Subacute effusive constrictive epicarditis.

Rasaretnam, Rudra; Chanmugam, D.

doi:10.1136/hrt.44.1.44

Cited by 14 publications

(15 citation statements)

References 14 publications

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“…Epicarditis (inflammation of the visceral pericardium) is a unique and rare diagnosis. It is almost always associated with parietal pericardial involvement and occurs in medical conditions such as viral, bacterial (mycobacterial) infections and uremia or postoperatively in the setting of cardiac surgery 2,3 . Frequently, no etiology is found 2,4 .…”

Section: Management and Discussionmentioning

confidence: 99%

“…Frequently, no etiology is found 2,4 . Most cases are associated with constrictive physiology, and patients present with signs and symptoms of right‐sided heart failure 2–4 . Effusive epicarditis is often present, and the clinical features may easily be confused with those of pericardial effusion with tamponade 3 .…”

Section: Management and Discussionmentioning

confidence: 99%

“…Most cases are associated with constrictive physiology, and patients present with signs and symptoms of right‐sided heart failure 2–4 . Effusive epicarditis is often present, and the clinical features may easily be confused with those of pericardial effusion with tamponade 3 . To date, there have only been very few cases described of pure constrictive epicarditis and only one other case of epicarditis simulating a presentation of a right atrial mass 2,3,5,6 …”

Section: Management and Discussionmentioning

confidence: 99%

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Retracted: Isolated Subacute Effusive and Nonconstrictive Epicarditis Masquerading as a Right Atrial Mass

Suma¹,

Makaryus²,

Rascon

et al. 2009

Echocardiography

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Epicarditis (visceral pericardial inflammation) is a very unique and rare diagnosis. It is almost always associated with parietal pericardial involvement and may occur in medical conditions such as viral, bacterial (mycobacterial) infections and uremia or postoperatively in the setting of cardiac surgery. Frequently, no etiology is found. Most cases are associated with constrictive physiology, and patients present with symptoms and signs of right-sided heart failure. Effusive epicarditis is often present, and the clinical features may easily be confused with those of pericardial effusion with tamponade. We report a unique case of isolated subacute effusive and nonconstrictive epicarditis mimicking a right atrial mass in a 72-year-old patient who was diagnosed with nonmetastatic gastric adenocarcinoma. Our case is unique for several reasons: inflammation was limited to the epicardium (very few cases have been described to date); the patient was asymptomatic, with no clinical or echocardiographic evidence of constriction (this represents a novel finding, explained in part by the more limited extent of inflammation, with no significant fibrotic component and no parietal pericardial involvement); and this is the first report of epicarditis occurring in association with a malignancy, which we hypothesize may represent an inflammatory paraneoplastic process.

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Section: Management and Discussionmentioning

confidence: 99%

Section: Management and Discussionmentioning

confidence: 99%

Section: Management and Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Retracted: Isolated Subacute Effusive and Nonconstrictive Epicarditis Masquerading as a Right Atrial Mass

Suma¹,

Makaryus²,

Rascon

et al. 2009

Echocardiography

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“…Frequently, features more typical of tamponade may dominate early during the course, and a constrictive pattern may emerge later. A detailed consideration of these syndromes is beyond the scope of this review [23,24]. Suffice it to say that interpretation of the hemodynamic alteration is often challenging [25].…”

Section: Pericardial Hemodynamicsmentioning

confidence: 95%

Pericardial Disease in the Intensive Care Setting

Thomas

LeWinter

1987

J Intensive Care Med

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Pericardial disease commonly occurs in the intensive care setting, but its timely diagnosis may be missed. The normal pericardium serves as a lubricated sac within which the heart may beat with minimal friction. The effect of the pericardium on cardiac filling at normal diastolic pressures is not clear; however, it may limit cardiac dilation in states of acute volume overload such as mitral regurgitation and right ventricular infarction. Pericardial disease may be divided into two catego ries : those cases that result from inflammation of the pericardium (pericarditis), and those cases in which a pericardial effusion or the thickened pericardium itself causes hemodynamic changes (tamponade and constric tion). Simple pericarditis should not lead to any hemo dynamic alteration other than tachycardia. In both tam ponade and constriction, the jugular venous pressure is elevated with low forward cardiac output; tamponade typically shows pulsus paradoxus, whereas constric tion more frequently shows Kussmaul's sign. The electrocardiogram may show diffuse ST segment elevation with PR segment depression in pericarditis; a large pericardial effusion, even with early tamponade, may not by itself cause any changes in the electrocar diogram. The echocardiogram is invaluable in diagnos ing the presence of a pericardial effusion and recogniz ing tamponade physiology (diastolic collapse of the right ventricular outflow tract and invagination of the right atrium). In selected patients, simple pericarditis may be managed outside of the hospital. Anyone suspected of having a hemodynamically significant pericardial effu sion should be hospitalized, usually in an intensive care unit. Pericardiocentesis should be performed under op timal monitoring conditions, although in an emergency, blind pericardiocentesis may be attempted. Recognition of the cause of the pericardial process will guide its treatment. Management of selected pericardial syn dromes is discussed later in this review.

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“…However, the natural course of effusive‐constrictive pericarditis is to evolve into a pure chronic constrictive pericarditis, and, although somewhat uncommon, can progress to infiltrate the myocardium. When this occurs, gradual dissection of the visceral pericardium is even more difficult and can further impair cardiac function 10 . Any identifiable underlying cause should be appropriately treated, which may include antibiotics for infectious diseases, immune modulating therapy for rheumatologic conditions, and chemotherapy, radiation, or surgery for neoplasm.…”

Section: Commentsmentioning

confidence: 99%

A 63‐Year‐Old Woman with a Pericardial Effusion, Bilateral Pleural Effusions, and Ascites: Is the Whole Greater than the Sum of Its Parts?

Sparano¹,

Kohli²,

Gulati

2010

Echocardiography

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A 63-year-old female presented with dyspnea, leg edema, and abdominal distention. Exam revealed blood pressure of 104/58, pulse 108/min, jugular venous pressure of 8 cm, no pulsus paradoxus, a pericardial rub, muffled heart sounds, decreased basilar breath sounds, ascites, and ankle edema. Electrocardiogram showed low voltage. Imaging revealed thickened pericardium and a pericardial effusion. Hemodynamic tracings postpericardiocentesis revealed elevated right-sided pressures. The patient was diagnosed with effusive constrictive pericarditis. The case and review of this condition are described. Patients with a pericardial effusion and symptoms unresponsive to pericardiocentesis or with pericardial thickening should undergo evaluation for effusive-constrictive pericarditis.

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Subacute effusive constrictive epicarditis.

Cited by 14 publications

References 14 publications

Retracted: Isolated Subacute Effusive and Nonconstrictive Epicarditis Masquerading as a Right Atrial Mass

Retracted: Isolated Subacute Effusive and Nonconstrictive Epicarditis Masquerading as a Right Atrial Mass

Pericardial Disease in the Intensive Care Setting

A 63‐Year‐Old Woman with a Pericardial Effusion, Bilateral Pleural Effusions, and Ascites: Is the Whole Greater than the Sum of Its Parts?

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