Pericarditis acute

Glucocorticoids Regulate carbohydrate, lipid and protein metabolism block inflammation regulate body s immune response Indications Asthma, advance pulmonary tuberculosis, pericarditis, acute and chronic inflammation, adrenal insufficiency, antenatal use in preterm labor, hypercalcemia, cerebral edema, acute SCI, MS, shock Common drug examples ... 

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). 

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)... 

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

Unlabeled Uses To reduce frequency of recurrence of familial Mediterranean fever treatment of acute calcium pyrophosphate deposition, amyloidosis, biliary cirrhosis, recurrent pericarditis, sarcoid arthritis... 

Codeine, also known as methylmorpliine, C H2 NOt H20, is a colorless white crystalline substance, mp 154.9 C, slightly soluble in water, soluble in alcohol and chloroform, effloresces slowly in dry air. Codeine is derived from opium by extraction or by the methylation of morphine. For medical use, codeine is usually offered as the dichlotide, phosphate, or sulfate. Codeine is habit forming. Codeine is known to exacerbate urticaria (familiarly known as hives). Since codeine is incorporated in numerous prescription medicines for headache, heartburn, fatigue, coughing, and relief of aches and pains, persons with a history of urticaria should make this fact known to their physician. Codeine is sometimes used ill cases of acute pericarditis to relieve severe chest pains in early phases of disease. Codeine is sometimes used in drug therapy of renal (kidney) diseases. 

ANCA-positive microscopic polyangiitis has been associated with propylthiouracil, with a fatal outcome despite treatment with glucocorticoids and cyclophosphamide (87). Another patient presented atypically with acute pericarditis 10 months after starting to take propylthiouracil 100 mg tds (88). Another patient developed ANCA-negative leukocytoclastic vasculitis of the skin (89). 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

The main dose-limiting toxicity of all anthracyclines is myelosuppression, with neutropenia more commonly observed than thrombocytopenia. In some cases, mucositis is dose-limiting. Two forms of cardiotoxicity are observed. The acute form occurs within the first 2-3 days and presents as arrhythmias or conduction abnormalities, other electrocardiographic changes, pericarditis, and myocarditis. This form is usually transient and is asymptomatic in most cases. The chronic form results in a dose-dependent, dilated cardiomyopathy associated with heart failure. The chronic cardiac toxicity appears to result from increased production of free radicals within the myocardium. This effect is rarely seen at total doxorubicin dosages below 500-550 mg/m2. Use of lower weekly doses or continuous infusions of doxorubicin appear to reduce the incidence of cardiac toxicity. In addition, treatment with the iron-chelating agent dexrazoxane (ICRF-187) is currently approved to prevent or reduce anthracycline-induced cardiotoxicity in women with metastatic breast cancer who have received a total cumulative dose of doxorubicin of 300 mg/m2. All anthracyclines can produce "radiation recall reaction," with erythema and desquamation of the skin observed at sites of prior radiation therapy. 

An increase in blood both in the sinusoids and in Disse s spaces culminates in hepatomegaly. This can be witnessed particularly in cases of right heart failure, constrictive pericarditis, veno-occlusive disease and the Budd-Chiari syndrome. Inflammation-related hyper-aemia also occurs in acute viral hepatitis. 

Acute pericarditis has been reported in a 17-year-old man with severe ulcerative colitis who had taken mesalazine 1.5 g/day for 2 weeks (25). The pericarditis resolved on withdrawal and recurred on rechaUenge with a low dose (62.5 mg) of mesalazine 3 weeks later. 

Ishikawa N, Imamura T, Nakajima K, Yamaga J, Yuchi H, Ootsuka M, Inatsu H, Aoki T, Eto T. Acute pericarditis associated with 5-aminosalicylic acid (5-ASA) treatment for severe active ulcerative colitis. Intern Med 2001 40(9) 901. ... 

A 50-year-old woman with chronic renal insufficiency treated with acetazolamide for simple glaucoma developed confusion, cerebellar ataxia, and metabolic acidosis 2 weeks after starting to take aspirin for acute pericarditis (30). A diagnosis of salicylism was made despite low serum salicylate concentrations. 

Cardiac glycosides are contraindicated in conditions in which there is obstruction to ventricular outflow, for example hypertrophic obstructive cardiomyopathy, constrictive pericarditis, and cardiac tamponade. Acute myocarditis may also increase the risk of toxicity. 

Boccara F, Benhaiem-Sigaux N, Cohen A. Acute myo-pericarditis after diphtheria, tetanus, and polio vaccination. Chest 2001 120(2) 671-2. 

Acute myocarditis after vaccination against smallpox has been reported (22). Fatal myocarditis is rare, but electrocardiographic evidence of myocarditis has been found more frequently this adverse effect is probably not always noticed (23-25). Pericarditis after smallpox vaccination has also been described (26). 

Price MA, Alpers JH. Acute pericarditis following smallpox vaccination. Papua N Guinea Med J 1968 11 30. 

Cautions Recent major surgery (Coronary artery bypass graft, OB delivery, organ biopsy), cerebrovascular disease, recent GI or GU bleeding, hypertension, mitral stenosis with atrial fibrillation, acute pericarditis, bacterial endocarditis, hepatic/renal impairment, diabetic retinopathy, ophthalmic hemorrhaging, septic thrombophlebitis, occluded AV cannula at an infected site, advanced age, those receiving oral anticoagulants... 

The changes of serum CK and its MB isoenzyme following a myocardial infarction are discussed in Chapter 44. Other cardiac conditions have been reported to increase serum CK and CK-MB in serum. These conditions include cardioversion, cardiopulmonary bypass and coronary artery bypass surgery, cardiac transplantation, myocarditis, pericarditis, and pulmonary embolism. Despite improvements, in the diagnostic performance and practicality of CK and CK-MB assays, there is no controlled cUnicai impact trial showing that these tests are effective for decisions to send a patient home or to the appropriate level of care of admission for patients with suspected acute cardiac ischemia, either as one-time or serial tests.For diagnosis of acute myocardial infarction, it is now advantageous to use more cardiac-specific nonenzymatic tests, such as cardiac troponin I orT. 

Acute pericarditis. (Usually with mild ST elevation ... 

Figure 4.13 More characteristic ST-segment elevation morphologies observed in patients with ischaemic heart disease (A) and other processes (B). Type A(1) to A(6) morphologies are suggestive of acute coronary syndrome type B ST-segment elevation in other processes B(1) early repolarisation B(2) normal variant in V1 B(3) pericarditis B(4) and B(5) Brugada s syndrome (B(4) is similar to A(6)...

In Table 4.3 the most frequent causes of ST-segment elevation, aside from IHD (typical and atypical ACS), are shown. At the time of making the differential diagnosis in clinical practice, out of all these different entities the possibility of a pericarditis or an early phase acute myopericarditis (Figures 4.48 and 4.49) should be kept in mind. These also cause chest pain that may complicate the diagnosis. 

Acute pericarditis in its early stage and myopericarditis (Figures 4.48 and 4.49)... 

Among the non-ischaemic cardiovascular causes of thoracic pain that should be ruled out, some present a benign prognosis as pericarditis, while others, in turn, point to a much serious prognosis, such as an acute aortic syndrome (dissecting aneurysm or other aortic pathologies) and a pulmonary embolism. On the whole, these account for 5-10% of all cases of thoracic pain. 

The most characteristic morphologies of ST-segment elevation in IHD and other situations are shown in Figure 4.13. The most important features that allow for differentiation of ACS from acute pericarditis, early repolarisation and dissecting aneurysm are given in Table 7.1. 

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