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Pericardium
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
In up to 90% of cases, no clear aetiology is established and a diagnosis of idiopathic acute pericarditis is made. The pericarditis leads to a fibrinous exudate which forms a shaggy pale coating on the surface of the epicardium (Fig. 12.7) and there is accumulation of pale-yellow clear fluid (Fig. 12.8). Histologically, there is granulation tissue with an irregular dense eosinophilic fibrin-rich surface which explains the shaggy appearance on the surface (Figs. 12.9a,b).
Radiotherapy in cancer patients
Published in Susan F. Dent, Practical Cardio-Oncology, 2019
Girish Kunapareddy, Adarsh Sidda, Christopher Fleming, Chirag Shah, Patrick Collier
Acute pericarditis usually occurs within the first few weeks of radiation therapy. Pericarditis, the most common cardiac complication historically, is now seldom observed on account of newer techniques incorporating cardioprotective methods, including lowered radiation doses, more efficient targeting, and incorporation of shielding blocks (62). Acute pericarditis is generally self-limiting, with half of the patients recovering with rest alone, while others are treated with nonsteroidal anti-inflammatory drugs, colchicine, and possibly the addition of diuretics. Increased vascular permeability accounts for extravasation of protein-rich fluid leading to pericardial effusions. Pericardial effusions may be seen in the acute setting but usually accumulate gradually, without sudden cardiovascular compromise. If hemodynamic instability from effusions does occur, it needs to be rapidly relieved with a needle pericardiocentesis or surgical window.
Heart muscle disease
Published in Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol, Handbook of Aviation and Space Medicine, 2019
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol
Acute pericarditis: May be acutely incapacitating secondary to severe pain.Is usually a self-limiting condition and amenable to treatment with NSAIDS.Can be treated with colchicine if recurrence occurs; this is most likely within 12 months of the initial attack.Can take 3–6 weeks to resolve and aircrew should desist from flying for this period and if ECG changes have resolved.Aircrew should return to restricted (dual-crew) operation for 6 months and echocardiography and assessment of inflammatory markers should be considered.
Usefulness of neutrophil-to-lymphocyte ratio for predicting acute pericarditis outcomes
Published in Acta Cardiologica, 2022
Fatih Yılmaz, Filiz Kizilirmak Yılmaz, Ali Karagöz, Arzu Yıldırım, Haci Murat Gunes, Ravza Betül Akbas, Süleyman Çağan Efe, İrfan Barutçu
Acute pericarditis is a common inflammatory condition. In clinical practice, the diagnosis of acute pericarditis is established based on the presence of two out of four criteria [chest pain, pericardial friction rub, PR depression and diffuse ST elevation in electrocardiography (ECG), pericardial effusion], and the role of inflammatory markers has not been clearly defined to date [1–6]. Increased C-reactive protein (CRP) levels have been associated with pericarditis recurrence and major cardiac complications [7,8]. The increase in neutrophil-to-lymphocyte ratio (NLR) as a result of lymphocytopenia and increased neutrophil count has been associated with adverse outcomes in several inflammatory diseases [8–12]. NLR has also been found to be an indicator of poor prognosis in myocardial infarction, coronary artery disease, atherosclerosis and chronic obstructive pulmonary disease [13–17]. The fact that it may not always be adequate to use CRP alone for the follow-up and risk classification of patients with pericarditis in clinical setting [5] necessitates additional parameters for the follow-up of these patients. To date, no study has been conducted to investigate the relationship between NLR and the prognosis of acute pericarditis prognosis.
Use of Anakinra in steroid dependent recurrent pericarditis: a case report and review of literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Vinay Kumar Thallapally, Sonia Gupta, Sai Giridhar Gundepalli, Joseph Nahas
Acute pericarditis accounts for about five percent of all presentations for acute chest pain [1]. About 30% of all the cases of acute pericarditis progress to recurrent pericarditis [2]. In developed countries, most of the cases of acute pericarditis are of idiopathic or viral origin [3] while tuberculosis accounts for most of the cases in the developing countries with high prevalence [4]. NSAIDs/Aspirin (ASA) remains the cornerstone of treatment. The adjuvant use of colchicine with NSAIDs more than halves the risk of recurrence of pericarditis [5–7]. Corticosteroids are used in patients who fail initial therapy with ASA/NSAIDs/Colchicine. Third-line options include intravenous immunoglobulin, and steroid-sparing immunosuppressants like azathioprine, methotrexate, and cyclosporine [2]. IL-1 inhibitors like anakinra have been proposed in patients with recurrent pericarditis. In this article, we will discuss a case of successful treatment of recurrent constrictive pericarditis with anakinra and review the current evidence regarding the safety and efficacy of anakinra in patients with refractory recurrent pericarditis.
Predictors and risk factors of short-term readmission of acute pericarditis
Published in Expert Review of Cardiovascular Therapy, 2021
Yasser Al-Khadra, Yasar Sattar, Waqas Ullah, Tanveer Mir, Marvin Kajy, Fahed Darmoch, Homam Moussa Pacha, Mohamad Soud, Fnu Zafrullah, Mohamed Zghouzi, Ghaith Alhatemi, Ali Banisad, Zaher Hakim, Allan Klein, M Chadi Alraies
Acute pericarditis is a frequent cause of chest pain comprising up to 3.32/100,000 patients every year [1–3]. Acute pericarditis can make up to 5% of emergency visits and 0.1% of hospital admissions [4]. The real incidence and prevalence can be higher, given the cases ranging from mild asymptomatic self-resolving to severely symptomatic patients [2]. The cost of pericarditis hospitalization is reported to range from 8,404 USD to 9,982 USD from 1999 to 2012 [5]. Furthermore, the pericarditis readmission rate can be 18% during 30-day follow up [5]. High readmission can be a medical and financial burden to the healthcare system. The cost of unplanned rehospitalizations of pericarditis patients under Medicare insurance in 2004 was 17.4 USD billion [6]. Furthermore, a fifth of Medicare patients had 30-day readmission [6]. Therefore, we sought to evaluate the causes and predictors of 30-day readmissions in acute pericarditis patients using the National Readmission Database (NRD).