viral pericarditis

ウイルス性心膜炎

WordNet

1. relating to or caused by a virus; "viral infection"
2. inflammation of the pericardium

PrepTutorEJDIC

1. ウィルスの;ウィルスが原因の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/06/01 13:13:15」(JST)

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Pericarditis
Classification and external resources
An ECG showing pericarditis. Note the ST elevation in multiple leads with slight reciprocal ST depression in aVR.
ICD-10	I01.0, I09.2, I30-I32
ICD-9	420.0, 420.90, 420.91, 420.99, 423.1, 423.2
DiseasesDB	9820
MedlinePlus	000182
eMedicine	med/1781 emerg/412
MeSH	D010493

An ECG showing pericarditis.

Pericarditis is an inflammation of the pericardium (the fibrous sac surrounding the heart). A characteristic chest pain is often present.

The causes of pericarditis are varied, including viral infections of the pericardium, idiopathic causes, uremic pericarditis, bacterial infections of the pericardium (e.g., Mycobacterium tuberculosis), post-infarct pericarditis (pericarditis due to heart attack), or Dressler's pericarditis.

Classification

Pericarditis can be classified according to the composition of the inflammatory exudate or in other words the composition of the fluid that accumulates around the heart.

Types include:

• serous
• purulent
• fibrinous
• caseous
• hemorrhagic
• Post infarction

Acute vs. chronic

Depending on the time of presentation and duration, pericarditis is divided into "acute" and "chronic" forms. Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or even as a result of a heart attack (myocardial infarction). Chronic pericarditis however is less common, a form of which is constrictive pericarditis. The following is the clinical classification of acute vs. chronic:

• Clinically: Acute (<6 weeks), Subacute (6 weeks to 6 months) and Chronic (>6 months)

Signs and symptoms

Substernal or left precordial pleuritic chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back), which is relieved by sitting up and bending forward and worsened by lying down (recumbent or supine position) or inspiration (taking a breath in), is the characteristic pain of pericarditis. The pain may resemble the pain of angina pectoris or heart attack, but differs in that pain changes with body position, as opposed to heart attack pain that is pressure-like, and constant with radiation to the left arm and/or the jaw. Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety. Due to similarity to myocardial infarction (heart attack) pain, pericarditis can be misdiagnosed as an acute myocardial infarction (a heart attack) solely based on the clinical data and so extreme suspicion on the part of the diagnostician is required. Ironically an acute myocardial infarction (heart attack) can also cause pericarditis, but often the presenting symptoms vary enough to warrant a diagnosis. The following table organises the clinical presentation of pericarditis:

Characteristic/Parameter	Pericarditis	Myocardial infarction
Pain description	Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain	Crushing, pressure-like, heavy pain. Described as "elephant on the chest."
Radiation	Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation.	Pain radiates to the jaw, or the left or arm, or does not radiate.
Exertion	Does not change the pain	Can increase the pain
Position	Pain is worse in the supine position or upon inspiration (breathing in)	Not positional
Onset/duration	Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER	Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER

Physical examinations

The classic sign of pericarditis is a friction rub auscultated on the cardiovascular examination usually on the lower left sternal border. Other physical signs include a patient in distress, positional chest pain, diaphoresis (excessive sweating), and possibility of heart failure in form of precardial tamponade causing pulsus paradoxus, and the Beck's triad of hypotension (due to decreased cardiac output), distant (muffled) heart sounds, and JVD (jugular vein distention).

Acute complications

Pericarditis can progress to pericardial effusion and eventually cardiac tamponade. This can be seen in patients who are experiencing the classic signs of pericarditis but then show signs of relief, and progress to show signs of cardiac tamponade which include decreased alertness and lethargy, pulsus paradoxus (decrease of at least 10 mmHg of the systolic blood pressure upon inspiration), hypotension (due to decreased cardiac index), JVD (jugular vein distention from right sided heart failure and fluid overload), distant heart sounds on auscultation, and equilibration of all the diastolic blood pressures on cardiac catheterization due to the constriction of the pericardium by the fluid.

In such cases of cardiac tamponade, EKG or Holter monitor will then depict electrical alterans indicating wobbling of the heart in the fluid filled pericardium, and the capillary refill might decrease, as well as severe vascular collapse and altered mental status due to hypoperfusion of body organs by a heart that can not pump out blood effectively.

The diagnostic test for cardiac tamponade, is trans-esophageal echocardiography (TEE) although trans-thoracic echocardiography (TTE) can also be utilized in cases where there is a high suspicion of aortic dissection and high blood pressure, or in patients where esophageal probing is not feasible. Chest X-ray can depict a "water bottle" appearance of the heart in tamponade, although chest X-ray is not specific enough neither is it accurate enough in the acute setting. Of note is the fact that chest X-ray can be entirely normal in acute pericardial effusion/tamponade, so should not be relied upon as the sole diagnostic tool.

Causes

Infectious

Pericarditis may be caused by viral, bacterial, or fungal infection. The most common viral pathogen has traditionally been considered to be coxsackievirus based on studies in children from the 1960s, but recent data suggest that adults are most commonly affected with cytomegalovirus, herpesvirus, and HIV. Pneumococcus or tuberculous pericarditis are the most common bacterial forms. Anaerobic bacteria can also be rare cause. Fungal pericarditis is usually due to histoplasmosis, or in immunocompromised hosts Aspergillus, Candida, and Coccidioides. The most common worldwide cause of pericarditis is infectious pericarditis with Tuberculosis.

Other

• Idiopathic: No identifiable etiology found after routine testing.
• Immunologic conditions including systemic lupus erythematosus (more common among women) or rheumatic fever
• Myocardial Infarction (Dressler's syndrome)
• Trauma to the heart, e.g. puncture, resulting in infection or inflammation
• Uremia (uremic pericarditis)
• Malignancy (as a paraneoplastic phenomenon)
• Side effect of some medications, e.g. isoniazid, cyclosporine, hydralazine, warfarin, and heparin
• Radiation induced
• Aortic dissection
• Tetracyclines
• Postpericardiotomy syndrome: Usually after CABG surgery

Diagnosis

Laboratory tests

This diagram depicts the elevation of respective cardiac markers in a myocardial infarction (heart attack). Although this diagram is only for heart attack, elevated values of these markers might be seen in pericarditis.

Laboratory values can show increased urea (BUN), or increased blood creatinine in cases of uremic pericarditis. Generally however, laboratory values are normal, but if there is a concurrent myocardial infarction (heart attack) or great stress to the heart, laboratory values may show increased cardiac markers like Troponin (I, T), CK-MB, Myoglobin, and LDH1 (Lactase Dehydrogenase isotype 1). The preferred initial diagnostic testing is the EKG which will show a 12-lead electrocardiogram with diffuse, non-specific, concave, ST segment-elevations all leads except aVR and V1 and PR segment-depression possible in any lead except aVR; sinus tachycardia, and low-voltage QRS complexes can also be seen if there is subsymptomatic levels of pericardial effusion.

Since the mid-19th Century, retrospective diagnosis of pericarditis has been made upon the finding of adhesions of the pericardium. When pericarditis is diagnosed clinically, the underlying cause is often never known; it may be discovered in only 16 to 22 percent of patients with acute pericarditis.

Imaging

• Ultrasounds showing a pericardial effusion in someone with pericarditis

• A pericardial effusion as seen on CXR in someone with pericarditis

Treatment

The treatment in viral or idiopathic pericarditis is with Aspirin, or non-steroidal anti-inflammatory drugs (NSAIDs such as naproxen). Severe cases may require:

• pericardiocentesis to treat pericardial effusion/tamponade
• antibiotics to treat tuberculosis or other bacterial causes.
• steroids are used in acute pericarditis but are not favored because they increase the chance of recurrent pericarditis.
• colchicine is a very effective treatment option. If Aspirin and NSAIDs are not sufficient, colchicine should be added to the regimen.
• in rare cases, surgery
• in cases of constrictive pericarditis, pericardectomy

References

General References

• Troughton RW, Asher CR, Klein AL (February 2004). "Pericarditis". Lancet 363 (9410): 717–27. DOI:10.1016/S0140-6736(04)15648-1. PMID 15001332. http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(04)15648-1. 
• Maisch B, Seferović PM, Ristić AD, et al. (April 2004). "Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology". Eur. Heart J. 25 (7): 587–610. DOI:10.1016/j.ehj.2004.02.002. PMID 15120056. http://eurheartj.oxfordjournals.org/cgi/content/full/25/7/587. 

External links

• Pericarditis — Cleveland Clinic
• Pericarditis — National Library of Medicine
• Pericarditis — National Heart Lung Blood Institute

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 心膜疾患の病因 etiology of pericardial disease
• 2. 急性心膜炎の治療 treatment of acute pericarditis
• 3. Acute pericarditis: Clinical presentation and diagnostic evaluation
• 4. 化膿性心膜炎 purulent pericarditis
• 5. 心嚢液貯留の診断および治療 diagnosis and treatment of pericardial effusion

English Journal

• Patterns of cardiovascular disease in a group of HIV-infected adults in Yaoundé, Cameroon.

• Menanga AP1, Ngomseu CK1, Jingi AM1, Mfangam BM1, Noubiap JJ1, Gweth MN1, Blackett KN1, Kingue S1.
• Cardiovascular diagnosis and therapy.Cardiovasc Diagn Ther.2015 Dec;5(6):420-7. doi: 10.3978/j.issn.2223-3652.2015.08.04.
• BACKGROUND: Cardiovascular disease is an increasingly important issue in human immunodeficiency viral (HIV)-infected individuals. There is dearth of information on the patterns of cardiovascular disease especially in sub-Saharan Africa (SSA) patients. This study reports on the clinical, biological,
• PMID 26675421

• Characteristics, Complications, and Treatment of Acute Pericarditis.

• Kloos JA1.
• Critical care nursing clinics of North America.Crit Care Nurs Clin North Am.2015 Dec;27(4):483-97. doi: 10.1016/j.cnc.2015.08.001. Epub 2015 Sep 26.
• Acute pericarditis occurs most frequently after a viral attack. Other causes are autoimmune conditions, infection, chest trauma, cardiac surgery, or cardiac procedure. The presenting symptom is retrosternal chest pain. A pericardial rub is characteristic. Diffuse upward sloping ST segments are found
• PMID 26567493

• Acute renal failure during immediate post transplant period due to a pericardial effusion.

• Weerakkody RM1, Lokuliyana PN2, Sheriff MH3.
• BMC research notes.BMC Res Notes.2015 Oct 20;8:587. doi: 10.1186/s13104-015-1571-4.
• BACKGROUND: Pericardial effusions and acute renal failure are common findings in clinical practice. However, acute renal failure resulting from pericardial effusions (without tamponade) is a rare finding. We report the first such case to occur in a transplanted kidney.CASE PRESENTATION: A 20-year-ol
• PMID 26486858

Japanese Journal

• 結膜炎を初発症状とし, 経過中に心膜・心筋炎を併発した劇症1型糖尿病の1例

• 糖尿病 53(3), 180-186, 2010-03-30
• NAID 10026317689

• Constrictive Pericarditis

• Circulation journal : official journal of the Japanese Circulation Society 72(10), 1555-1562, 2008-09-20
• NAID 110006935592

• Epstein Barr Virus (EBV) and Acute Myopericarditis in an Immunocompetent Patient: First Demonstrated Case and Discussion

• Internal Medicine 47(7), 627-629, 2008
• NAID 130000080064

Related Links

• Pediatric Infective Pericarditis - Diseases & Conditions ...

Pediatric Infective Pericarditis. Bacterial, fungal, and viral infections may involve the pericardium (pericarditis), although viral pericarditis is more common than bacterial pericarditis in both children and adults. ... Bacterial ...

• viral pericarditis - definition of viral pericarditis by Medical ...

vi·ral per·i·car·di·tis pericarditis due to a viral infection. ... Disclaimer All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only.

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★リンクテーブル★

リンク元	「ウイルス性心膜炎」
拡張検索	「nonviral pericarditis」
関連記事	「viral」

「ウイルス性心膜炎」

　　[★]

英

viral pericarditis

関

急性心膜炎、心膜炎

「nonviral pericarditis」

　　[★] 非ウイルス性心膜炎

「viral」

　　[★]

• adj.

• ウイルス性の、ウイルスの

関

virally、virogenic、virus