1/11. The postpericardiotomy syndrome as a cause of pleurisy in rehabilitation patients.Pleuritic chest pain in patients on a rehabilitation unit may be caused by several conditions. We report 2 cases of postpericardiotomy syndrome (PPS) as a cause of pleuritic pain. PPS occurs in 10% to 40% of patients who have coronary bypass or valve replacement surgery. The syndrome is characterized by fever, chest pain, and a pericardial or pleural friction rub. Its etiology is believed to be viral or immunologic. The syndrome can be a diagnostic challenge, and an increase in length of hospitalization because of it has been documented. Identified risk factors for PPS include age, use of prednisone, and a history of pericarditis. A higher incidence has been reported from May through July. Many patients undergo a battery of expensive procedures before PPS is diagnosed. The pain is sharp, associated with deep inspiration, and changes with position. Pleural effusions may be present and tend to occur bilaterally. Pericardial effusions are a documented complication. A pericardial or pleural rub may be present and is often transient. Serial auscultation is important. Laboratory work provides clues with a mild leukocytosis and an elevated erythrocyte sedimentation rate. However, this does not provide the definitive diagnosis. Cardiac enzymes are not reliably related to the syndrome. An electrocardiogram will show changes similar to those associated with pericarditis. The patient may have a fever, but it is rarely higher than 102.5 degrees F. Complications include pericardial effusions, arrhythmias, premature bypass graft closure, and cardiac tamponade. Treatment consists of a 10-day course of nonsteroidal anti-inflammatory drugs.- - - - - - - - - - ranking = 1keywords = pericarditis (Clic here for more details about this article) |
2/11. Probable postcardiotomy syndrome following implantation of a transvenous pacemaker: report of the first case.The syndrome of fever and pericarditis is reported following implantation of a transvenous pacemaker in a 72-year-old man. The pacemaker was placed for prophylactic reasons (i.e., presence of bifascicular block). The syndrome resolved spontaneously after over four weeks of fever and a pericardial friction rub. Perforation of the right ventricle, although not recognized in this patient, is a complication which occurs with passage of a transvenous pacemaker. There was no other antecedent events to explain the syndrome such as myocardial infarction or trauma to the chest.- - - - - - - - - - ranking = 0.5keywords = pericarditis (Clic here for more details about this article) |
3/11. The postcardiac injury syndrome: case report and review of the literature.The postcardiac injury syndrome (PCIS) includes the postmyocardial infarction syndrome, the postcommissurotomy syndrome, and the postpericardiotomy syndrome. Dressler reported a series of patients who developed a pericarditis-like illness days to weeks after a myocardial infarction. Postcardiac injury syndrome also has been observed after cardiac surgery, percutaneous intervention, pacemaker implantation, and radiofrequency ablation. Postcardiac injury syndrome is characterized by pleuritic chest pain, low-grade fever, an abnormal chest x-ray, and the presence of exudative pericardial and/or pleural effusions. The pathophysiology of PCIS involves auto-antibodies that target antigens exposed after damage to cardiac tissue. The treatment of PCIS includes the use of nonsteroidal anti-inflammatory drugs and corticosteroids. Prophylactic use of corticosteroids before cardiac surgery has not been effective in preventing PCIS. The widespread use of reperfusion therapy and cardiac medications with anti-inflammatory properties may have reduced the incidence of PCIS. Although PCIS can follow a relapsing course, it does carry a favorable prognosis.- - - - - - - - - - ranking = 0.5keywords = pericarditis (Clic here for more details about this article) |
4/11. Pseudo-myocardial infarction pattern after aortocoronary saphenous vein bypass graft surgery. A case report.In a 51-year-old medical colleague with symptomatic atherosclerotic coronary artery disease, coronary arteriography delineated significant left mainstem, left anterior descending and left circumflex coronary artery lesions and cine angiography demonstrated normal left ventricular contractility. Aortocoronary saphenous vein bypass grafting was successful. The postoperative appearance of QS waves on the ECG suggested the possible complication of an acute transmural anteroseptal and anterolateral myocardial infarction (MI). However, this possibility was excluded by resting technetium-99m and thallium-201 scintiscans, as well as by a technetium-99m-gated blood pool scintiscan. The occurrence of acute pericarditis approximately 2 weeks after surgery made clinical evaluation more difficult. The ECG may represent a pseudo-MI pattern, the patient having suffered a post-pericardiotomy syndrome. The importance of excluding postoperative acute MI is stressed. The causes of the appearance of new Q waves after aortocoronary saphenous vein bypass graft surgery are briefly outlined.- - - - - - - - - - ranking = 0.5keywords = pericarditis (Clic here for more details about this article) |
5/11. The post-pericardiotomy syndrome and penetrating injury of the chest.The post-pericardiotomy syndrome is an uncommon complication of chest trauma. We present a case of recurrent pleural and pericardial effusions, pyrexia, pain in the chest and ECG changes of pericarditis in a young man with a penetrating chest injury.- - - - - - - - - - ranking = 0.5keywords = pericarditis (Clic here for more details about this article) |
6/11. Pericardial complications in hepatic trauma.During a 5-year period, 35 of 70 patients with liver trauma required entry of the thoracic cavity, with nine deaths. Pericardial complications developed in four of the nine survivors who had both thoracic and abdominal incisions. Two patients resolved their problems (postpericardiotomy syndrome, late pericarditis) with medical therapy. One patient required emergency thoracotomy for pericardial tamponade, and one patient developed constrictive pericarditis that required pericardiectomy. Available data support closure of the pericardium after pericardiotomy. Thoracic extension of abdominal incisions is often necessary. Pericardial complications may occur with hepatic trauma in the early or late postoperative periods and are potentially fatal.- - - - - - - - - - ranking = 1keywords = pericarditis (Clic here for more details about this article) |
7/11. Constrictive pericarditis following cardiac surgery.Five patients with constriction secondary to pericarditis or membrane formation following cardiac surgical procedures are reported. In 4 of the 5 patients, a postpericardiotomy syndrome developed after the original procedure. constriction occurred from ten weeks to almost 6 years after the cardiac operation. Clinicians should watch carefully for the delayed onset of constriction in patients with a postpericardiotomy syndrome after cardiac operation.- - - - - - - - - - ranking = 2.5keywords = pericarditis (Clic here for more details about this article) |
8/11. Unusual complications of epicardial pacemakers. Recurrent pericarditis, cardiac tamponade and pericardial constriction.Three patients with unusual complications after insertion of an epicardial pacemaker are described. In one patient pericarditis and severe cardiac tamponade developed that required emergency pericardiocentesis 8 weeks after pacemaker insertion. No evidence of myocardial perforation was observed at operation. In another patient two unusual complications developed: (1) migration of the pulse generator from the epigastric site of implantation into the pelvis, and (2) recurrent pericarditis with occult signs of constriction. In another patient recurrent pericarditis and clinical evidence of constriction developed. All three patients required pericardiectomy. Recurrent pericarditis after insertion of an epicardial pacemaker requires careful medical follow-up because either life-threatening tamponade or chronic constrictive pericarditis may develop.- - - - - - - - - - ranking = 4.5keywords = pericarditis (Clic here for more details about this article) |
9/11. postpericardiotomy syndrome: its diagnosis and treatment after muscle flap closure of an infected sternal wound.After nearly any form of cardiac surgery, an acute febrile illness characterized by leukocytosis, pericarditis with pericardial effusion, and pleural effusion may occur. In some instances, this postpericardiotomy syndrome may suggest the presence of mediastinal infection. Treatment of postpericardiotomy syndrome is conservative, and symptoms typically resolve with nonsteroidal antiinflammatory medication. We report a case of postpericardiotomy syndrome that mimicked recurrent mediastinal infection and developed after muscle flap closure of an infected sternal wound. Pericardial, pleural, and periflap fluid accumulated postmuscle flap closure and was sterile on culture. A diagnosis of postpericardiotomy syndrome was made, and the patient improved while receiving oral indomethacin. She has remained free of infection as of the 2-year follow-up.- - - - - - - - - - ranking = 0.5keywords = pericarditis (Clic here for more details about this article) |
10/11. Pericardial color Doppler flow in postpericardiotomy effusive constrictive pericarditis.A laminar color Doppler flow was discovered in the pericardial space in a 35-year-old man with postpericardiotomy effusive constrictive pericarditis. The flow was detected by transesophageal color Doppler echocardiography. A further pulsed Doppler study revealed a to-and-fro flow, which was synchronized with the cardiac rhythm. We hypothesized that this flow was generated by the rhythmic cardiac contraction. It was then augmented by hard fibrous pericardium and became detectable by color Doppler echocardiography. pericardial effusion is a frequent echocardiographic finding but little attention has been paid to the flow in it. The laminar flow in the pericardial space in our patient is related to his hard pericardium and can aid in making the diagnosis of effusive constrictive pericarditis. We suggest that flow in the pericardial space deserves more attention and may provide valuable diagnostic aid.- - - - - - - - - - ranking = 3keywords = pericarditis (Clic here for more details about this article) |
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