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Kosaka N, Uchiyama T, Onozawa M, Nagai J, Koya J, Ishizaka S, Nagai T, Ikebe Y, Kato K, Tanei ZI, Sakakibara-Konishi J, Hasegawa Y, Ohigashi H, Goto H, Hashimoto D, Ujiie H, Hirano S, Konno S, Anzai T, Taniguchi K, Tanaka S, Teshima T. Acute onset of constrictive pericarditis due to acute myelomonocytic leukemia: A case and literature review. Intern Med 2024:3505-24. [PMID: 38631853 DOI: 10.2169/internalmedicine.3505-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
We herein present a fatal case of constrictive pericarditis (CP) due to acute myelomonocytic leukemia (AMML) in a patient who initially complained of an acute onset of chest pain two days after COVID-19 vaccination. An autopsy revealed pericardial infiltration of leukemic cells. CP is rarely associated with leukemia and only 14 cases have been reported in the literature. The etiology of CP in previous reports included leukemic infiltration, graft-versus-host disease, drug-induced, post-radiation, autoimmune, and otherwise unidentified. This case indicates that leukemic infiltration can cause CP and that clinicians should include leukemia in the differential diagnosis of CP.
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Affiliation(s)
- Naoki Kosaka
- Clinical Training Center, Hokkaido University Hospital, Japan
| | | | - Masahiro Onozawa
- Clinical Training Center, Hokkaido University Hospital, Japan
- Department of Hematology, Hokkaido University Hospital, Japan
| | - Jun Nagai
- Department of Hematology, Hokkaido University Hospital, Japan
| | - Jiro Koya
- Department of Cardiology, Hokkaido University Hospital, Japan
| | - Suguru Ishizaka
- Department of Cardiology, Hokkaido University Hospital, Japan
| | - Toshiyuki Nagai
- Department of Cardiology, Hokkaido University Hospital, Japan
| | - Yohei Ikebe
- Center for Cause of Death Investigation, Faculty of Medicine, Hokkaido University, Japan
| | - Kenjiro Kato
- Department of Surgical Pathology, Hokkaido University Hospital, Japan
| | - Zen-Ichi Tanei
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Japan
| | | | - Yuta Hasegawa
- Department of Hematology, Hokkaido University Hospital, Japan
| | | | - Hideki Goto
- Department of Hematology, Hokkaido University Hospital, Japan
| | - Daigo Hashimoto
- Department of Hematology, Hokkaido University Hospital, Japan
| | - Hideki Ujiie
- Clinical Training Center, Hokkaido University Hospital, Japan
| | - Satoshi Hirano
- Clinical Training Center, Hokkaido University Hospital, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Hokkaido University Hospital, Japan
| | - Toshihisa Anzai
- Department of Cardiology, Hokkaido University Hospital, Japan
| | - Koji Taniguchi
- Department of Integrative Pathology, Faculty of Medicine, Hokkaido University, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Japan
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Yan KL, Lee YJ, Baik AH. Acute radiation-induced pericarditis complicated by polymicrobial infectious pericarditis in a patient with mediastinal sarcoma: a case report. Eur Heart J Case Rep 2024; 8:ytae084. [PMID: 38405193 PMCID: PMC10894000 DOI: 10.1093/ehjcr/ytae084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Background Acute pericarditis is often caused by viral infections, autoimmune diseases, and radiation therapy (RT). Infectious pericarditis is rare and associated with high morbidity and mortality. We present a case of acute RT-induced pericarditis complicated by bacterial pericarditis and cardiac tamponade due to oesophageal bacterial translocation. Case summary A 65-year-old man with a recurrent mediastinal sarcoma complicated by oesophageal compression and recent oesophageal stenting presented with shortness of breath. Electrocardiogram showed diffuse ST elevations, and he was diagnosed with presumed RT-induced pericarditis. Despite anti-inflammatory therapy, he developed haemodynamic instability and clinical tamponade, with transthoracic echocardiogram showing a large circumferential pericardial effusion. He underwent emergent pericardiocentesis, and pericardial fluid cultures grew polymicrobial species. Anti-inflammatories were held, and he was started on broad spectrum intravenous antibiotics and antifungals. Due to clinical decompensation and repeat computed tomography imaging demonstrating worsening pericardial disease, he underwent pericardial irrigation and subxiphoid pericardial window. The patient died from hypoxaemic and hypercapnic respiratory failure. Autopsy revealed constrictive pericarditis and no bacterial organisms in the pericardium. Discussion Anti-inflammatories are standard treatment for viral and RT-induced pericarditis. Purulent, bacterial pericarditis is rare and an uncommon complication of RT-induced pericarditis. Polymicrobial infectious pericarditis is often refractory to intravenous antibiotics, requiring surgical intervention. This case highlights the importance of maintaining a high index of suspicion of various potential aetiologies of pericarditis in order to tailor medical and surgical therapies especially in high-risk, immunosuppressed cancer patients.
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Affiliation(s)
- Kimberly L Yan
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - Yoo Jin Lee
- Department of Radiology, University of California, San Francisco, San Francisco, CAUSA
| | - Alan H Baik
- Department of Medicine, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
- Division of Cardiology, Section of Cardio-Oncology and Immunology, University of California, San Francisco, 555 Mission Bay Blvd South, San Francisco, CA 94158, USA
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Saleh A, D'amico A, Hasnie A, Clarkson S, Heindl B. Atrial arrhythmias and acute pericarditis triggered by bleach ingestion-associated oesophageal perforation: a case report. Eur Heart J Case Rep 2024; 8:ytae046. [PMID: 38374983 PMCID: PMC10875924 DOI: 10.1093/ehjcr/ytae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/07/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024]
Abstract
Background Acute pericarditis due to oesophageal perforation and caustic injury is a rare presentation of bleach ingestion. Cardiac arrhythmias such as atrial fibrillation and atrial flutter have been associated with certain aetiologies of acute pericarditis. This case report presents a unique occurrence of acute pericarditis following bleach ingestion and intermittent atrial fibrillation and atrial flutter triggered by liquid intake. Case summary A 36-year-old male with no significant past medical history presented after attempted suicide by ingesting bleach. He had acute pericarditis resulting from caustic oesophageal perforation and extensive mediastinal injury. In the following days, he developed recurrent episodes of atrial fibrillation and atrial flutter following fluid intake, prompting treatment with metoprolol. On Day 5 of hospitalization, he underwent an oesophagogram and developed persistent atrial arrhythmia with haemodynamic instability requiring cardioversion. He underwent thoracoscopic surgery to address the oesophageal injury. A jejunostomy tube was placed and he had complete resolution of his recurrent atrial arrhythmia. Discussion This case highlights a rare presentation of atrial arrhythmias and acute pericarditis caused by corrosive oesophageal injury due to bleach ingestion. The effective management of such cases necessitates a co-ordinated approach, involving the collaboration of cardiothoracic surgeons, cardiologists, and critical care specialists, with the aim of enhancing patient outcomes and mitigating the life-threatening risks associated with oesophageal perforation and cardiac arrhythmias. Furthermore, this case underscores the imperative for further research to better understand the relationship between traumatic acute pericarditis and atrial arrhythmias, offering the potential for improved patient care in these intricate clinical scenarios.
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Affiliation(s)
- Ahmed Saleh
- Internal Medicine, University of Alabama at Birmingham School of Arts and Humanities: The University of Alabama at Birmingham College of Arts and Sciences, 1802 6th Ave S, Birmingham, AL 35233, USA
| | - Alex D'amico
- Internal Medicine, University of Alabama at Birmingham School of Arts and Humanities: The University of Alabama at Birmingham College of Arts and Sciences, 1802 6th Ave S, Birmingham, AL 35233, USA
| | - Ammar Hasnie
- Internal Medicine, University of Alabama at Birmingham School of Arts and Humanities: The University of Alabama at Birmingham College of Arts and Sciences, 1802 6th Ave S, Birmingham, AL 35233, USA
| | - Stephen Clarkson
- Internal Medicine, University of Alabama at Birmingham School of Arts and Humanities: The University of Alabama at Birmingham College of Arts and Sciences, 1802 6th Ave S, Birmingham, AL 35233, USA
| | - Brittain Heindl
- Internal Medicine, University of Alabama at Birmingham School of Arts and Humanities: The University of Alabama at Birmingham College of Arts and Sciences, 1802 6th Ave S, Birmingham, AL 35233, USA
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Aikawa H, Fujino M, Murai K, Iwai T, Sawada K, Matama H, Miura H, Honda S, Yoneda S, Takagi K, Otsuka F, Kataoka Y, Asaumi Y, Tahara Y, Ogata S, Nishimura K, Tsujita K, Noguchi T. In-hospital adverse events and recurrence in hospitalized patients with acute pericarditis. J Cardiol 2023; 82:268-273. [PMID: 36906259 DOI: 10.1016/j.jjcc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/04/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Acute pericarditis occasionally requires invasive treatment, and may recur after discharge. However, there are no studies on acute pericarditis in Japan, and its clinical characteristics and prognosis are unknown. METHODS This was a single-center, retrospective cohort study of clinical characteristics, invasive procedures, mortality, and recurrence in patients with acute pericarditis hospitalized from 2010 to 2022. The primary in-hospital outcome was adverse events (AEs), a composite of all-cause mortality and cardiac tamponade. The primary outcome in the long-term analysis was hospitalization for recurrent pericarditis. RESULTS The median age of all 65 patients was 65.0 years [interquartile range (IQR), 48.0-76.0 years], and 49 (75.3 %) were male. The etiology of acute pericarditis was idiopathic in 55 patients (84.6 %), collagenous in 5 (7.6 %), bacterial in 1 (1.5 %), malignant in 3 (4.6 %), and related to previous open-heart surgery in 1 (1.5 %). Of the 8 patients (12.3 %) with in-hospital AE, 1 (1.5 %) died during hospitalization and 7 (10.8 %) developed cardiac tamponade. Patients with AE were less likely to have chest pain (p = 0.011) but were more likely to have symptoms lasting 72 h after treatment (p = 0.006), heart failure (p < 0.001), and higher levels of C-reactive protein (p = 0.040) and B-type natriuretic peptide (p = 0.032). All patients complicated with cardiac tamponade were treated with pericardial drainage or pericardiotomy. We analyzed 57 patients for recurrent pericarditis after excluding 8 patients: 1 with in-hospital death, 3 with malignant pericarditis, 1 with bacterial pericarditis, and 3 lost to follow-up. During a median follow-up of 2.5 years (IQR 1.3-3.0 years), 6 patients (10.5 %) had recurrences requiring hospitalization. The recurrence rate of pericarditis was not associated with colchicine treatment or aspirin dose or titration. CONCLUSIONS In acute pericarditis requiring hospitalization, in-hospital AE and recurrence were each observed in >10 % of patients. Further large studies on treatment are warranted.
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Affiliation(s)
- Hirohiko Aikawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan.
| | - Kota Murai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, NCVC, Suita, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, NCVC, Suita, Osaka, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center (NCVC), Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Lazaros G, Vlachakis PK, Theofilis P, Dasoula FE, Imazio M, Lazarou E, Vlachopoulos C, Tsioufis C. D-dimer as a diagnostic and prognostic plasma biomarker in patients with a first episode of acute pericarditis. Eur J Intern Med 2023; 116:58-64. [PMID: 37357033 DOI: 10.1016/j.ejim.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES The impact of plasma biomarkers on diagnosis and prognosis of patients with acute pericarditis (AP) has been poorly investigated. This study aims to assess the diagnostic and prognostic role of d-dimer (DD), an easily obtainable biomarker, in patients with AP. PATIENTS AND METHODS This is a prospective clinical study enrolling 265 consecutive patients hospitalized between September 2010 and May 2019 with a first episode of AP. At baseline, demographics, clinical features, laboratory and imaging findings were recorded. All patients were followed-up for a minimum of 18 months. Endpoints included cardiac tamponade, new-onset atrial fibrillation, pericardial drainage, recurrent/constrictive pericarditis and death. RESULTS DD was measured in 165 out of 265 patients (62.3%, median levels 1456 ng/mL) Among them, 121 patients (73.3%) presented with elevated age-adjusted DD levels. Patients with elevated DD depicted a higher rate of pleural (69.4%, vs 38.6%, p<0.001) and pericardial effusions (89.3% vs 72.7%, p = 0.009). Elevated DD correlated with admission (rho=0.37) and peak (rho=0.36) C-reactive protein values. Patients with elevated DD depicted a trend towards a greater prevalence of pericardial tamponade vs those without (14.9% vs 4.5% respectively, p = 0.07). In the 43.8% of patients with elevated DD who underwent computed tomography pulmonary angiography (CTPA), no case of pulmonary embolism or aortic syndrome was unveiled. CONCLUSION DD elevation is detected in the majority of AP cases at presentation and may herald cardiac tamponade. In patients with chest pain not attributable to alternative causes, elevated DD denotes an inflammatory condition and should not prompt unnecessary investigations, such as CTPA.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece.
| | - Panagiotis K Vlachakis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Panagiotis Theofilis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Foteini E Dasoula
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria della Misericordia", ASUFC, Udine, Italy
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, Athens 11527, Greece
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Saeed S, Mohamed Ali A, Wasim D, Saeed N, Lunde T, Solheim E, Vegsundvåg J, Imazio M. Natural Course of Electrocardiogram Changes and the Value of Multimodality Imaging in Acute Pericarditis. Cardiology 2023; 148:219-227. [PMID: 36948161 DOI: 10.1159/000530207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND ECG is the initial diagnostic tool that in combination with typical symptoms often raises the suspicion of pericarditis. Echocardiography remains the first-line imaging modality for assessment of pericardial diseases, particularly effusion/tamponade, constrictive physiology, and assessment of regional wall motion abnormalities as differential diagnoses. However, cardiac CT and cardiac magnetic resonance may be necessary in complicated cases and to identify pericardial inflammation in specific settings (atypical presentation, new onset constriction), as well as myocardial involvement and monitoring the disease activity. SUMMARY In acute pericarditis, the most commonly used ECG criteria recommended by international guidelines are the widespread ST-segment elevation or PR depression. However, the classic ECG pattern of widespread ST-segment elevation or PR depression can be seen in less than 60% of patients. In addition, ECG changes are often temporally dynamic, evolve rapidly during the course of disease, and may be influenced by a number of factors such as disease severity, time (stage) of presentation, degree of myocardial involvement, and the treatment initiated. Overall, temporal dynamic changes on ECG during acute pericarditis or myopericarditis have received limited attention. Hence, the aim of this brief clinical review was to increase awareness about the various ECG changes observed during the course of acute pericarditis. KEY MESSAGES ECG may be normal at presentation or for days after the index episode of chest pain, but serial ECGs can reveal specific patterns of temporally dynamic ST elevation in patients with pericarditis or myopericarditis, particularly during new episodes of chest pain.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Abukar Mohamed Ali
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Daanyaal Wasim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Nasir Saeed
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Torbjørn Lunde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Massimo Imazio
- Cardiology, Cardiothoracic Department, University Hospital "Santa Maria Della Misericordia", ASUFC, Udine, Italy
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Dini FL, Baldini U, Bytyçi I, Pugliese NR, Bajraktari G, Henein MY. Acute pericarditis as a major clinical manifestation of long COVID-19 syndrome. Int J Cardiol 2023; 374:129-134. [PMID: 36513284 PMCID: PMC9734068 DOI: 10.1016/j.ijcard.2022.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The long COVID-19 syndrome has been recently described and some reports have suggested that acute pericarditis represents important manifestation of long COVID-19 syndrome. The aim of this study was to identify the prevalence and clinical characteristics of patients with long COVID-19, presenting with acute pericarditis. METHODS We retrospectively included 180 patients (median age 47 years, 62% female) previously diagnosed with COVID-19, exhibiting persistence or new-onset symptoms ≥12 weeks from a negative naso-pharyngeal SARS CoV2 swamp test. The original diagnosis of COVID-19 infection was determined by a positive swab. All patients had undergone a thorough physical examination. Patients with suspected heart involvement were referred to a complete cardiovascular evaluation. Echocardiography was performed based on clinical need and diagnosis of acute pericarditis was achieved according to current guidelines. RESULTS Among the study population, shortness of breath/fatigue was reported in 52%, chest pain/discomfort in 34% and heart palpitations/arrhythmias in 37%. Diagnosis of acute pericarditis was made in 39 patients (22%). Mild-to-moderate pericardial effusion was reported in 12, while thickened and bright pericardial layers with small effusions (< 5 mm) with or without comet tails arising from the pericardium (pericardial B-lines) in 27. Heart palpitations/arrhythmias (OR:3.748, p = 0.0030), and autoimmune disease and allergic disorders (OR:4.147, p = 0.0073) were independently related to the diagnosis of acute pericarditis, with a borderline contribution of less likelihood of hospitalization during COVID-19 (OR: 0.100, p = 0.0512). CONCLUSION Our findings suggest a high prevalence of acute pericarditis in patients with long COVID-19 syndrome. Autoimmune and allergic disorders, and palpitations/arrhythmias were frequently associated with pericardial disease.
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Affiliation(s)
- Frank Lloyd Dini
- Centro Medico Sant'Agostino, Milano, Italy; University Clinical Centre of Kosova, Prishtina, Kosovo.
| | | | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; University Clinical Centre of Kosova, Prishtina, Kosovo
| | | | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Sousa JP, Roque D, Guerreiro C, Teixeira R. Anti-SARS-CoV-2 vaccine-induced myocarditis - real but, in general, rare and mild: A consensus statement from the Studies Committee of the Portuguese Society of Cardiology. Rev Port Cardiol 2023; 42:161-167. [PMID: 36621565 PMCID: PMC9812843 DOI: 10.1016/j.repc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 01/07/2023] Open
Abstract
Acute myocarditis (especially) and pericarditis have been consistently associated with the administration of vaccines against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), generating anxiety in the general population, uncertainty in the scientific community and obstacles to ambitious mass vaccination programs, especially in foreign countries. Like some of its European counterparts, the Portuguese Society of Cardiology (SPC), through its Studies Committee, decided to take a position on some of the most pressing questions related to this issue: (i) How certain are we of this epidemiological association? (ii) What is the probability of its occurrence? (iii) What are the pathophysiological bases of these inflammatory syndromes? (iv) Should their diagnosis, treatment and prognosis follow the same steps as for typical idiopathic or post-viral acute myopericarditis cases? (v) Is the risk of post-vaccine myocarditis great enough to overshadow the occurrence of serious COVID-19 disease in unvaccinated individuals? In addition, the SPC will issue clinical recommendations and offer its outlook on the various paths this emerging disease may take in the future.
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Affiliation(s)
- José Pedro Sousa
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal.
| | - David Roque
- Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | - Cláudio Guerreiro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal
| | - Rogério Teixeira
- Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal
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9
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Dursun AD, Saricam E, Erdem H, Sariyildiz GT, Ozyer EU, Bozkurt E, Ilkay E, Cantekin ÖF. Clinical and laboratory evaluation of acute pericarditis associated with antinuclear antibodies positivity. Curr Vasc Pharmacol 2023; 21:51-58. [PMID: 36718967 DOI: 10.2174/1570161121666230131122649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Up to 30% of patients with acute pericarditis develop recurrent pericarditis. Acute pericarditis may be a manifestation of an underlying systemic autoimmune disease. Therefore, we evaluated the characteristics of patients with acute pericarditis according to antinuclear antibodies (ANA) positivity/negativity. METHODS Participants with acute pericarditis and negative ANA (n=29), recurrent pericarditis with positive ANA (n=30) and healthy controls (n=11) were examined. The groups were compared using serum parameters (ANA, C-reactive protein, leucocyte count, erythrocyte sedimentation rate, total antioxidant status, nitric oxide (NO), and oxidative stress index (OSI)) and imaging techniques (electrocardiogram, echocardiography, cardiovascular magnetic resonance, and venous Doppler ultrasound). RESULTS In females, acute pericarditis associated with ANA occurred more frequently (p<0.001). ANA-positive acute pericarditis had significantly lower NO and OSI (p<0.05 and p<0.001, respectively) and pericardial inflammation on magnetic resonance. We found a pulmonary embolism in one patient with positive ANA. Slow venous flow (SVF) occurred more often in acute pericarditis associated with ANA than in the ANA-negative group on venous ultrasound (p<0.05). The prevalence of positive ANAs was 1.6 times higher among SVF patients than in controls. CONCLUSION This study suggests that acute pericarditis associated with ANA is more common in middle-aged females. SVF and lower oxidative stress tests were more common in patients with ANA-associated acute pericarditis. Acute pericarditis associated with ANA could be considered as a hypercoagulable state. Therefore, all newly diagnosed pericarditis patients (especially females) should be checked for ANA positivity. Awareness of this coexistence should be promptly addressed to establish management strategies.
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Affiliation(s)
- Ali Doğan Dursun
- Department of Physiology, Atilim University Medical School, Ankara, Turkey
| | - Ersin Saricam
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Hakan Erdem
- Department of Rheumatology, Medicana International Ankara Hospital, Ankara, Turkey
| | | | - Esref Umut Ozyer
- Department of Radiology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Engin Bozkurt
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Erdogan Ilkay
- Department of Cardiology, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ömer Faruk Cantekin
- Faculty of Health Sciences, Department of Social Work, Gazi University, Ankara, Turkey
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10
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Abstract
PURPOSE OF REVIEW Thyroid disorders, especially hypothyroidism, are known to be associated with pericardial diseases. The aim of this paper is to review the current knowledge of the pericardial manifestations of hypothyroidism and hyperthyroidism. RECENT FINDINGS Many reports have described associations between dysthyroidism, which encompasses hypothyroidism and hyperthyroidism, and several pericardial diseases, including acute pericarditis, constrictive pericarditis, pericardial effusion, and tamponade. The diagnosis of dysthyroidism-induced pericardial diseases consists of a combination of thyroid blood levels that fall outside of the normal range and the exclusion of other causes. Treatment of the thyroid disorder is key, along with treatment of the pericardial disease as recommended by the guidelines. Early recognition of the thyroid disorder is key in patients with pericardial diseases, since treating the underlying cause should assist resolution of the pericardial issues and ideally prevent recurrence and possible future complications of suboptimally treated pericarditis or pericardial effusions.
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Affiliation(s)
- Johnny Chahine
- Department of Cardiovascular Disease, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Zeina Jedeon
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kevin Y Chang
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christine L Jellis
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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11
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Lazarou E, Tsioufis P, Vlachopoulos C, Tsioufis C, Lazaros G. Acute Pericarditis: Update. Curr Cardiol Rep 2022. [PMID: 35595949 DOI: 10.1007/s11886-022-01710-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/17/2022]
Abstract
Purpose of Review Since 2015, when ESC guidelines for the diagnosis and management of pericardial diseases were published, ongoing research has enhanced the current state of knowledge on acute pericarditis. This review is an update on the latest developments in this field. Recent Findings In recurrent acute pericarditis, autoinflammation has been included among causative mechanisms restricting the vague diagnoses of “idiopathic” pericarditis. Cardiac magnetic resonance that detects ongoing pericardial inflammation may guide treatment in difficult-to-treat patients. Development of risk scores may assist identification of patients at high risk for complicated pericarditis, who should be closely monitored and aggressively treated. Treatment with IL-1 inhibitors has been proven efficacious in recurrent forms with a good safety profile. Finally, acute pericarditis has recently attracted great interest as it has been reported among side effects post COVID-19 vaccination and may also complicate SARS-CoV-2 infection. Summary Recent advancements in acute pericarditis have contributed to a better understanding of the disease allowing a tailored to the individual patient approach. However, there are still unsolved questions that require further research. Supplementary Information The online version contains supplementary material available at 10.1007/s11886-022-01710-8.
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12
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Marques da Silva B, Oliveira J, Pereira M, Lopes JA, Pinto Abreu C. Acute pericarditis after COVID 19 in a peritoneal dialysis patient. CEN Case Rep 2022; 11:487-489. [PMID: 35507290 PMCID: PMC9067338 DOI: 10.1007/s13730-022-00705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is known to affect numerous organs which have ACE-2 receptors, lung being the most involved organ. Nevertheless, cardiac involvement is not uncommon and can occur through a variety of manifestations. The authors hereby report a case of pericarditis following SARS-CoV-2 infection. A 54-year-old man with end stage kidney disease under peritoneal dialysis presented with acute chest pain approximately 1 month after being diagnosed with COVID-19. Electrocardiogram revealed widespread ST segment elevation. The diagnosis of acute pericarditis secondary to the viral infection was made and the patient was treated accordingly. Etiology of acute pericarditis can be very varied, and, in many times, no cause is ascertained. In such circumstances, viral or immune mediated etiologies are assumed. In our case, since no cause was proven, pericarditis was assumed as secondary to the SARS-CoV-2 infection. This entity is probably underdiagnosed. In patients undergoing dialysis, uremic pericarditis is commonly the etiology. However, different causes must be taken into consideration, COVID-19 being one of them.
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Affiliation(s)
- Bernardo Marques da Silva
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal.
| | - João Oliveira
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal
| | - Marta Pereira
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal
| | - José António Lopes
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal
| | - Cristina Pinto Abreu
- Department of Nephrology and Renal Transplantation, Centro Hospitalar Universitário de Lisboa Norte, Av. Prof. Egas Moniz MB, 1649-028, Lisbon, Portugal
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13
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Affiliation(s)
| | - Ken Umetani
- Address reprint requests and correspondence: Dr Ken Umetani, Yamanashi Prefectural Central Hospital, Fujimi 1-1-1 Kofu, Yamanashi, Japan 400-8506.
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14
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Acquaro M, Breviario F, Greco A, Ghio S. Acute pericarditis, Graves' disease, and thymic hyperplasia: a case report. Eur Heart J Case Rep 2021; 5:ytab392. [PMID: 34676356 PMCID: PMC8526917 DOI: 10.1093/ehjcr/ytab392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/09/2021] [Accepted: 09/27/2021] [Indexed: 12/11/2022]
Abstract
Background Acute pericarditis as a sign of mediastinal mass is rare and aetiological diagnosis can be challenging without adequate imaging. Case summary An 18-year-old woman came to our attention describing acute sharp chest pain radiated to the left arm, exacerbated with supine positioning and attenuated while sitting or leaning forward. The electrocardiogram showed diffuse ST elevation and PR depression, with sinus tachycardia. Cardiac biomarkers and D-dimer were negative; echocardiography showed no abnormalities and the absence of pericardial effusion. Her blood work revealed no sign of inflammation or bacterial infection (PCR and procalcitonin were normal); thyroid-stimulating hormone plasma levels were suppressed, showing decompensated thyrotoxicosis. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Epstein-Barr virus, human immunodeficiency virus, hepatitis C virus, Enterovirus, Parvovirus B19, and Adenovirus tests were normal. Her past medical history was silent, apart from Grave's disease on treatment with methimazole. Chest computed tomography (CT) was performed and showed the presence of slightly increased density pericardial effusion, with a maximum thickness of 15 mm in the upper mediastinum. Finally, cardiac magnetic resonance (MR) identified a mass of 73 × 51 mm located in the upper mediastinum. The mass was subsequently biopsed with video-assisted thoracoscopic surgery and the histological analysis showed thymic hyperplasia. Discussion This case shows the importance of an adequate clinical suspicion of thymic hyperplasia in the context of acute pericarditis symptoms and known Graves' disease. In this case, a negative chest CT finding may not be sufficient to rule out the diagnosis and cardiac MR imaging is necessary.
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Affiliation(s)
- Mauro Acquaro
- Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
| | - Federico Breviario
- Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
| | - Alessandra Greco
- Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
| | - Stefano Ghio
- Divisione di Cardiologia, Fondazione IRCCS San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
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15
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Abstract
PURPOSE OF REVIEW Pericardial diseases include a wide range of pathologies and their diagnosis can often be challenging. The goal of this review is to describe the established and emerging CMR imaging techniques used in the assessment of common pericardial diseases and explain the role of pericardial characterization in their diagnosis and management. RECENT FINDINGS CMR is indicated in cases of diagnostic uncertainty and for a comprehensive evaluation of the pericardium and its impact on the heart. This includes assessment of pericardial anatomy and associated cardiac hemodynamics, quantification and characterization of an effusion, disease staging, tissue characterization, guiding management, and even prognostication in some diseases of the pericardium. An emerging technique, pericardial characterization, utilizes various sequences to diagnose and stage pericardial inflammation, act as a biomarker in recurrent pericarditis, and guide management in inflammatory pericardial conditions. Beyond imaging, it has ushered in an era of tailored therapy for patients with pericardial diseases. Future directions should aim at exploring the role of tissue characterization in various pericardial diseases.
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16
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Vecchié A, Del Buono MG, Chiabrando GJ, Dentali F, Abbate A, Bonaventura A. Interleukin-1 and the NLRP3 Inflammasome in Pericardial Disease. Curr Cardiol Rep 2021; 23:157. [PMID: 34599390 DOI: 10.1007/s11886-021-01589-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 01/12/2023]
Abstract
Purpose of Review Pericarditis is a generally benign disease, although complications and/or recurrences may occur in up to 30% of cases. New evidence on the pathophysiology of the disease has accumulated in recent years. Recent Findings Recently, it has been shown that the activation of the NLRP3 (NACHT, leucine-rich repeat, and pyrin domain-containing protein 3) inflammasome is central in the pathophysiology of pericarditis. These findings derive from clinical data, an experimental animal model of acute pericarditis supporting a role for the NLRP3 inflammasome in pericarditis, and from indirect evidence of inhibitors of NLRP3 inflammasome in clinical trials. Summary Pericarditis is regarded as a stereotypical response to an acute damage of the mesothelial cells of the pericardial layers. NLRP3 inflammasome, a macromolecular structure sensing damage and releasing pro-inflammatory cytokines, is centrally involved as it releases interleukin (IL)-1β, whose auto-induction feeds an autoinflammatory disease, mostly responsible for recurrences. Colchicine, an inhibitor of NLRP3 inflammasome formation, and IL-1-targeted therapies, such as anakinra and rilonacept, were found to effectively blunt the acute inflammation and reduce the risk for recurrences.
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17
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Patoulias D, Papachristou S, Vitos D, Apostolidou X, Georgopoulou V, Kozanidou A, Stamou D, Samarentsis N, Chioni A, Bakatselos S. All That Glitters is not Gold! A Case of Concomitant Acute Pericarditis and Subsegmental Pulmonary Embolism. Mediterr J Rheumatol 2021; 32:88-90. [PMID: 34386707 PMCID: PMC8314879 DOI: 10.31138/mjr.32.1.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/10/2020] [Accepted: 11/20/2020] [Indexed: 11/04/2022] Open
Abstract
Concomitance of acute pericarditis and pulmonary embolism is extremely rare, with only a few case reports published so far. Herein we present a case of a 50-year-old man that presented to the Emergency Department, complaining of fever up to 38.5°C, pleuritic chest pain, nausea, arthralgias, and general symptoms during the previous two weeks. Thorough diagnostic work-up revealed the diagnosis of concomitant acute pericarditis and pulmonary embolism, which raised high index of clinical suspicion for systemic lupus erythematosus (SLE). Indeed, the patient did not marginally meet the diagnostic criteria for SLE (total score=8), according to the updated 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria. Since then, the patient remains asymptomatic, while he is under close monitoring for potential manifestation of other SLE clinical features. Our case highlights the need for long-term follow-up in such patients, especially when the first episode is attributed as idiopathic.
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Affiliation(s)
- Dimitrios Patoulias
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
| | - Savvas Papachristou
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
| | - Dimitrios Vitos
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
| | - Xanthi Apostolidou
- Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vivian Georgopoulou
- Department of Radiology, General Hospital "Hippokration", Thessaloniki, Greece
| | - Andreanna Kozanidou
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
| | - Dafni Stamou
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
| | - Nikolaos Samarentsis
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
| | - Andriana Chioni
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
| | - Spyridon Bakatselos
- First Department of Internal Medicine, General Hospital "Hippokration", Thessaloniki, Greece
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18
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Nomoto F, Suzuki S, Hashizume N, Kanzaki Y, Maruyama T, Kozuka A, Saigusa T, Ebisawa S, Okada A, Motoki H, Yahikozawa K, Kuwahara K. A case of Dressler's syndrome successfully treated with colchicine and acetaminophen. J Cardiol Cases 2021; 23:131-135. [PMID: 33717379 PMCID: PMC7917394 DOI: 10.1016/j.jccase.2020.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/18/2020] [Accepted: 10/03/2020] [Indexed: 11/05/2022] Open
Abstract
The incidence of Dressler’s syndrome after myocardial infarction (MI) has decreased in the reperfusion therapy era. Although guidelines recommend high-dose aspirin for treatment based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era, bleeding and thrombotic concerns occurred upon aspirin administration after coronary stenting. A 69-year-old man with recent MI was admitted to our hospital. The patient presented with chest pain 1 week before admission. Electrocardiography revealed newly detected atrial fibrillation with no ST segment change. Urgent coronary angiography demonstrated a left circumflex artery occlusion. He underwent PCI, and a sirolimus-eluting stent was deployed. Aspirin, prasugrel, and apixaban were administered. However, hospital discharge was delayed because he developed heart failure during hospitalization. Twenty-three days after admission, he developed a fever of >39 °C. Electrocardiography showed anterior ST segment elevation, and echocardiography revealed a 6-mm pericardial effusion. We diagnosed the patient with Dressler’s syndrome, and colchicine 0.5 mg/day + acetaminophen 2000 mg/day were administered. His condition clinically improved after treatment and he was discharged 32 days after admission. There was hesitation about administration of high-dose aspirin in a patient who has undergone recent coronary stenting. Combination therapy of colchicine and acetaminophen could be a treatment option for Dressler’s syndrome. <Learning objective: Guidelines recommend high-dose aspirin for the treatment of Dressler’s syndrome based on evidence from the pre-percutaneous coronary intervention (pre-PCI) era. However, bleeding and thrombotic concerns are present upon high-dose aspirin administration in patients who have undergone PCI. Therefore, a combination therapy of low-dose colchicine and acetaminophen could be a treatment option for patients with Dressler’s syndrome who have undergone recent coronary stenting.>
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Affiliation(s)
- Fumika Nomoto
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Sho Suzuki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Naoto Hashizume
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Takuya Maruyama
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Ayako Kozuka
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kumiko Yahikozawa
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital, Nagano, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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19
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Faraj R, Belkhayat C, Bouchlarhem A, El Aidouni G, Bkiyar H, Housni B. Acute pericarditis revealing COVID-19 infection: Case report. Ann Med Surg (Lond) 2021; 62:225-227. [PMID: 33520219 PMCID: PMC7826081 DOI: 10.1016/j.amsu.2021.01.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/04/2022] Open
Abstract
The COVID-19 is a global pandemic that is now responsible for more than 2 million deaths around the world. Its clinical manifestations are well known such as fever, fatigue and other respiratory signs like severe cough, dyspnea. Cardiac involvement, however, is less recognized and often underestimated and could be the only manifestation of COVID-19. Case presentation: We report a case of pericarditis as the primary presentation of COVID-19 among a young, healthy individual with no medical background, in the absence of the conventional respiratory signs. The diagnosis was based on a set of clinical, biological, radiological and electrocardiographic findings. In this case, the treatment was based on the use of Colchicine in addition to COVID-19 treatment. The outcome was favorable; noticing regression of symptoms and disappearance of pericardial effusion within two weeks. Clinical discussion: Acute pericarditis has been widely described in literature as probable complication of COVID-19, yet only few articles have reported it as a primary manifestation of COVID-19. Conclusion: Chest pain could be the only presenting symptom of COVID-19 among young, healthy individuals.To that end, clinicians should recognize cardiac involvement of COVID-19 and act accordingly to isolate patients and further limit the spread of the disease. The covid-19 is a global pandemic that is responsible for millions of deaths. Cardiovascular involvement in COVID-19 is less recognized and described. Acute pericarditis as the primary manifestation of COVID-19 is rare. Colchicine is the main treatment of pericarditis related to COVID-19.
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Affiliation(s)
- Raid Faraj
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Chifaa Belkhayat
- Radiology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Amine Bouchlarhem
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Ghizlane El Aidouni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Houssam Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
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20
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Al-Khadra Y, Sattar Y, Ullah W, Mir T, Kajy M, Darmoch F, Pacha HM, Soud M, Zafrullah F, Zghouzi M, Alhatemi G, Banisad A, Hakim Z, Klein A, Alraies MC. Predictors and risk factors of short-term readmission of acute pericarditis. Expert Rev Cardiovasc Ther 2021; 19:261-268. [PMID: 33499696 DOI: 10.1080/14779072.2021.1876564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Yasser Al-Khadra
- Cardiology Department, Cleveland Clinic Foundation, Internal Medicine, Cleveland, Ohio, USA
| | - Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital New York, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Tanveer Mir
- Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Marvin Kajy
- Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Fahed Darmoch
- Cardiology Department, Beth Israel Deaconess Medical center/Harvard School of Medicine, Boston, Massachusetts, USA
| | - Homam Moussa Pacha
- Cardiology Department, University of Texas Health Science Center, McGovern Medical School, Memorial Hermann Heart & Vascular Institute, Houston, Texas, USA
| | - Mohamad Soud
- Cardiology Department, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Fnu Zafrullah
- Cardiology Department, University of Toledo, Toledo, OH, USA
| | - Mohamed Zghouzi
- Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Ghaith Alhatemi
- Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Ali Banisad
- Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Zaher Hakim
- Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
| | - Allan Klein
- Cardiology Department, Cleveland Clinic Foundation, Internal Medicine, Cleveland, Ohio, USA
| | - M Chadi Alraies
- Cardiology Department, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA
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21
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Sreenivasan J, Khan MS, Hooda U, Khan SU, Aronow WS, Mookadam F, Krasuski RA, Cooper HA, Michos ED, Panza JA. Rate, Causes, and Predictors of 30-Day Readmission Following Hospitalization for Acute Pericarditis. Am J Med 2020; 133:1453-1459.e1. [PMID: 32598902 DOI: 10.1016/j.amjmed.2020.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Jayakumar Sreenivasan
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY.
| | | | - Urvashi Hooda
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | | | | | - Howard A Cooper
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julio A Panza
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY
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22
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Motonaga T, Furuta T, Okada S, Ohnishi Y, Suzuki Y, Yasudo H, Hasegawa S. Responses to Treatment According to the Cytokine Profiles of Pericardial Effusion in Two Children with Idiopathic Pericarditis. Int Heart J 2020; 61:1307-1310. [PMID: 33191347 DOI: 10.1536/ihj.20-282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute pericarditis is inflammation of the pericardium with or without pericardial effusion. In the pediatric population, most patients with acute pericarditis are diagnosed with idiopathic pericarditis. Herein, we present two children with idiopathic pericarditis who underwent immunological assessment of pericardial effusion for the first time. Both patients showed equally high levels of interleukin-6 in the pericardial effusion. However, they had different treatment responses, in accordance with the pericardial effusion and serum interleukin-10 concentrations. Our present cases suggest that interleukin-10 may be associated with the response to anti-inflammatory therapy in idiopathic acute pericarditis.
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Affiliation(s)
- Takahiro Motonaga
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Takashi Furuta
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Seigo Okada
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Yuji Ohnishi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Yasuo Suzuki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Hiroki Yasudo
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
| | - Shunji Hasegawa
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine
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Walker C, Peyko V, Farrell C, Awad-Spirtos J, Adamo M, Scrocco J. Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report. J Med Case Rep 2020; 14:158. [PMID: 32907623 PMCID: PMC7479748 DOI: 10.1186/s13256-020-02467-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.
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Affiliation(s)
- Christina Walker
- Mercy Health St. Elizabeth Boardman Hospital, 8401 Market Street, Boardman, OH, 44512, USA.
| | - Vincent Peyko
- Mercy Health St. Elizabeth Boardman Hospital, 8401 Market Street, Boardman, OH, 44512, USA
| | - Charles Farrell
- Mercy Health St. Elizabeth Boardman Hospital, 8401 Market Street, Boardman, OH, 44512, USA
| | - Jeanine Awad-Spirtos
- Mercy Health St. Elizabeth Boardman Hospital, 8401 Market Street, Boardman, OH, 44512, USA
| | - Matthew Adamo
- Mercy Health St. Elizabeth Boardman Hospital, 8401 Market Street, Boardman, OH, 44512, USA
| | - John Scrocco
- Mercy Health St. Elizabeth Boardman Hospital, 8401 Market Street, Boardman, OH, 44512, USA
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24
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Cohen SI. Oliver Wendell Holmes’ 1836 doctorate dissertation and his journey in medicine. World J Cardiol 2020; 12:362-367. [PMID: 32879700 PMCID: PMC7439451 DOI: 10.4330/wjc.v12.i8.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/07/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
Oliver Wendell Holmes’ 1836 hand written doctorate dissertation on acute pericarditis was discovered in the archives of the Boston Medical Library 101 years after it was successfully defended. It was then printed as an unabridged monograph with an explanation of its provenance. The dissertation has received little scrutiny since then. Holmes gathered materials for the scholarly work while he was a third and fourth year student at Ecole de Medecine in Paris. His mentor, Pierre-Charles-Alexandre- Louis insisted on the meticulous gathering and recording of every patient’s history and findings. Each category of data was given a weighted numerical value of diagnostic importance and the information was placed in a registry. Holmes became a disciple of Louis in gathering data by direct observation and measuring outcomes in a “statistical” fashion. Holmes dissertation on acute pericarditis describes the state of knowledge about the illness in the 1830s. When Holmes and other students who had studied in Paris returned to the United States, they helped turn American Medicine from opinion and strong personal bias toward scientific objectivity. Oliver Wendell Holmes eventually became both a professor of anatomy/physiology and a dean at Harvard Medical School. He is recognized as a leader in medicine and a popular author in America and beyond. In his late and infirmed years, Holmes questioned the wisdom of his unswerving advocacy for the scientific underpinnings of medicine. In retrospect he had overlooked the importance of also advocating that each patient be approached with comforting compassion.
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Affiliation(s)
- Stafford I Cohen
- Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, MA 02215, United States
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25
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Lazaros G, Antonopoulos AS, Imazio M, Solomou E, Lazarou E, Vassilopoulos D, Adler Y, Stefanadis C, Tousoulis D. Clinical significance of pleural effusions and association with outcome in patients hospitalized with a first episode of acute pericarditis. Intern Emerg Med 2019; 14:745-751. [PMID: 30868443 DOI: 10.1007/s11739-019-02041-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/18/2019] [Indexed: 12/31/2022]
Abstract
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.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528, Athens, Greece.
| | - Alexios S Antonopoulos
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528, Athens, Greece
| | - Massimo Imazio
- University Cardiology, AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
- Department of Medical Science, AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Eirini Solomou
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528, Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Yehuda Adler
- Sheba Medical Center, The Gertner Instutute, Affiliated to Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- The College for Academic Studies, Rishon Lezion, Israel
| | - Christodoulos Stefanadis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528, Athens, Greece
- Athens Heart Center, Athens Medical Center, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Department, Hippokration General Hospital, National and Kapodistrian University of Athens, Vas. Sofias 114, 11528, Athens, Greece
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26
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Kotake M, Imai H, Kaira K, Fujisawa T, Yanagita Y, Minato K. Intrapericardial carboplatin in the management of malignant pericardial effusion in breast cancer: a pilot study. Cancer Chemother Pharmacol 2019; 84:655-660. [PMID: 31250155 PMCID: PMC6682572 DOI: 10.1007/s00280-019-03897-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Malignant pericarditis is observed in 5.1-7.0% of all cases of acute pericarditis, and malignant pericardial effusion (MPE) can lead to cardiac tamponade in the later stages of cancer. Breast cancer is the second most common primary cancer associated with MPE, but the efficacy and safety of intrapericardial carboplatin (CBDCA) have never been evaluated in breast cancer. In this study, we assessed the clinical significance of intrapericardial CBDCA following catheter drainage in patients with breast cancer-related MPE. METHODS A catheter was inserted percutaneously into the pericardial space under echocardiographic guidance. After complete drainage, 150 mg of CBDCA was instilled into the pericardial space through the catheter. RESULTS Eight patients with symptomatic breast cancer-related MPE were treated at the Gunma Prefectural Cancer Center, between July 2010 and March 2016. One month after treatment, 100% of MPE was controlled. The median survival time from the recurrence of breast cancer until death or study follow-up was 2336 days (range 293-3937 days), while that from intrapericardial CBDCA administration until death or study follow-up was 552 days (range 35-1673 days). Grade 1 fever, nausea, hypotension, fatigue, and chest discomfort were observed in one patient (12.5%) after intrapericardial CBDCA administration. CONCLUSIONS We found that intrapericardial administration of CBDCA after catheter drainage appears to be safe and effective in managing breast cancer-associated MPE. As the number of patients in this study was small, further studies are warranted to determine the safety and efficacy of intrapericardial CBDCA in the management of breast cancer-related MPE.
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Affiliation(s)
- Mie Kotake
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan.
| | - Hisao Imai
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomomi Fujisawa
- Division of Breast Oncology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Yasuhiro Yanagita
- Division of Breast Oncology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, 617-1, Takahayashinishi, Ota, Gunma, 373-8550, Japan
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27
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Hamasaki A, Uchida T, Yamashita A, Akabane K, Sadahiro M. Cardiac tamponade caused by acute coxsackievirus infection related pericarditis complicated by aortic stenosis in a hemodialysis patient: a case report. Surg Case Rep 2018; 4:141. [PMID: 30523492 PMCID: PMC6283806 DOI: 10.1186/s40792-018-0550-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022] Open
Abstract
Background Pericardial effusion is observed in the majority of viral pericarditis cases; however, viral pericarditis accompanied by a large effusion resulting in cardiac tamponade is rare. Case presentation Here, we report the case of a 75-year-old hemodialysis patient with acute viral pericarditis complicated by aortic stenosis. The patient was referred with a diagnosis of aortic stenosis and pericardial effusion. The pericardial effusion had increased during the preoperative examinations, and the inflammatory reaction had progressed. We decided to abort the surgical intervention and start oral administration of anti-inflammatory agents. We subsequently performed a pericardiocentesis. High antibody titers to coxsackievirus were noted in the pericardial effusion. Since no recurrence of the pericardial effusion was observed, the patient underwent an aortic valve replacement 2 months later. The pericardium completely adhered to the heart. Pathological examination of the pericardium showed fibrous pericarditis without active inflammation. Conclusions Here, we successfully treated a hemodialysis case with severe aortic stenosis complicated by cardiac tamponade and worsened by acute viral pericarditis. We waited for the pericarditis to resolve after administering anti-inflammatory agents and performed pericardial drainage before carrying out aortic valve replacement. The perioperative course of our case was unique and suggestive.
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Affiliation(s)
- Azumi Hamasaki
- Second Department of Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan.
| | - Tetsuro Uchida
- Second Department of Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Atsushi Yamashita
- Second Department of Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Kentaro Akabane
- Second Department of Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
| | - Mitsuaki Sadahiro
- Second Department of Surgery, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan
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28
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Abstract
Pericardial diseases represent diverse conditions, ranging from painful inflammatory states, such as acute pericarditis, to life-threatening tamponade and chronic heart failure due to constrictive pericarditis. Multimodality cardiovascular imaging plays important roles in diagnosis and management of pericardial conditions. This review provides a clinical update on multimodality cardiovascular imaging of the pericardium, incorporating echocardiography, multidetector computed tomography, and cardiac magnetic resonance imaging, focusing on guiding clinicians about when each cardiac imaging modality should be used in each relevant pericardial condition.
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Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Deborah H Kwon
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Allan L Klein
- Section of Cardiovascular Imaging, Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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29
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Gerardin C, Mageau A, Benali K, Jouan F, Ducrocq G, Alexandra JF, van Gysel D, Papo T, Sacre K. Increased FDG-PET/CT pericardial uptake identifies acute pericarditis patients at high risk for relapse. Int J Cardiol 2018; 271:192-194. [PMID: 29884293 DOI: 10.1016/j.ijcard.2018.05.126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/19/2018] [Accepted: 05/30/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We aimed to evaluate the prognostic value of FDG pericardial uptake using FDG-PET/CT in patients admitted for acute pericarditis with pericardial effusion. METHODS In this monocentric retrospective cohort study, all patients admitted for idiopathic acute pericarditis with pericardial effusion from January 2009 to December 2016 who underwent a FDG-PET/CT at diagnosis were considered. Pericardial FDG uptake was measured by generating a volume of interest to calculate the maximal standardized uptake value. The primary outcome was the pericarditis relapse rate during follow-up. RESULTS FDG-PET/CT was performed 23 [7-99] days after diagnosis in 39 patients (52 [18-83] years, 43.6% of women) admitted for acute pericarditis with pericardial effusion. During a median follow-up period of 7.6 [2.4-77.2] months, 7 (17.9%) patients suffered pericarditis relapse that occurred 3.8 [1.6-14.6] months after FDG-PET CT. In the multivariable analysis, pericardial FDG uptake at diagnosis (OR: 16.6; 95% confidence interval [CI]: 1.25 to 220.8; p = 0.033) was independently associated with pericarditis relapse. Eventually, patients with pericardial FDG uptake at diagnosis had a higher recurrence rate during follow up (p = 0.047). CONCLUSIONS In acute pericarditis with pericardial effusion, increased FDG-PET/CT pericardial uptake is associated with a higher risk for relapse.
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Affiliation(s)
- Christel Gerardin
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Arthur Mageau
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Khadija Benali
- Département de Médecine Nucléaire, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Fanny Jouan
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Gregory Ducrocq
- Département de Cardiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France; INSERM U1148, Paris, France
| | - Jean-Francois Alexandra
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Damien van Gysel
- Département d'Information Médicale, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France; INSERM U1149, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France; Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France; INSERM U1149, Paris, France.
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30
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Lazaros G, Antonopoulos AS, Oikonomou EK, Vasileiou P, Oikonomou E, Stroumpouli E, Karavidas A, Antoniades C, Tousoulis D. Prognostic implications of epicardial fat volume quantification in acute pericarditis. Eur J Clin Invest 2017; 47:129-136. [PMID: 27931089 DOI: 10.1111/eci.12711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/05/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The pathophysiology of acute pericarditis remains largely unknown, and biomarkers are needed to identify patients susceptible to complications. As adipose tissue has a pivotal role in cardiovascular disease pathogenesis, we hypothesized that quantification of epicardial fat volume (EFV) provides prognostic information in patients with acute pericarditis. MATERIALS AND METHODS Fifty (n = 50) patients with first diagnosis of acute pericarditis were enrolled in this study. Patients underwent a cardiac computerized tomography (CT) scan to quantify EFV on a dedicated workstation. Patients were followed up in hospital for atrial fibrillation (AF) development and up to 18 months for the composite clinical endpoint of development of constrictive, recurrent or incessant pericarditis or poor response to nonsteroidal anti-inflammatory drugs. RESULTS Patients presenting with chest pain had lower EFV vs. patients without chest pain (167·2 ± 21·7 vs. 105·1 ± 11·1 cm3 , respectively, P < 0·01); EFV (but not body mass index) was strongly positively correlated with pericardial effusion size (r = 0·395, P = 0·007) and associated with in-hospital AF. At follow-up, patients that reached the composite clinical endpoint had lower EFV (P < 0·05). After adjustment for age, EFV was associated with lower odds ratio for the composite clinical endpoint point of poor response to NSAIDs or the development of constrictive, recurrent or incessant pericarditis during follow-up (per 20 cm3 increase in EFV: OR = 0·802 [0·656-0·981], P < 0·05). CONCLUSIONS We report for the first time a significant association of EFV with the clinical features and the outcome of patients with acute pericarditis. Measurement of EFV by CT may have important prognostic implications in these patients.
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Affiliation(s)
- George Lazaros
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece.,Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Evangelos K Oikonomou
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece.,Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Panagiotis Vasileiou
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Apostolos Karavidas
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece
| | | | - Dimitris Tousoulis
- 1st Cardiology Department, Hippokration Hospital, Athens Medical School, Athens, Greece
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31
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Abstract
A 37-year-old male presented with sharp, severe chest pain following seven days of intravenous injection of crushed morphine tablets. The chest pain was positional and pleuritic in nature and resolved with leaning forward. Work-up was notable for an ECG with inferior and anterolateral PR depressions as well as a CT chest with diffuse centrilobular nodules. Per radiology, the CT findings along with the patient's history were concerning for pulmonary granulomatosis from deposition of talc or some other foreign body. Cardiology was consulted and diagnosed the patient with acute pericarditis, given his typical symptoms and ECG changes. On review of the literature, pulmonary granulomatosis following intravenous injection of foreign bodies is well documented. There are numerous studies documenting foreign body deposition and granulomatosis in organs other than the lungs on post-mortem analyses of individuals with a history of IV injection of crushed tablets. We are suggesting that intravenous injection of crushed morphine tablets can cause pericardial irritation and a syndrome of acuter pericarditis. To our knowledge, there has not been a previous report of acute pericarditis secondary to intravenous injection of crushed tablets.
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Affiliation(s)
- Ryan J Anderson
- a Internal Medicine Resident, Department of Internal Medicine , University of California San Diego , San Diego , CA , USA
| | - Bryan Corbett
- b Toxicology Fellow, Division of Medical Toxicology, Department of Emergency Medicine , University of California San Diego , San Diego , CA , USA
| | - Binh T Ly
- c Professor of Emergency Medicine, Division of Medical Toxicology, Department of Emergency Medicine , University of California San Diego , San Diego , CA , USA
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32
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Abstract
Acute pericarditis occurs most frequently after a viral attack. Other causes are autoimmune conditions, infection, chest trauma, cardiac surgery, or cardiac procedure. The presenting symptom is retrosternal chest pain. A pericardial rub is characteristic. Diffuse upward sloping ST segments are found with electrocardiogram. Pericardial effusions may be demonstrated with an echocardiogram. High-dose nonsteroidal antiinflammatory medications are the primary treatment. Adding colchicine reduces recurrence. It responds well to pharmacologic therapy within 1 to 2 weeks. Monitoring for complications is essential. The most serious complication is cardiac tamponade. For this, prompt diagnosis and treatment can be life-saving.
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Affiliation(s)
- Janet A Kloos
- University Hospitals Case Medical Center, 11100 Euclid Avenue, Harrington Heart and Vascular Institute, Wearn 109-Mailstop 5057, Cleveland, OH 44106, USA.
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33
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Affiliation(s)
- Puneet Gupta
- Dept. of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA
| | - Lovely Chhabra
- Dept. of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA.
| | - Brett Hiendlmayr
- Dept. of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA
| | - David H Spodick
- Dept. of Cardiology, Hartford Hospital, University of Connecticut School of Medicine, Hartford, CT 06102, USA
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34
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Abstract
Acute viral myocarditis and acute pericarditis are self-limiting conditions that run a benign course and that may not involve symptoms that lead to medical assessment. However, ventricular arrhythmia is frequent in viral myocarditis. Myocarditis is thought to account for a large proportion of sudden cardiac deaths in young people without prior structural heart disease. Identification of acute myocarditis either with or without pericarditis is therefore important. However, therapeutic interventions are limited and nonspecific. Identifying those at greatest risk of a life-threatening arrhythmia is critical to reducing the mortality. This review summarizes current understanding of this challenging area in which many questions remain.
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Affiliation(s)
- A John Baksi
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Imperial College London, Sydney Street, London SW3 6NP, UK; Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - G Sunthar Kanaganayagam
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Imperial College London, Sydney Street, London SW3 6NP, UK; Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - Sanjay K Prasad
- Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Harefield NHS Foundation Trust and Imperial College London, Sydney Street, London SW3 6NP, UK; Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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35
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Abstract
BACKGROUND Acute pericarditis is a close clinical mimic of pulmonary embolism (PE) in the emergency department, and thus many of these patients are evaluated with chest computed tomography (CT). PURPOSE To study whether CT findings can be diagnostic of acute pericarditis. MATERIAL AND METHODS Using the electronic medical record, we retrospectively identified 46 cases of acute pericarditis and 46 control patients with pericardial effusions due to volume overload, all of whom underwent CT examination. Cases were reviewed by two blinded academic thoracic radiologists. RESULTS The majority, 67%, of the pericarditis cases were evaluated with PE-protocol CTs. Pericardial thickening/enhancement was the most accurate single parameter for pericarditis, with sensitivity of 54-59% and specificity of 91-96%. CONCLUSION CT findings, while not sensitive for pericarditis, are diagnostic, with few false-positives. Radiologists should be attentive to pericardial thickening or enhancement on CT studies done for chest pain, as they may be able to suggest pericarditis as an alternative diagnosis for the chest pain.
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Affiliation(s)
- Mark M Hammer
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Cylen Javidan-Nejad
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO, USA
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Inami T, Seino Y, Goda H, Okazaki H, Shirakabe A, Yamamoto M, Okajima F, Emoto N, Hata N, Shimizu W. Acute pericarditis: unique comorbidity of thyrotoxic crisis with Graves' disease. Int J Cardiol 2014; 171:e129-30. [PMID: 24411211 DOI: 10.1016/j.ijcard.2013.12.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/20/2013] [Indexed: 12/17/2022]
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Sone M, Tamiya E, Sesoko M, Takabe T, Koizumi A, Doi Y, Kanoh T, Ebihara I, Koide H, Okai I, Yamashita H, I S, Okazaki S, Sai E, Daida H. Massive Pericardial Effusion in a Case of Acute Pericarditis with Slight ST-Segment Elevation of Short Duration. Int J Angiol 2012; 20:185-8. [PMID: 22942636 DOI: 10.1055/s-0031-1284203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
We present the case of a 77-year-old woman who suffered from chest pain. Her white blood cell count was 10,200/μL and C-reactive protein level was 5.5 mg/dL. There was no electrocardiogram abnormality up to 5 hours after admission. At 15 hours, slight ST-segment elevation occurred, but this disappeared on day 4. Imaging revealed slight pericardial effusion. Nonsteroidal anti-inflammatory drugs and antibiotics were administered. However, the pericardial effusion, inflammatory response, and bilateral heart failure worsened. Pericardiotomy on day 6 released 350 mL of fluid, and symptoms improved. Viral pericarditis was assumed. Massive pericardial effusion is rare in cases of acute viral pericarditis, as is slight, short-duration ST-segment elevation.
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Choi WS, Im MS, Kang JH, Kim YG, Hwang IC, Lee JM, Lee S, Shin HS, Lee SP, Cho GY. Primary malignant pericardial mesothelioma presenting as acute pericarditis. J Cardiovasc Ultrasound 2012; 20:57-9. [PMID: 22509441 PMCID: PMC3324730 DOI: 10.4250/jcu.2012.20.1.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 01/17/2012] [Accepted: 02/16/2012] [Indexed: 11/22/2022] Open
Abstract
We report on a 21-year-old man with fever, dyspnea, and pleuritic chest pain. An electrocardiography showed ST elevation in multiple lead and thoracic echocardiography revealed moderate pericardial effusion. He was initially diagnosed with acute pericarditis, and treated with nonsteroidal anti-inflammatory drugs and colchicines with clinical and laboratory improvement. After 1 month of medication, his symptoms recurred. An echocardiography showed constrictive physiology and the patient was treated with steroid on the top of current medication. The patient had been well for 7 months until dyspnea and edema developed, when an echocardiography showed marked increased pericardial thickness and constriction. Pericardial biopsy was performed and primary malignant pericardial mesothelioma was diagnosed. Malignancy should be considered in the differential diagnosis of recurrent pericarditis.
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Affiliation(s)
- Won-Suk Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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