Diagnosis Of Acute Pericarditis Research Articles

Good Prognosis for Pericarditis With and Without Myocardial Involvement

Background— The natural history of myopericarditis/perimyocarditis is poorly known, and recently published studies have presented contrasting data on their outcomes. The aim of the present article is to assess the prognosis of myopericarditis/perimyocarditis in a multicenter, prospective cohort study. Methods and Results— A total of 486 patients (median age, 39 years; range, 18–83 years; 300 men) with acute pericarditis or a myopericardial inflammatory syndrome (myopericarditis/perimyocarditis; 85% idiopathic, 11% connective tissue disease or inflammatory bowel disease, 5% infective) were prospectively evaluated from January 2007 to December 2011. The diagnosis of acute pericarditis was based on the presence of 2 of 4 clinical criteria (chest pain, pericardial rubs, widespread ST-segment elevation or PR depression, and new or worsening pericardial effusion). Myopericardial inflammatory involvement was suspected with atypical ECG changes for pericarditis, arrhythmias, and cardiac troponin elevation or new or worsening ventricular dysfunction on echocardiography and confirmed by cardiac magnetic resonance. After a median follow-up of 36 months, normalization of left ventricular function was achieved in >90% of patients with myopericarditis/perimyocarditis. No deaths were recorded, as well as evolution to heart failure or symptomatic left ventricular dysfunction. Recurrences (mainly as recurrent pericarditis) were the most common complication during follow-up and were recorded more frequently in patients with acute pericarditis (32%) than in those with myopericarditis (11%) or perimyocarditis (12%; P <0.001). Troponin elevation was not associated with an increase in complications. Conclusions— The outcome of myopericardial inflammatory syndromes is good. Unlike acute coronary syndromes, troponin elevation is not a negative prognostic marker in this setting.

Etiological Profile, Clinical Features and Medical Management of Acute Pericarditis in Burkina Faso

Diagnosis of acute pericarditis is sometimes difficult but the first challenge to the clinician is to establish an etiologic diagnosis. This study aimed to describe etiologies of this pathology and its clinical pictures, and expose the medical treatment and outcome, at the time of the success of antiretroviral treatment. Through a prospective study, we follow up a sample of patients presenting acute pericarditis from January 2010 to December 2011. There were 43 cases composed of 20 men and 23 women. The average age was 41.4 ± 16.1 years. The leading clinical signs were infectious syndrome (100%), dyspnea (86%), and chest pain (79.1%). Right heart failure was found in 27.9% of cases, hypotension in 23.2% of cases and pulsus paradoxus in 20.9% of cases. Echocardiography found pericardial effusion in 88.4% of cases. This effusion was of great amount in 26.3% of cases of pericardial effusion. Cardiac tamponade was encountered in six cases. We identified an etiology in 88.4% of cases. These etiologies were tuberculosis in 47.4% of cases. As treatment, anti-tuberculous drugs associated to corticosteroids were systematic in tuberculous forms. In other cases, we used aspirin associated to corticosteroids or colchicine as appropriate. Six cases of recurrence were observed in exclusively tuberculous forms. Two cases of deaths were occurred.

Diagnostic Yield of Extensive Infectious Panel Testing in Acute Pericarditis: Fanne RA, Banai S, Chorin U, et al. Cardiology 2011;119:134–9.

This retrospective cohort study from Israel examined the diagnostic yield of the standard infectious panel, characteristics of myocardial involvement, and the utility of investigating myocardial involvement in patients with viral or idiopathic pericarditis. All consecutive patients with a diagnosis of acute pericarditis or myopericarditis admitted to the Cardiology Department from an urban area (> 500,000) from March 2005 through March 2008 were enrolled. Acute pericarditis was defined as pericarditic typical chest pain, pericardial friction rubs, new widespread ST elevation or PR depression, and new or worsening pericardial effusion.

Acute Pericarditis Assessed With Magnetic Resonance Imaging

A 19-year-old man with the diagnosis of acute pericarditis based on the classic clinical syndrome and an ECG (Figure 1A) was referred to our cardiac magnetic resonance (CMR) unit 1 month after his hospital admission because of suspected associated acute myocarditis. A follow-up ECG within the time frame of referral showed essentially significant regression of ST elevation (Figure 1B). An echocardiogram performed at the referring hospital on the same day (Figure 2A and 2B) was reported as showing mild concentric left ventricular (LV) hypertrophy with good LV systolic function (ejection fraction 75%). Figure 1. A, 12-Lead ECG showing sinus rhythm and widespread saddle-shaped ST elevation in the inferolateral leads. B, 12-Lead ECG showing sinus rhythm, PR-segment depression, and elevated ST-segment uptake in the inferior and septal leads. Figure 2. Transthoracic echocardiographic images during end diastole showing normal LV and right ventricular size and mild LV hypertrophy. Left parasternal short-axis view (A) and apical 4-chamber view (B) at the time of the initial MRI scan. …

Acute Pericarditis

Acute pericarditis (AP) is basically a clinical diagnosis. Although specific electrocardiographic (ECG) manifestations may indeed point to its diagnosis, sole reliance on such findings in isolation of the clinical setting, however, is often the common pitfall that could lead to a misguided diagnosis. We briefly review the anatomy of the pericardium and the pathophysiology of pericarditis to highlight common signs and symptoms as well as clinical findings that may assist in the diagnosis of AP. We also feature the characteristic evolution of its ECG manifestations and point out some of its typical and atypical features to help better differentiate AP from commonly confused conditions.

The Diagnosis of Acute Pericarditis in the Absence of Pericardial Friction Sound or Electrocardiographc Changes: Report of Two Cases

The Diagnosis of Acute Pericarditis in the Absence of Pericardial Friction Sound or Electrocardiographc Changes: Report of Two Cases

THE USE OF PERICARDIAL BIOPSY IN ESTABLISHING ETIOLOGIC DIAGNOSIS IN ACUTE PERICARDITIS

THE ETIOLOGIC diagnosis of acute pericarditis is at times difficult and expensive from the time and financial standpoint. Likewise, prognosis may be greatly affected when an etiology is discovered which previously had been unsuspected. Of such a nature is the case to be presented here. REPORT OF CASE A 35-year-old Negro mail-truck driver entered the hospital for his first admission with a chief complaint of fever of one month's duration. The patient had been completely well until two months before admission, at which time he noted the onset of a nonproductive cough not associated with pain. A chest x-ray at this time was interpreted as normal. These symptoms continued in progressive fashion until about a month before admission, when the development of low-grade fever sent him to his local physician, who treated him with penicillin. However, he continued to have fever (temperature to 101 F) daily. The penicillin had no

Acute pericarditis associated with infectious mononucleosis.

DESCRIPTIONS of the syndrome of acute nonspecific or idiopathic pericarditis appearing since the report by Barnes and Burchell1 have added little to knowledge of the subject. They have, however, emphasized the variability of this type of pericarditis and have suggested to some the concept that the etiology may likewise be diverse. It is interesting that in 1947 Burchell,2 commenting on the differential diagnosis, stated: "When the diagnosis of acute pericarditis seems evident, the search for an etiologic factor should not be abandoned too quickly."Benign pericarditis has been reported under a wide variety of circumstances. The syndrome has been noted . . .

Acute Pericarditis

WITHIN a period of three months, 8 cases of pericarditis were treated on the Cardiology Section of the Medical Service at the Battey General Hospital. In studying these patients, a graphic method was devised to correlate the clinical, x-ray and electrocardiographic changes. It was found that the observed alterations followed a variable sequence in different cases — variations that are incompletely described in the textbooks. Inasmuch as the diagnosis of acute pericarditis is often difficult, it is important to discuss thoroughly the variations that may be encountered. It was also noted that patients with purulent pericardial infections, when treated with . . .

ELECTROCARDIOGRAPHIC CHANGES ASSOCIATED WITH PERICARDITIS

There are more clinical conditions than are apparent on first consideration in the diagnosis of which a knowledge of the electrocardiographic patterns occurring in pericarditis may be helpful. It has been said often that the diagnosis of acute pericarditis is more often missed than made. When purulent pericarditis is present as a primary disease or as a complication of pleurisy or pulmonary disease it is especially important to make the diagnosis early so that surgical treatment may be instituted promptly. The postoperative occurrence of substernal or precordial pain, evidences of embarrassment of the circulation and a pericardial friction may provide a puzzling problem in differentiating between simple pericarditis and thrombosis of a coronary artery. The similarity between the electrocardiograms of the two conditions may lead to serious error unless the dissimilarities are appreciated. Pericarditis may also complicate acute rheumatic fever, cardiac wounds, pneumonia, uremia and occlusion of a coronary artery.