Pericardial syndromes: an update after the ESC guidelines 2004
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- 作者：Petar M. Seferovi? (1)
Arsen D. Risti? (1)
Ru?ica Maksimovi? (2)
Dejan S. Simeunovi? (1)
Ivan Milinkovi? (1)
Jelena P. Seferovi? Mitrovi? (1)
Vladimir Kanjuh (1)
Sabine Pankuweit (3)
Bernhard Maisch (3) - 关键词：Pericardial syndromes ; Acute pericarditis ; Pericardial effusion ; Cardiac tamponade ; Recurrent pericarditis ; Constrictive pericarditis
- 刊名：Heart Failure Reviews
- 出版年：2013
- 出版时间：May 2013
- 年：2013
- 卷：18
- 期：3
- 页码：255-266
- 全文大小：617KB
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Arsen D. Risti? (1)
Ru?ica Maksimovi? (2)
Dejan S. Simeunovi? (1)
Ivan Milinkovi? (1)
Jelena P. Seferovi? Mitrovi? (1)
Vladimir Kanjuh (1)
Sabine Pankuweit (3)
Bernhard Maisch (3)
1. Department of Cardiology, Clinical Center of Serbia and Belgrade University School of Medicine, Koste Todorovi?a 8, 11000, Belgrade, Serbia
2. Department of Radiology, Clinical Center of Serbia and Belgrade University School of Medicine, Belgrade, Serbia
3. Department of Internal Medicine-Cardiology, Faculty of Medicine, Philipps University, UKGM GmbH, Marburg, Germany - ISSN：1573-7322
文摘
Despite a myriad of causes, pericardial diseases present in few clinical syndromes. Acute pericarditis should be differentiated from aortic dissection, myocardial infarction, pneumonia/pleuritis, pulmonary embolism, pneumothorax, costochondritis, gastroesophageal reflux/neoplasm, and herpes zoster. High-risk features indicating hospitalization are: fever >38?°C, subacute onset, large effusion/tamponade, failure of non-steroidal anti-inflammatory drugs (NSAIDs), previous immunosuppression, trauma, anticoagulation, neoplasm, and myopericarditis. Treatment comprises 10-4-days NSAID plus 3?months colchicine (2?×?0.5?mg; 1?×?0.5?mg in patients <70?kg). Corticosteroids are avoided, except for autoimmunity, as they facilitate the recurrences. Echo-guided pericardiocentesis (±fluoroscopy) is indicated for tamponade and effusions >2?cm. Smaller effusions are drained if neoplastic, purulent or tuberculous etiology is suspected. In recurrent pericarditis, repeated testing for autoimmune and thyroid disease is appropriate. Pericardioscopy and pericardial/epicardial biopsy may clarify the etiology. Familial clustering was recently associated with tumor necrosis factor receptor-associated periodic syndrome (TNFRSF1A gene mutation). Treatment includes 10-4?days NSAIDs with colchicine 0.5?mg bid for up to 6?months. In non-responders, low-dose steroids, intrapericardial steroids, azathioprine, and cyclophosphamide can be tried. Successful management with interleukin-1 receptor antagonist (anakinra) was recently reported. Pericardiectomy remains the last option in >2?years severely symptomatic patients. In constriction, expansion of the heart is impaired by the rigid, chronically inflamed/thickened pericardium (no thickening ~20?%). Chest radiography, echocardiography, computerized tomography, magnetic resonance imaging, hemodynamics, and endomyocardial biopsy indicate the diagnosis. Pericardiectomy is the only treatment for permanent constriction. Predictors of poor survival are prior radiation, renal dysfunction, high pulmonary artery pressures, poor left ventricular function, hyponatremia, age, and simultaneous HIV and tuberculous infection.