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Myocarditis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
In patients who die either suddenly or after some days of cardiac failure, the left ventricle may be dilated and the cut surface of the myocardium show marked variation in colour with pale and haemorrhagic areas mimicking infarction or can be macroscopically normal. In giant cell myocarditis in particular, there can be large areas of necrosis mimicking infarction. Pericarditis may or may not be present. Emphatically, acute myocarditis is not a diagnosis which can be accurately made without histology (seeTable 6.1).
Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Restrictive cardiomyopathy causes exertional dyspnea, PND, orthopnea, and peripheral edema. A fixed CO rate causes fatigue because of resistance to ventricular filling. Atrial and ventricular arrhythmias as well as AV block are seen, but angina and fainting are rare. The signs and symptoms closely resemble constrictive pericarditis. During physical examination, the precordium is quiet. There a low-volume yet rapid carotid pulse, with pulmonary crackles. Sometimes there is a murmur due to functional mitral or tricuspid regurgitation.
Extrapulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
A 6-month regimen is recommended for patients with drug-susceptible pericardial TB.36 The 2003 ATS/IDSA/CDC guidelines recommended that patients with TB pericarditis receive adjunctive corticosteroids based on small studies that reported mortality and morbidity benefits.170,176–178 A subsequent systematic review that included five clinical trials showed a benefit to steroid treatment with regard to death, constrictive pericarditis, and treatment adherence.36 However, another systematic review,179 which included six randomized trials, concluded that in HIV-uninfected patients with pericardial TB, corticosteroids probably reduced deaths and need for repeated pericardiocentesis and in HIV-infected patients, the use of corticosteroids may reduce constriction and hospitalization. However, the largest (1400 patients) study showed no benefit of steroids.180 A subgroup analysis suggested a benefit in preventing constrictive pericarditis. In this study, 67% of subjects were HIV-positive and only 14% were on ART. Among HIV-negative patients, a small mortality benefit was shown with steroid treatment. In another smaller study of 58 subjects, in which all were HIV-positive, steroids were found to reduce mortality.
Advances in multi-modality imaging for constrictive pericarditis and pericardial inflammation: role of imaging-guided therapy
Published in Expert Review of Cardiovascular Therapy, 2023
Tahir S Kafil, Tom Kai Ming Wang, Ankit Agrawal, Muhammad Majid, Alveena B Syed, Erika Hutt, Ben Alencherry, Joshua A Cohen, Sachin Kumar, Agam Bansal, Brian P Griffin, Allan L Klein
Interleukin-1 (IL-1) Inhibitors are biologic therapies that block the IL-1 mediated inflammatory pathway [52]. This medication class has been used in autoinflammatory conditions such as cryopyrin-associated periodic syndromes (CAPS) [52]. This inflammatory pathway has also been implicated in recurrent pericarditis with systemic inflammation [52,53]. In addition to standard anti-inflammatory therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine, IL-1 inhibition is increasingly being considered for treatment of recurrent pericarditis. Given recurrent pericarditis can subsequently lead to constrictive pericarditis and given that CP with active pericardial LGE may be reversible, there is interest in optimizing anti-inflammatory therapies to reduce recurrent hits of inflammation.
Rechallenging nivolumab following immune checkpoint inhibitor–induced pericarditis
Published in Baylor University Medical Center Proceedings, 2023
Mustafa Rami Ali, Omar Jamil Darwish, Laith Alhuneafat, Bayan Nidal Abdallah, Yacob Saleh
A 47-year-old man was diagnosed with de novo RCC of the right kidney metastatic to the lungs and bone. His International Metastatic RCC Database Consortium risk score was 2 (intermediate; <1 year to treat from diagnosis, elevated neutrophil count [8890/mm3]).2 First-line sunitinib was started, and 2 months later he developed extensive right lower limb deep vein thrombosis. His disease remained stable for 9 months until he underwent right renal artery embolization to control for hematuria. A computed tomography (CT) scan showed disease progression, so he was started on second-line nivolumab. Thirty-six days later, he reported progressive pleuritic chest pain and dyspnea for 31 days. An electrocardiogram (ECG) showed ST-segment depression in the lateral leads and diffuse PR depression, troponin was negative, and an echocardiogram showed mild pericardial effusion. A diagnosis of pericarditis was made.
Sarcoidosis presenting as acute pericarditis. A case report and review of pericardial sarcoidosis
Published in Acta Cardiologica, 2022
Alexandre Unger, Philippe Unger, Raphaël Mottale, Mihaela Amzulescu, Abraham J. Beun
There is no evidence of survival benefit resulting from corticosteroids in cardiac sarcoidosis [3]. It is recommended to treat sarcoidosis immediately when there is a risk of severe dysfunction or irreversible damage to major organs, or death, or in the presence of incapacitating constitutional symptoms. There is no validated protocol regarding the optimal dosage and duration [14]. In life-threatening situations including those with cardiac involvement, it is recommended to start at a dose of prednisolone 1 mg/kg [1]. Sohn et al. proposed to treat patients who are in an active stage of the disease with corticosteroids, with an initial dose of <30 mg prednisolone [8]. There is currently no recommendation addressing the treatment of pericardial involvement in the absence of myocardial involvement. However, as confirmed by this review, it is common practice to use corticosteroids in pericarditis with and without myocardial involvement. Despite limited data, the standard of care for the management of pericarditis may also prove beneficial in this setting. Wyplocz et al. and Verdickt et al. even suggested treating pericardial effusion with standard pericarditis treatment in the absence of cardiac involvement [5,13]. Because of the relapse on aspirin and colchicine, and considering the known intermediate risk of constrictive pericarditis in the setting of immune pathology, we chose to treat our patient with low a dose of methylprednisolone and methotrexate as a corticosteroid-sparing agent [1,7].