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Cardiology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Causes: viruses (Coxsackie), TB (calcification on CXR), malignancy, Dressler’s syndrome, radiotherapy, connective tissue disease (e.g. SLE), uraemia. Clinical features: classically, sharp, pleuritic, central chest pain, relieved by leaning forward. Listen for a pericardial rub. Investigations: widespread ST elevation on ECG except in lead aVR. Management: treat underlying cause, NSAIDs; steroids if resistant. Complications: pericardial effusion, cardiac tamponade.
Cardiac Masses
Published in Takahiro Shiota, 3D Echocardiography, 2020
Sonia Velasco del Castillo, Miguel Angel García-Fernández
Although the diagnosis of pericardial effusion is often simple using TTE, echocardiography has an important limitation for the complete visualization of the pericardium compared to other techniques. Localized effusions or pericardial cysts are frequently accidental findings of CCT or CMR requested for another reason, as they are techniques that offer a greater field of anatomical vision. Pericardial cysts are benign lesions, usually diagnosed by chance as they are often asymptomatic although they may cause dyspnea, chest pain, or cough (Figure 19.6). They are more frequent on the right side, especially in the right cardiophrenic angle. They may lead to cardiac tamponade if the pericardium is ruptured or resolve spontaneously probably by drainage in the pleural space. Its treatment depends on the size, symptoms, or doubt of malignancy. They are treated by percutaneous drainage or surgical resection by thoracotomy, which is a low-risk surgery.
Very long-chain acyl-CoA dehydrogenase deficiency
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Neonatal presentations include lethargy, tachypnea, or seizures, and hypoglycemia; metabolic acidosis or arrhythmia may be found. This is followed by decompensation and evidence of hypertrophic cardiopathy. There may be pericardial effusion. Approximately 50 percent of patients have died within two months of initial symptomatology [17, 22].
The effect of early follow-up after open cardiac surgery in a student clinic
Published in Scandinavian Cardiovascular Journal, 2023
Christine Ilkjær, Torben Hoffmann, Johan Heiberg, Laura Sommer Hansen, Vibeke E. Hjortdal
Previous studies have stated that readmissions often occur before the first planned follow-up, and timely detection of complications has been proposed to lower readmission rates [4]. Borregaard et al. concluded that the lower readmission rate in their intervention group was primarily driven by fewer unplanned readmissions caused by pericardial effusions or unspecific cardiac symptoms [2]. Due to small patient groups and the well-described limitations in chart-level details, we chose robust outcome parameters such as pericardial and pleural drainages to compare groups. We identified a tendency for earlier detection of the potentially serious condition of pericardial effusion. In the intervention group, pericardial drainage was scheduled (initiated by the student clinic). In the control group, patients were readmitted acutely to the hospital (symptom-driven). Our study does not have the statistical power to support solid conclusions. Still, our findings correspond with previous studies where routine FATE after cardiac surgery has changed patient management [2,29]. The timely detection of imminent complications may support clinical decision-making and treatment strategy and improve procedure safety. Still, as the Choosing Wisely concept advocates, unnecessary tests are aimed to be reduced [30]. Therefore, we need better evidence regarding balancing the detection and treatment of impending post-operative complications, including effusions.
Differences in radiation-induced heart dysfunction in male versus female rats
Published in International Journal of Radiation Biology, 2023
Neal Andruska, Rachel A. Schlaak, Anne Frei, Aronne M. Schottstaedt, Chieh-Yu Lin, Brian L. Fish, Tracy Gasperetti, Cedric Mpoy, Jamie L. Pipke, Lauren N. Pedersen, Michael J. Flister, Ali Javaheri, Carmen Bergom
Radiation-induced cardiotoxicity can manifest as coronary artery disease, pericarditis, myocardial fibrosis, cardiomyopathy, pericardial effusion, and/or arrhythmias (Schlaak, SenthilKumar, Boerma, et al. 2020). Pericardial disease is the most common manifestation of RIHD, with an incidence of 20–45% in non-small cell lung cancer patients receiving radiation (Ning et al. 2017; Wang et al. 2017; Xue et al. 2019). It also is one of the earliest manifestations of RIHD. Pericardial disease can present as pericarditis, pericardial effusions, and/or delayed thickening and constrictive pericarditis, which is associated with a particularly poor prognosis (George et al. 2012). Pericardial effusions can be asymptomatic or progress to shortness of breath and even cardiac tamponade (Boerma et al. 2008; Boerma et al. 2015). Retrospective studies have used the whole heart dose to develop several RT dose parameters predictive of RIHD (Darby et al. 2013; Speirs et al. 2017), but studies only recently have begun to evaluate doses to critical heart substructures and their associations with pericardial toxicities (Hayashi et al. 2015; McWilliam et al. 2017; Wang et al. 2017).
The evolution of the CTO-PCI landscape in Belgium and Luxembourg: a four-year appraisal
Published in Acta Cardiologica, 2021
Ward Eertmans, Peter Kayaert, Johan Bennett, Claudiu Ungureanu, Yoann Bataille, Georges Saad, Steven Haine, Patrick Coussement, Bruno Pereira, Pierfrancesco Agostoni, Luc Janssens, Bert Vandeloo, Patrick Maréchal, Kristoff Cornelis, Quentin de Hemptinne, Adel Aminian, Francis Stammen, Stéphane Carlier, Patrick Timmermans, Steven Vercauteren, Jeroen Sonck, Frédéric De Vroey, Benny Drieghe, Keir McCutcheon, Benjamin Scott, Laurent Davin, Chadi Gafari, Jo Dens
In-hospital MACCE occurred in 43 cases (2.3%). Five patients died: one patient due to worsening hypotension culminating in electromechanical dissociation, probably related to diffuse ischaemia, one patient due to coronary perforation with rapid cardiac arrest, one patient due to cardiogenic shock, one patient due to an unknown non-cardiovascular cause and one patient, admitted with an out-of-hospital cardiac arrest where the CTO lesion was successfully treated, died as the result of irreversible hypoxic brain injury. In total, 31 patients suffered an in-hospital MI: non ST-segment elevated MI (n = 24), a STEMI (n = 3) and a not further defined MI (n = 4)). Four patients experienced a stroke. Three patients had target vessel revascularisation during index hospitalisation. A pericardial effusion occurred in 21 patients. In 15 out of these 21 patients, the management was not reported, but of the remaining six patients, one required urgent surgery, three had pericardiocentesis, and two patients did not require any treatment.