出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2013/09/30 10:39:15」(JST)
Postpericardiotomy syndrome | |
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Classification and external resources | |
ICD-9 | 429.4 |
eMedicine | article/891471 |
Postpericardiotomy syndrome (PPS) is a medical syndrome referring to an immune phenomenon that occurs days to months (usually 1–6 weeks[1]) after surgical incision of the pericardium (membranes encapsulating the human heart).[2] PPS can also be caused after a trauma, a puncture of the cardiac or pleural structures (such as a bullet or stab wound), after percutaneous coronary intervention (such as stent placement after a myocardial infarction or heart attack), or due to pacemaker or pacemaker wire placement.[1]
The typical signs of post-pericartiotomy syndrome include fever, pleuritis (with possible pleural effusion), pericarditis (with possible pericardial effusion), occasional but rare pulmonary infiltrates, and fatigue.[1][2] Cough, pleuritic or retrosternal chest pain, and decreased oxygen saturation can also be seen in some cases.[1]
During medical doctor examination,a pericardial friction rub can be auscultated indicating precarditis. Auscultation of the lungs can show crackles indicating pulmonary infiltration, and there can be retrosternal/pleuritic chest pain worse on inspiration (breathing in). Patient can also depict sweating (diaphoresis) and agitation or anxiety.
A chest X-ray might depict pleural effusion, pulmonary infiltration, or pericardial effusion.[2]
This condition is a febrile illness caused by immune attack of the pleura and the pericardium. Possible cell mediated immunity led by Helper T-cells and Cytotoxic T-cells is postulated to be important in the pathogenesis of this condition.[1] There is also possibility of anti-cardiac antibodies created idiopathically, or due to concurrent cross-reactivity of the antibodies produced against viral antigens, however the latter assumption is not fool-proof or completely reliable due to conflicting studies.[1]
Uncommon in children and often common in patients receiving cardiac operations that involves opening the pericardium.[1] CABG surgery is a common culprit.
Complications include pericarditis, pericardial effusion, pericardial tamponade, pleuritis, and pulmonary infiltration. Of these cardiac tamponade is the most life threatening complication. The pericardial fluid increases intra-pericardial pressure therefore preventing complete expansion of the atria and the ventricles upon the diastole. This causes equilibration of the pressure in all four heart chambers, and results in the common findings of the tamponade which are pulsus paradoxus, Beck's triad of hypotension, muffled heart sounds, and JVD, as well as EKG or Holter monitor findings such as electrical alternans. Physically the patients who progress to severe pericardial tamponade obtundate, become mentally altered, and lethargic. If left untreated, severe cardiac output decrease, vascular collapse, and hypoperfusion of body including the brain results in death.
Avoidance of injurious procedures is the only sure way to avoid this syndrome, however PPS by itself it not an indication of the quality of an operation. The mere opening of the pericardium in any form of cardiac operation is enough to cause this syndrome. Post-surgical obeservation and astute patient-physician relationship are great tools to identify the syndome before it progresses to complications such as tamponade.
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リンク元 | 「心筋梗塞後症候群」「心膜切開後症候群」 |
関連記事 | 「syndrome」 |
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