years, mean gestational age 39.0 weeks), and subdivided in 2 cohorts: eight pregnancies were analyzed retrospectively (2002-2010), thirteen (2011-2017) prospectively and followed according a predefined management protocol. Ten pregnancies were uneventful, three ended in spontaneous early abortion, one fetal death occurred at 19 weeks. Recurrences of pericarditis occurred in eight and were treated by adding NSAIDs in two cases; in five cases the dose of corticosteroids was increased and in two cases aspirin was started/increased; paracetamol was always allowed. Colchicine was used in two cases in the prospective cohort. HELLP syndrome occurred in one patient, which resolved after delivery, and one patient experienced arterial hypertension and elevated transaminase. All infants had a good outcome (mean birth weight 3114 g, 10 males). Birth weight was significantly lower in the retrospective cohort (respectively 2806 g vs. 3320 g, p-value 0.017) in which higher doses of corticosteroids were used (median dose respectively 10.0 mg vs. 2.5 mg, p-value 0.048). Five recurrences of pericarditis occurred after delivery, easily treated with standard therapy. CONCLUSION: General outcomes of pregnancy in patients with idiopathic recurrent pericarditis is good, especially when patients are carefully followed by multidisciplinary teams according to standardized protocols.


Assuntos
Gerenciamento Clínico , Pericardite/diagnóstico , Pericardite/terapia , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Aspirina/administração & dosagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Gravidez , Recidiva , Estudos Retrospectivos
18.
Am J Case Rep ; 20: 252-257, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30804319

RESUMO

BACKGROUND Stress induced cardiomyopathy (SIC) is characterized by non-obstructive coronary arteries and characteristic ventricular apical ballooning. The exact pathogenesis of SIC is not well recognized. We present an unusual case of SIC that mimicked acute myopericarditis and discuss the effect of this masquerading presentation of SIC in recognizing pathophysiological association between myopericarditis and SIC and limitations of current diagnostic criteria. CASE REPORT A 47-year-old female presented with flu-like illness and pleuritic chest pain. An electrocardiogram (ECG) showed diffuse PR depressions and ST elevations, troponin 5 ng/mL, hemoglobin 14.2 mg/dL, leukocytosis (white blood cell count of 15.1×103/uL) and erythrocyte sedimentation rate (ESR) of 22.4 mm/hour. Echocardiogram showed reduced ejection fraction (EF) with apical ballooning. Catheterization showed non-obstructive coronary disease. The patient was given colchicine and ibuprofen for 1 day with symptom resolution over the next 2 days and repeat echocardiogram with preserved EF. Troponin trended down to 3.24 ng/mL and 0.44 ng/mL, 6 hours apart. ECG showed resolution of PR depressions and subsequent T wave inversions in 1, AVl, V1-V6 by day 3. The diagnosis of myopericarditis was favored by viral prodrome, fever, pleuritic pain, pericardial rub, ECG findings, and elevated ESR. History of emotional stress, characteristic ballooning of left ventricle apex with rapid resolution favored SIC. CONCLUSIONS This case showed that SIC and myocarditis need not be mutually exclusive and differentiating clinically between these 2 entities can be difficult. Alternatively, SIC can accompany other cardiac conditions like myocardial infarction, pericarditis, and myocarditis making diagnosis and management challenging. Clinicians need to be cautious while making this differentiation as duration and type of therapy may be significantly different. SIC can be considered a variant of regional inflammatory myocarditis wherein pericarditis may result secondary to extension of myocardial inflammation to overlying pericardium. The current Mayo Clinic criteria for diagnosis of SIC appears to be outdated, not accounting for such atypical presentations, and therefore needs to be revised.


Assuntos
Miocardite/diagnóstico , Miocardite/etiologia , Pericardite/diagnóstico , Pericardite/etiologia , Estresse Psicológico/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Miocardite/terapia , Pericardite/terapia
20.
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
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