Management Of Acute Pericarditis Research Articles

Atrial and ventricular strain using cardiovascular magnetic resonance in the prediction of outcomes of pericarditis patients: a pilot study.

Our study aimed to explore with cardiovascular magnetic resonance (CMR) the impact of left atrial (LA) and left ventricular (LV) myocardial strain in patients with acute pericarditis and to investigate their possible prognostic significance in adverse outcomes. This retrospective study performed CMR scans in 36 consecutive patients with acute pericarditis (24 males, age 52 [23-52]). The primary endpoint was the combination of recurrent pericarditis, constrictive pericarditis, and surgery for pericardial diseases defined as pericardial events. Atrial and ventricular strain function were performed on conventional cine SSFP sequences. After a median follow-up time of 16months (interquartile range [13-24]), 12 patients with acute pericarditis reached the primary endpoint. In multivariable Cox regression analysis, LA reservoir and LA conduit strain parameters were all independent determinants of adverse pericardial diseases. Conversely, LV myocardial strain parameters did not remain an independent predictor of outcome. With receiving operating characteristics curve analysis, LA conduit and reservoir strain showed excellent predictive performance (area under the curve of 0.914 and 0.895, respectively) for outcome prediction at 12months. LA reservoir and conduit mechanisms on CMR are independently associated with a higher risk of adverse pericardial events. Including atrial strain parameters in the management of acute pericarditis may improve risk stratification. Atrial strain could be a suitable non-invasive and non-contrast cardiovascular magnetic resonance parameter for predicting adverse pericardial complications in patients with acute pericarditis. • Myocardial strain is a well-validated CMR parameter for risk stratification in cardiovascular diseases. • LA reservoir and conduit functions are significantly associated with adverse pericardial events. • Atrial strain may serve as an additional non-contrast CMR parameter for stratifying patients with acute pericarditis.

Management of Acute Idiopathic (Viral) Pericarditis in the Emergency Department: A Review for the Nursing Professional.

Acute pericarditis is an inflammatory disorder that contributes to chest pain admissions in the emergency department (ED). Nursing professionals can play a vital role in the differential, triage and management of acute pericarditis in the ED. First-line pharmacotherapy to specifically treat acute pericarditis of viral or idiopathic origin is paramount in improving patients' quality of life and reducing the risk of further recurrences of pericarditis and consists of combination therapy with aspirin (acetylsalicylic acid [ASA]) or a nonsteroidal anti-inflammatory drug (NSAID), in combination with colchicine. Corticosteroids should not be initiated as first-line therapy in idiopathic (viral) pericarditis, as they increase the risk of recurrences. Nursing professionals are also pivotal in monitoring pharmacotherapy with respect to safety and efficacy. Overall, the nursing professional can facilitate timely administration and monitoring of medications, provide patient education, promote adherence, and assist in transitions of care for patients diagnosed with acute idiopathic (viral) pericarditis in the ED.

Acute Pericarditis: Descriptive Study and Etiology Determination in a Predominantly African American Population.

INTRODUCTION­­­Acute pericarditis is the most commonly encountered manifestation of pericardial disease (incidence: 0.2 percent to 0.5 percent in hospitalized patients). However, data regarding manifestations, workup, and the management of acute pericarditis in the African American population is lacking. This study aims to collect and analyze more clinical data related to acute pericarditis in this understudied population.METHODOLOGYWe conducted a retrospective chart review of all patients managed for acute pericarditis at a university hospital serving a predominantly African American population. A total of 78 charts were reviewed during the period of study from January 2011 to July 2016. Out of these, nine charts were excluded due to poor data. We descriptively analyzed data regarding presenting symptoms, underlying etiologies, co-morbidities, investigation results, management strategies, and prognoses.RESULTSWe found an equal number of males and females in our study population. The most common comorbid conditions were hypertension, chronic kidney disease, and diabetes mellitus (in order of incidence). The most common presentation of symptomatic pericarditis consisted of chest pain, dyspnea, tachycardia, and tachypnea. Electrocardiogram (EKG) findings included diffuse ST elevation (15 percent) and sinus tachycardia (41 percent). Leukocytosis was seen in 15 percent of the patients. The most common etiology noted in our patient population was idiopathic and was treated with NSAIDS.CONCLUSIONAs compared to other populations, the incidence of uremic pericarditis and pericarditis secondary to cardiac etiologies is slightly higher in the African American population; however, the clinical presentation, examination and laboratory findings, as well as investigations, are remarkably similar.

0036: Management of acute pericarditis in the emergency room. A real-life study in a tertiary care center in France

Few data on the management of acute pericarditis (AP) in emergency departments (ED) are available. We sought to describe the characteristics and outcomes of patients diagnosed for acute pericarditis (AP) in our ED in a tertiary care university hospital. We retrospectively retrieved all the patients diagnosed for AP in our ED from 01/2011 to 06/2013. We collected the data from medical files and through a questionnaire sent to general practitioners. We identified 150 patients (age 42±16 years, 66% males). The 2004-ESC guidelines criteria for the diagnosis of AP were met only in 48% of cases. An increased (>5 mg/l) C-reactive protein (CRP) was present in 51.3% of patients, with significantly higher levels when symptoms onset exceeded 24 hours in patients meeting the diagnostic criteria (79.1 vs. 14.9 mg/l in patient with – vs. without ESC diagnostic criteria, p<0.029). In 49% of cases, ECG was compatible with the diagnosis of AP. An echocardiography was performed during the ED stay in 77% of patients, showing a pericardial effusion in 26% of cases. Patients were hospitalized in 27% of cases. Aspirin was the most often prescribed (84%). Colchicine alone or in association with aspirin was proposed in 30% of patients and was significantly associated with a medical history of pericarditis (63% with- vs. 25% without history of AP, p<0.0001). The duration of drug therapy was longer for colchicine than for other anti-inflammatory drugs (respectively 58±31 vs. 26±13 days, p<0.01). Follow-up data were only available in 50 patients: only 52% have consulted their physician within a period of 1 to 120 days after discharge. Treatment side effects were noted in 6% and recurrence in 4% of cases. This study highlights the lack of a systematic guidelinesbased management of patients with acute pericarditis in the emergency room. The assessment of CRP is of diagnostic value in this setting especially after 24 hours of symptoms onset. This marker may be considered in the future guidelines updates. Since a majority of these cases are managed as outpatients, emphasis should also be made for an adequate and systematic follow-up.

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.

Current and emerging strategies for the treatment of acute pericarditis: a systematic review

Pericarditis is a common disorder that has multiple causes and presents in various primary-care and secondary-care settings. It is diagnosed in 0.1% of all hospital admissions and in 5% of emergency room visits for chest pain. Despite the advance of new diagnostic techniques, pericarditis is most commonly idiopathic, and radiation therapy, cardiac surgery, and percutaneous procedures have become important causes. Pericarditis is frequently benign and self-limiting. Nonsteroidal anti-inflammatory agents remain the first-line treatment for uncomplicated cases. Integrated use of new imaging methods facilitates accurate detection and management of complications such as pericardial effusion or constriction. In this article, we perform a systematic review on the etiology, clinical presentation, diagnostic evaluation, and management of acute pericarditis. We summarize current evidence on contemporary and emerging treatment strategies.

The management of acute pericarditis

Acute pericarditis is usually a benign self-limiting condition, often of unexplained or viral aetiology, involving inflammation of the pericardial layers. It is often part of the differential diagnosis in patients admitted with acute chest pain and can be confused with acute myocardial infarction, acute pulmonary embolism and pleurisy. Occasionally it can result in cardiac tamponade and, if associated with myocarditis, in heart failure. This article sets out how to diagnose acute pericarditis, the common underlying causes, the possible treatment options and outcomes.

THE SURGICAL MANAGEMENT OF ACUTE PERICARDITIS.

1. Six cases of acute pericarditis, three of which are discussed, required pericardiectomy after failure to respond to medical therapy. 2. Reference is made to etiologic agents, operative approach and extent of the pericardiectomy to relieve tamponade and prevent constriction. 3. Median sternotomy approach with removal of the pericardium anterior to and surrounding the hilar structures of the lung is the procedure of choice while the left anterolateral approach with anterior and left pericardiectomy may suffice for cases with acute onset and of short duration. Transthoracic drainage is preferable to external drainage. 4. A plea is made for better timing and a more aggressive attitude to avoid critical situations and operations performed under life-threatening circumstances. 5. The physiology of pericardial effusion-tamponade is discussed.