fibrinous pericarditis

線維素性心膜炎

WordNet

1. characterized by the presence of fibrin
2. inflammation of the pericardium

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/12/10 11:02:59」(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; within 24-hours or if weeks-months after: Dressler's syndrome's).

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. Acute myocardial infarction (heart attack) can also cause pericarditis, but the presenting symptoms often differ enough to warrant 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 alternans 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

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• 1. 急性心膜炎の臨床症状および診断的評価 clinical presentation and diagnostic evaluation of acute pericarditis
• 2. 化膿性心膜炎 purulent pericarditis
• 3. 悪性腫瘍に対する放射線療法の心毒性 cardiotoxicity of radiation therapy for malignancy
• 4. 成人における全身性エリテマトーデスの冠動脈疾患以外の心症状 non coronary cardiac manifestations of systemic lupus erythematosus in adults
• 5. 成人における胸水の診断的評価：病因未確定に対する追加検査 diagnostic evaluation of pleural effusion in adults additional tests for undetermined etiology

English Journal

• Pericarditis mediated by respiratory syncytial virus in a hematopoietic stem cell transplant patient.

• Rubach MP, Pavlisko EN, Perfect JR.SourceDepartment of Medicine, Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA.
• Transplant infectious disease : an official journal of the Transplantation Society.Transpl Infect Dis.2013 Aug;15(4):E152-6. doi: 10.1111/tid.12099. Epub 2013 Jun 3.
• We describe a case of pericarditis and large pericardial effusion in a 63-year-old African-American man undergoing autologous hematopoietic stem cell transplant for multiple myeloma. Pericardial tissue biopsy demonstrated fibrinous pericarditis, and immunohistochemistry stains were positive for resp
• PMID 23725410

• New development of cardiac tamponade on underlying effusive-constrictive pericarditis: an uncommon initial presentation of scleroderma.

• Subramanian SR, Akram R, Velayati A, Chadow H.SourceDepartment of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA.
• BMJ case reports.BMJ Case Rep.2013 Jul 12;2013. pii: bcr2013010254. doi: 10.1136/bcr-2013-010254.
• A 40-year-old man with a medical history of hypertension was admitted for weight loss, generalised weakness, joint pains and mottling of fingertips. The initial laboratory data revealed microangiopathic haemolytic anaemia, thrombocytopenia and acute renal failure. Intravenous steroids were started f
• PMID 23853085

• Riemerella anatipestifer outbreaks in commercial goose flocks and identification of isolates by MALDI-TOF mass spectrometry.

• Hess C, Enichlmayr H, Jandreski-Cvetkovic D, Liebhart D, Bilic I, Hess M.SourceDepartment for Farm Animals and Veterinary Public Health, Clinic for Avian, Reptile and Fish Medicine, University of Veterinary Medicine Vienna, Veterinaerplatz 1, 1210 Vienna, Austria. claudia.hess@vetmeduni.ac.at
• Avian pathology : journal of the W.V.P.A.Avian Pathol.2013 Apr;42(2):151-6. doi: 10.1080/03079457.2013.775401.
• Several outbreaks of Riemerella anatipestifer in commercial geese occurred within a short time period. A serious disease was recognized in the affected birds, mainly characterized by depression and severe neurologic disturbances. The morbidity ranged from 20 to 30% and the mortality from 5 to 20%. G
• PMID 23581442

Japanese Journal

• 急性線維素性心膜炎の病態を呈した降下性壊死性縦隔炎の1例

• 松浦 陽介,渡 正伸
• 日本呼吸器外科学会雑誌 = The journal of the Japanese Association for Chest Surgery 25(2), 182-186, 2011-03-15
• 降下性壊死性縦隔炎（DNM）は口腔や咽喉頭周囲に生じた感染が，気管支周囲の疎性結合組織に波及し，縦隔に下降して生じる縦隔炎で，救命のためには早期診断・治療が必須の疾患である．症例は59歳，女性．扁桃炎の加療中，心不全症状と不明熱が認められるようになった．この時点で初めて全身CTが施行され，DNMと診断された．胸腔鏡下に縦隔ドレナージおよび心膜開窓術を施行し救命し得た．術中所見では，抗生剤が奏効し縦 …
• NAID 10027955345

• 緑膿菌によるブロイラーひなの線維素化膿性心膜炎

• 片岡 那津見
• 鶏病研究会報 46(2), 112, 2010-08-25
• NAID 10026603219

Related Links

• Fibrinous pericarditis | Define Fibrinous pericarditis at ...

Medical Dictionary fibrinous pericarditis n. Acute pericarditis accompanied by fibrinous exudate on the serous membrane. Also called hairy heart. The American Heritage® Stedman's Medical Dictionary Copyright © 2002, 2001, 1995 ...

• fibrinous pericarditis - definition of fibrinous pericarditis in the ...

pericarditis /peri·car·di·tis/ (-kahr-di´tis) inflammation of the pericardium.pericardit´ic adhesive pericarditis a condition due to the presence of dense fibrous tissue between the parietal and visceral layers of the pericardium. constrictive ...

Related Pictures

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★リンクテーブル★

リンク元	「線維素性心膜炎」
関連記事	「fibrinous」

「線維素性心膜炎」

　　[★]

英

fibrinous pericarditis

同

乾性心膜炎 dry pericarditis、serofibrinous pericarditis

関

[[]]

friction rub

• 尿毒症、全身性エリテマトーデスでfibrinous pericarditisを伴う

diffuse fibrinous pericarditis is more typical of systemic conditions such as uremia or SLE, whereas focal pericarditis may overlie a transmural MI(Dressler syndrome)

「fibrinous」

　　[★]

• adj.

• フィブリン性の、繊維素性の