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Pericardial disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Patients with end-stage renal disease may develop pericarditis, pericardial effusions, and rarely, constrictive pericarditis. There are three main presentations of pericarditis in renal failure: (1) uremic pericarditis, occurring before renal replacement therapy or within 8 weeks from its initiation and related to retention of toxic metabolites; (2) dialysis pericarditis, occurring on dialysis (usually ≥8 weeks after its initiation); and (3) constrictive pericarditis only rarely (59–61).
U
Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Uremic Pericarditis [Greek: ouron, urine + peri, round + kardia, heart + itis, inflammation] Occurs in cases of renal failure and was studied by Heinrich von Bamberger (1822–1888) of Vienna in 1857 and Ludwig von Buhl (1816–1880) of Stuttgart in 1878. More recent studies on the subject were done by Alvan Leroy Barach of NewYork in 1922.
Chronic Renal Failure
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
It is less common now for ESRF to present as a uremic emergency, but in these situations, symptoms of encephalopathy will often be present. Patients will have a reduced conscious level and evidence of neuromuscular irritability such as asterixis. In addition, they have an increased bleeding tendency; there may be evidence of skin bruising or gastrointestinal bleeding. Uremic pericarditis (characterized by a pericardial friction rub) or pulmonary edema can also occur. The presence of any of these features is an indication to commence dialysis urgently.
Primary prevention of post-pericardiotomy syndrome using corticosteroids: a systematic review
Published in Expert Review of Cardiovascular Therapy, 2018
Rachel Wamboldt, Gianluigi Bisleri, Benedict Glover, Sohaib Haseeb, Gary Tse, Tong Liu, Adrian Baranchuk
A potential option for avoiding the adverse effects associated with systemic corticosteroid administration would be the delivery of this medication into the intrapericardial space. Intrapericardial steroid instillation has been used in the setting of recurrent pericarditis and uremic pericarditis. In porcine models, the intrapericardial delivery of 2 mg/kg of triamcinolone acetate after radiofrequency ablation demonstrated success in preventing postoperative pericarditis [31]. Dyrda et al. evaluated the influence of intrapericardial triamcinolone compared to systemic administration (oral, intravenous) and no steroids [32]. They found that the incidence of pericarditic chest pain was significantly reduced in patients who received intrapericardial steroids (21.1%) compared with no steroids (58.8%; p = 0.006). Systemic steroid administration did not confer a statistically significant benefit in comparison to no steroids with regard to pericarditic chest pain (43.4% versus 58.8%; p = 0.31). It is important to note that there were no adverse consequences associated with the use of intrapericardial triamcinolone in terms of infections and myocardial perforation [32]. These results were limited by a small sample size of 85 patients. It should also be stressed that the population enrolled in these studies are very different from the previously analyzed trials; in fact, both D’Avila and Dyrda analyzed the impact of intra-pericardial delivery of steroids not in patients undergoing cardiac surgery but instead in epicardial catheter ablation, which may represent per se a major factor for post-procedural acute inflammatory response [31].
Acupuncture related acute purulent pericarditis masquerading uremic pericarditis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Waqas Ullah, Sohaib Roomi, Zeeshan Sattar, Asrar Ahmad, Zain Ali, Usman Sarwar, Vincent Figueredo
Initially, pericardial effusion and chest pain were thought to be due to the uremic pericarditis and arrangement was made for dialysis, but nephrology argued that acute kidney injury rarely causes uremic pericarditis. Other differentials included trauma and autoimmune and uremic pericarditis but negative trauma workup, ANA levels and normal renal functions a week prior to presentation excluded trauma, autoimmune and uraemia induced pericarditis. Acute coronary syndrome was also among the differentials but static troponin levels, echocardiography, normal interval EKGs with no Q wave formation and clean coronary arteries on catheterization ruled out ischaemia as a possible cause of ST-segment elevation.
Hydralazine-induced pericardial effusion
Published in Baylor University Medical Center Proceedings, 2019
Mohammed Faisal Rahman, Muhammad Ajmal Panezai, Harold M. Szerlip
The patient underwent pericardial window with drainage of 1800 mL of bloody fluid; cultures and acid-fast bacilli stain of the fluid returned negative, ruling out infectious etiology. The patient did not have any symptoms suggesting a viral infection, and myocardial infarction was also ruled out. Uremic pericarditis was unlikely, because he was compliant with outpatient hemodialysis and had maintained adequate hemodialysis adequacy per current guidelines. The only possible explanation for the patient’s hemorrhagic pericardial effusion was hydralazine-induced lupus, especially with antihistone antibody positivity.