Pericarditis

Pericarditis is an inflammation of the pericardium, the sac surrounding the heart (Fig. 8.9). The condition can be classified as being either acute or chronic. 

Retro-sternal chest pain Arrhythmias Fever/chills 

Reduction in pain on leaning forward Worsening pain on inspiration 

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Picornavimses are small, nonenveloped RNA vimses. Members of this family include rhino- and enteroviruses, which are responsible for a variety of human diseases (viral respiratory infection, viral meningitis, myocarditis, pericarditis, encephalitis, chronic meningoencephalitis, herpangina, otitis media, neonatal enteroviral disease, and acute exacerbations of asthma). 

Occurs as a result of circulatory insufficiency associated with overwhelming infection Occurs when obstruction of blood flow results in inadequate tissue perfusion. Examples include a severe reduction of blood flow as the result of massive pulmonary embolism, pericardial tamponade, restrictive pericarditis, and severe cardiac valve dysfunction Occurs as a result of blockade of neurohum oral outflow. Examples include from a pharmacological source (ie, spinal anesthesia) or direct injury to the spinal cord. This type of shock is rare. 

Tuberculosis is on the increase in developed countries such as the USA and UK furthermore, MAI may be associated with AIDS sufferers. Hospital-acquired opportunistic mycobacteria may cause disseminated infection and also lung infections, endocarditis and pericarditis. Transmission of mycobacterial infection by endoscopy is rare, despite a marked increase in the use of flexible fibreoptic endoscopes, but bronchoscopy is probably the greatest hazard for the transmission ofM tuberculosis and other mycobacteria. Thus, biocides used for bronchoscope disinfection must be ehosen carefully to ensure that such transmission does not occur. 

Evidence of active pericarditis, endocarditis, septic emboli, current or recent pregnancy, and lactating women... 

Cardiac Aortic dissection, coronary artery vasospasm, pericarditis, valvular heart disease... 

Myelosuppression (dose-related) mucositis (worse with continuous infusion) moderate emetogenic potential alopecia vesicant severe extravasation injury cardiac toxicities acute—not related to cumulative dose arrhythmias, pericarditis chronic— cumulative injury to myocardium (total dose greater than 550 mg/m2 lower total cumulative doses cause damage to myocardium in children (e.g., 350 mg/m2)... 

Pulsus paradoxus Exaggeration of normal variation in the pulse during respiration—the pulse becomes weaker during inhalation and stronger during exhalation characteristic of constrictive pericarditis or pericardial effusion. 

The answer is c. (Hardman, p 868. Katzung, pp 231—232) Procainamide blocks open Na+ channels. Long-term therapy can result in drug-induced lupus syndrome, identified by circulating antinuclear antibodies. Many patients may develop a facial rash and joint pains. Pericarditis can occur, but renal involvement is rare. 

Suggested Alternatives for Differential Diagnosis Hepatitis, Legionnaires disease, myocarditis, pericarditis, cardiac tamponade, pneumonia, ehrlichiosis, relapsing fever, Rocky Mountain spotted fever, and tularemia. 

Suggested Alternatives for Differential Diagnosis Pasteurellosis and other causes of pneumonia, East Coast fever, traumatic pericarditis, hydatid cyst, actinobacillosis and tuberculosis, and bovine farcy. 

Extra-articular involvement may include rheumatoid nodules, vasculitis, pleural effusions, pulmonary fibrosis, ocular manifestations, pericarditis, cardiac conduction abnormalities, bone marrow suppression, and lym-phadenopathy. 

Complications of MI include cardiogenic shock, heart failure, valvular dysfunction, various arrhythmias, pericarditis, stroke secondary to left ventricular (LV) thrombus embolization, venous thromboembolism, and LV free-wall rupture. 

Causes of diastolic dysfunction (restriction in ventricular filling) are increased ventricular stiffness, ventricular hypertrophy, infiltrative myocardial diseases, myocardial ischemia and infarction, mitral or tricuspid valve stenosis, and pericardial disease (e.g., pericarditis, pericardial tamponade). 

Severe congestive heart failure and constrictive pericarditis... 

Approximately 10 to 14 days after the onset of the disease and despite successful treatment, the patient develops a characteristic immunologic reaction of fever, arthritis (usually involving large joints), and pericarditis. 

Sarcoidiike NSAIDs or corticosteroids can be of benefit for some patients Pericarditis Severe disease corticosteroids I mg/kg/day or pericardial drainage procedure 0.05 Antifungal therapy generally recommended for all patients to halt further lung destruction and reduce mortality... 

Complications of influenza may include exacerbation of underlying comorbidities, primary viral pneumonia, secondary bacterial pneumonia or other respiratory illnesses (e.g., sinusitis, bronchitis, otitis), encephalopathy, transverse myelitis, myositis, myocarditis, pericarditis, and Reye s syndrome. 

Nonpulmonary manifestations are extremely common and include nausea, vomiting, diarrhea, myalgias, arthralgias, polyarticular arthritis, skin rashes, myocarditis and pericarditis, hemolytic anemia, meningoencephalitis, cranial neuropathies, and ft n i I lain - Bar re syndrome. Systemic symptoms generally clear in 1 to 2 weeks, whereas respiratory symptoms may persist up to 4 weeks. 

Colakovski, H. and Lorber, D.L., Propylthiouracil-induced perinuclear-staining antineutrophil cytoplasmic autoantibody-positive vasculitis in conjunction with pericarditis, Endocr. Pract., 7, 37, 2001. 

Patients with pericardial tamponade, restrictive cardiomyopathy, constrictive pericarditis, solutions containing dextrose in patients with known allergy to corn or corn products (IV). 

Significant adverse reactions include a lupus erythematosus-like syndrome of arthralgia, pleural or abdominal pain, and sometimes arthritis, pleural effusion, pericarditis, fever, chills, myalgia, and possibly related hematologic or skin lesions (after prolonged administration) neutropenia thrombocytopenia agranulocytosis (after repeated use deaths have occurred) anorexia nausea vomiting abdominal pain bitter taste diarrhea. 

Pericarditis Pericarditis has occurred rarely with mesalamine-containing products including sulfasalazine. 

Do not treat severe pneumonia, empyema, bacteremia, pericarditis, meningitis, or purulent or septic arthritis with an oral penicillin during the acute stage. 

Hypersensitivity Anaphylactoid purpura, anaphylaxis, angioneurotic edema, myocarditis, pericarditis, polyarthralgia, pulmonary infiltrates with eosinophilia, systemic lupus erythematous exacerbation, urticaria hypersensitivity syndrome (cutaneous reaction, eosinophilia, and one or more of the following Hepatitis, pneumonitis, nephritis, myocarditis, pericarditis, fever, lymphadenopathy). Muscuioskeietai - ArVr ra g a, arthritis, bone discoloration, joint stiffness and swelling, myalgia, polyarthralgia. 

Hypersensitivity Fever, skin eruptions of various types, including exfoliative dermatitis, infectious mononucleosis-like, or lymphoma-like syndrome, leukopenia, agranulocytosis, thrombocytopenia, Coombs positive hemolytic anemia, jaundice, hepatitis, pericarditis, hypoglycemia, optic neuritis, encephalopathy, Leoffler s syndrome, vasculitis, and a reduction in prothrombin. 

Mesalamine (Asacol, Lialda, Pentasa, Rowasa) [Anti-inflcinimcifory/Seilicyleite] Uses Mild-mod distal ulcerative colitis, proctosigmoiditis, proctitis Action Unknown may inhibit prostaglandins Dose Rectal 60 mL qhs, retain 8 h (enema), 500 mg bid-tid or 1000 mg qhs (supp) PO Cap 1 g PO qid Tab 1.6-2.4 g/d doses (tid-qid) delayed release 2.4-. 8 g PO daily 8 wk max, do not cut/crush/chew w/ food initial dose in elderly Caution [B, M] Contra Salicylate sensitivity Disp Tabs, caps, supp, rectal susp SE HA, malaise, abd pain, flatulence, rash, pancreatitis, pericarditis Interactions X Effect OF digoxin EMS May turn urine yellow-brown OD May cause NA /D, tinnitus, HA, and drowsiness activated charcoal may be effective... 

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