Heart muscle disease
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol in Handbook of Aviation and Space Medicine, 2019
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.
Radiotherapy in cancer patients
Susan F. Dent in Practical Cardio-Oncology, 2019
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.
Pericardium
Mary N. Sheppard in 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).
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.
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
To the best of our knowledge, this is the second case of a patient presenting with clinical features consistent with acute pericarditis as the first manifestation of sarcoidosis [5]. The diagnosis of sarcoidosis requires clinical, radiological and pathological assessment. In this case, the diagnosis was ascertained by the findings of non-caseous granulomatosis on mediastinal lymph node biopsy and by the uptake pattern on PET/CT. Other infectious causes were excluded by an extensive work-up including serology and microbiological analysis of the biopsy sample. The findings of ANA with anti-SSA specificity and rheumatoid factor, in the absence of auto-immune disease is likely explained by an exaggerated immune response [6]. The combination of typical pericardial chest pain, widespread concave ST elevation and pericardial effusion is consistent with the diagnosis of acute pericarditis [7]. MRI was vital in ruling out myocardial involvement. Furthermore, no ECG or wall motion abnormality suggestive of myocardial sarcoidosis could be detected after the acute event [8].
Related Knowledge Centers
- Chest Pain
- Inflammation
- Myocardial Infarction
- Pericarditis
- Pulmonary Embolism
- Pleurisy
- Pericardium
- Pulmonary Pleurae
- Trapezius
- Gastroesophageal Reflux Disease