Management of pericarditis in women

Management of postpartum preeclampsia complicated by idiopathic pericarditis: A case report

This case report discusses the rare occurrence of pericarditis with preeclampsia in the antepartum through to postpartum state. A woman in her 30s presented four days postnatally with positional central chest pain, elevated blood pressure and newly deranged liver function tests. Echocardiogram demonstrated new pleural effusion and she was diagnosed with preeclampsia and superimposed pericarditis. Her blood pressure was stabilised with a combination treatment regime of labetalol, enalapril and frusemide, whilst her pericarditis responded well to colchicine and ibuprofen. She was eventually discharge on enalapril and colchicine. By her 6-week follow-up she had made a full recovery and she had reported no recurrence of symptoms at the time of writing.

Pericarditis Management in Individuals Contemplating Pregnancy, Currently Pregnant, or Breastfeeding

PURPOSE OF REVIEW

Pericarditis complicates pregnancy planning, pregnancy, or the postpartum period, and the management approach requires special considerations. Here, we aim to summarize the latest research, diagnostic, and treatment strategies.

RECENT FINDINGS

Physiologic cardiovascular (CV) adaptations occurring during pregnancy complicate diagnosis, but for most patients, an electrocardiogram (ECG) and transthoracic echocardiogram (TTE) are sufficient to diagnosis pericarditis in the appropriate clinical context. Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) can be used until 20 weeks gestation as needed. The use of colchicine is encouraged at any time point to reduce the risk of recurrence. Glucocorticoids may be used at the lowest possible dose for the least amount of time throughout pregnancy and breastfeeding. For incessant, recurrent, or refractory pericarditis, or when the above therapies are contraindicated, there may be a consideration of the use of IL-1 inhibition during pregnancy, recognizing the limited data in pregnant patients. Finally, we encourage the use of a multidisciplinary team approach including OB-GYN, cardiology, and rheumatology when available. The diagnosis and treatment of pericarditis in female patients of reproductive age require special considerations. Although highly effective treatment options are available, there is a need for greater data and larger international registries to improve treatment recommendations.

Ultrasound Assessment in a Pregnant Woman? Not just for the Fetus

Pericarditis is a relatively common diagnosis worldwide; however, there are few data published on the frequency, diagnosis, and management of pericardial diseases in pregnant women. Ultrasonography has established its utmost importance and is worldwide recognized in pregnancy and fetal evaluation. Moreover, point-of-care ultrasonography of pregnant women, guided by clinical examination and history, can play an equally fundamental role. We present a case of a 37-year-old pregnant woman who presented at the emergency department with pleuritic chest pain, fever, and cough. Bedside point-of-care ultrasonography confirmed pericarditis revealing an organized pericardial effusion, leading to patient hospitalization and initiation of therapy. The importance and acknowledgment of portable and hand-held ultrasonography devices are growing since it enables physicians not only to make a fast and accurate diagnosis but also to access evolution in inpatient and outpatient settings.

Management of acute and recurrent pericarditis in pregnancy

This review summarizes the currently available evidence on the management of acute and recurrent pericarditis during pregnancy, focusing on the safety of diagnostic procedures and treatment options for the mother and foetus. Family planning should be addressed in women with recurrent pericarditis of reproductive age and adjustment of therapy should be considered before a planned pregnancy. The treatment of pericarditis in pregnancy is similar to that for non-pregnant women but considers current knowledge on drug safety during pregnancy and lactation. The largest case series on this topic described 21 pregnancies with idiopathic recurrent pericarditis. Pregnancy should be planned in a phase of disease quiescence. Non-steroidal anti-inflammatory drugs can be used at high dosages until the 20th week of gestation (except low-dose aspirin 100 mg/die). Colchicine is allowed until gravindex positivity; after this period, administration of this drug during pregnancy and lactation should be discussed with the mother if its use is important to control recurrent pericarditis. Prednisone is safe if used at low-medium doses (2,5 - 10 mg/die). General outcomes of pregnancy in patients with pericarditis are good when the mothers are followed by a multidisciplinary team with experience in the field.

Age- and sex-based differences in patients with acute pericarditis

BACKGROUND

Acute pericarditis has a wide spectrum of clinical presentations largely depending on underlying aetiologies. We assessed the role of age and sex in the clinical features and outcome of acute pericarditis.

MATERIALS AND METHODS

A total of 240 consecutive patients hospitalized with a first episode of acute pericarditis were included. At baseline demographics, clinical features, laboratory and imaging findings and medical therapy were recorded. Patients were followed up for at least 18 months for complications. Data comparisons were performed according to sex and age (≤60 or >60 years).

RESULTS

The male/female ratio was 1.42, and 56% of patients were >60 years. Younger patients depicted more often chest pain (P = .001), fever and rubs (P < .001 for both), ST elevation and PR depression (P = .032 and .009, respectively), higher CRP values (P = .009) and less often dyspnoea (P = .046) and pericardial effusion (P = .036). Moreover, they received less often glucocorticoids (P < .001) and depicted less atrial fibrillation (P = .003) and a higher rate of recurrent pericarditis (P = .013). After multivariate adjustment for confounders, age >60 years remained an independent predictor for a lower risk of recurrent pericarditis (hazard ratio 0.60, 95% CI: 0.39-0.96, P = .033). Regarding sex, females were older (P = .007), showed less often ST elevation and PR depression (P < .001 and .002, respectively) and had a higher baseline heart rate (P = .02). Sex was not associated with recurrent pericarditis risk.

CONCLUSIONS

Patients with acute pericarditis have distinct presenting clinical, biochemical and prognostic features according to age and sex. Awareness of such differences is important for clinical decision-making.

Predictors and risk factors of short-term readmission of acute pericarditis

Background: The 30-day readmission risk factors for acute pericarditis are not well known. We investigated the risk factors and predictors of pericarditis from a national cohort.Methods: Readmission data from the National Readmission Database (NRD) from the year 2016 were used to analyze the prevalence of risk factors and predictors of pericarditis 30-day readmission.Results: From the year 2016, 16,475 acute pericarditis hospitalizations were recorded. The rate of readmission from the year 2016 is similar to 2012 reported data (18%). A total of 13,844 patients (mean age 55.2 years, 40% of women) were found for acute pericarditis readmissions. The incidence rate of 30-day readmission of acute pericarditis patients in our study was 17.8% with the major cause of readmission was related to cardiovascular (pericarditis, endocarditis, and myocarditis) during 30-day follow-up. The median cost of the index and 30 days pericarditis admission $10,048 and $9,932, respectively.Conclusion: Chronic comorbidities, prolonged hospitalization, and admission to a short-term hospital/left against medical advice admission to metropolitan teaching hospital were associated with a higher risk of 30-day readmission.

Rate, Causes, and Predictors of 30-Day Readmission Following Hospitalization for Acute Pericarditis

BACKGROUND

Acute pericarditis is a frequent cause of hospitalization in the United States. Although recurrence of this condition is common, few studies have investigated hospital readmissions in this patient population.

METHODS

We queried the National Readmission Database for the years 2016 and 2017 to identify adult admissions for acute pericarditis, and analyzed the data for 30-day readmission. Using multivariate Cox regression analysis, we identified clinical characteristics that were independently predictive of hospital readmission within 30 days.

RESULTS

A total of 21,335 patients (mean age 52.5 ± 0.2 years; 38.3% women) who were discharged following hospitalization for acute pericarditis were included. The rate of 30-day readmission was 12.9% (n = 2740). Increasing age (adjusted hazard ratio [HR] 1.05 per 5-year increase; 95% confidence interval [CI], 1.02-1.09; P < 0.001), female sex (adjusted HR 1.33; 95% CI, 1.18-1.49; P < 0.001), dialysis dependence (adjusted HR 1.70; 95% CI, 1.30-2.22; P < 0.001), chronic obstructive pulmonary disease (adjusted HR 1.27; 95% CI, 1.11-1.45; P < 0.001), and presence of pericardial effusion (adjusted HR 1.24; 95% CI, 1.04-1.49; P = 0.02) were independently associated with a higher risk of readmission. In-hospital mortality was significantly higher after readmission than for the index hospitalization (3.4% vs 1.0%, P < 0.001).

CONCLUSION

After hospitalization for acute pericarditis, readmission within 30 days is common and is associated with increased mortality. Identification of characteristics associated with a higher risk of readmission may lead to focused interventions to improve outcomes.

Pericardial disease as a rare complication of pediatric appendicitis: a systematic literature search

BACKGROUND

Classic symptoms of acute appendicitis are well known but are uncommon and often misinterpreted in pediatric patients, potentially delaying diagnosis and resulting in rare sequelae.

METHODS

We conducted a comprehensive systematic literature search of case reports detailing pericardial disease as a rare complication of pediatric appendicitis through MEDLINE, Embase, and Cochrane Databases. Inclusion criteria was that the patient must be < 18 years old and present with both pericardial disease and appendicitis.

RESULTS

Our search yielded 7 cases with an average age of 10.3 ± 3.9 years old. The cases involved cardiac tamponade, pericarditis, and/or pericardial effusion. Five cases were diagnosed with appendicitis before complicated by pericardial disease. Most cases had an infectious component, but a majority had negative pericardial fluid cultures. Pleural effusion and abdominal abscesses were other common complications of pediatric appendicitis.

CONCLUSION

Awareness of this uncommon relationship may have prognostic value as this may facilitate appropriate management of pericardial effusions, tamponade, and/or appendicitis.

Clinical profile and influences on outcomes in patients hospitalized for acute pericarditis

BACKGROUND

The clinical profile with regard to sex and the influences on outcomes in patients who have been hospitalized for acute pericarditis is largely uncharacterized.

METHODS AND RESULTS

We studied all patients aged ≥16 years admitted to the hospital because of acute pericarditis (postpericardiotomy and myocardial infarction associated pericarditis were excluded). Data were collected from a Finnish national registry that included data on all cardiovascular admissions (670 409) during 9.5 years in 29 hospitals nationwide. During the study period, there were 1361 admissions for acute pericarditis. Pericarditis patients were more likely to be male (64.9% of patients) than female (35.1%), with an age-adjusted likelihood ratio of 1.85 (95% confidence interval [CI], 1.65-2.06; P<0.0001) for male sex. The standardized incidence rate of hospitalizations for acute pericarditis was 3.32 per 100 000 person-years. Men 16 to 65 years of age were at higher risk for pericarditis (relative risk, 2.02; 95% CI, 1.81-2.26; P<0.0001) than women in the general admitted population, with the highest risk difference among young adults. Acute pericarditis caused 0.20% (95% CI, 0.19%-0.22%) of all cardiovascular admissions. The proportion of pericarditis-caused admissions declined by an estimated 51% per 10-year increase in age. The in-hospital mortality rate for acute pericarditis was 1.1% (95% CI, 0.6%-1.8%). Mortality increased with age (hazard ratio, 3.26; 95% CI, 1.78-5.95 per 10-year increase in age; P=0.0001) and severe coinfection (pneumonia or septicemia; hazard ratio, 13.46; 95% CI, 2.26-80.01; P<0.005) but was not associated with sex in multivariate analysis.

CONCLUSIONS

Patients hospitalized for acute pericarditis are more commonly male. Increasing age and severe coinfection are associated with greater in-hospital mortality in hospitalized acute pericarditis patients.