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| __NOTOC__ | | __NOTOC__ |
| {{Pericarditis}} | | {{HIV induced pericarditis}} |
| | '''For patient information, click [[HIV induced pericarditis (patient information)|here]]''' |
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| {{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | | {{CMG}}; {{AE}} {{RG}} |
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| ==Overview==
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| A wide variety of cardiovascular complications are seen in advanced [[HIV]] infected patients. The most common are:
| | ==[[HIV induced pericarditis overview|Overview]]== |
| :*[[Pericarditis]] <ref name="pmid3181175">Corallo S, Mutinelli MR, Moroni M, Lazzarin A, Celano V, Repossini A et al. (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3181175 Echocardiography detects myocardial damage in AIDS: prospective study in 102 patients.] ''Eur Heart J'' 9 (8):887-92. PMID: [http://pubmed.gov/3181175 3181175]</ref> <ref name="pmid2926051">Himelman RB, Chung WS, Chernoff DN, Schiller NB, Hollander H (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2926051 Cardiac manifestations of human immunodeficiency virus infection: a two-dimensional echocardiographic study.] ''J Am Coll Cardiol'' 13 (5):1030-6. PMID: [http://pubmed.gov/2926051 2926051]</ref> <ref name="pmid1464334">De Castro S, Migliau G, Silvestri A, D'Amati G, Giannantoni P, Cartoni D et al. (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1464334 Heart involvement in AIDS: a prospective study during various stages of the disease.] ''Eur Heart J'' 13 (11):1452-9. PMID: [http://pubmed.gov/1464334 1464334]</ref> <ref name="pmid8017317">Hsia J, Ross AM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8017317 Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection.] ''Am J Cardiol'' 74 (1):94-6. PMID: [http://pubmed.gov/8017317 8017317]</ref> <ref name="pmid7586308">Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7586308 Pericardial effusion in AIDS. Incidence and survival.] ''Circulation'' 92 (11):3229-34. PMID: [http://pubmed.gov/7586308 7586308]</ref> <ref name="pmid9458682">Estok L, Wallach F (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9458682 Cardiac tamponade in a patient with AIDS: a review of pericardial disease in patients with HIV infection.] ''Mt Sinai J Med'' 65 (1):33-9. PMID: [http://pubmed.gov/9458682 9458682]</ref>
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| :*[[Myocarditis]]
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| :*[[Cardiomyopathy]]
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| :*[[Pulmonary hypertension]]
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| :*[[Coronary artery disease]]
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| ==Epidemiology and demographics== | | ==[[HIV induced pericarditis historical perspective|Historical Perspective]]== |
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| Pericardial diseases in the form of [[pericardial effusion]] or [[cardiac tamponade]]<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref><ref name="pmid2721281">{{cite journal| author=Stotka JL, Good CB, Downer WR, Kapoor WN| title=Pericardial effusion and tamponade due to Kaposi's sarcoma in acquired immunodeficiency syndrome. | journal=Chest | year= 1989 | volume= 95 | issue= 6 | pages= 1359-61 | pmid=2721281 | doi= | pmc= | url= }} </ref><ref name="pmid1582323">{{cite journal| author=Karve MM, Murali MR, Shah HM, Phelps KR| title=Rapid evolution of cardiac tamponade due to bacterial pericarditis in two patients with HIV-1 infection. | journal=Chest | year= 1992 | volume= 101 | issue= 5 | pages= 1461-3 | pmid=1582323 | doi= | pmc= | url= }} </ref><ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref> have been recognized as complications since HIV infection was first reported in 1981.
| | ==[[HIV induced pericarditis classification|Classification]]== |
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| *In a small autopsy study, '''24% cases''' were reported with major cardiac pathology <ref name="pmid3973269">{{cite journal| author=Cammarosano C, Lewis W| title=Cardiac lesions in acquired immune deficiency syndrome (AIDS). | journal=J Am Coll Cardiol | year= 1985 | volume= 5 | issue= 3 | pages= 703-6 | pmid=3973269 | doi= | pmc= | url= }} </ref>.
| | ==[[HIV induced pericarditis pathophysiology|Pathophysiology]]== |
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| *Another autopsy study reported '''9% cardiac lesions''' consisting of fibrinous pericarditis with or without [[Pericardial effusion|effusion]] in [[AIDS]] patients.<ref name="pmid7586308">Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7586308 Pericardial effusion in AIDS. Incidence and survival.] ''Circulation'' 92 (11):3229-34. PMID: [http://pubmed.gov/7586308 7586308]</ref><ref name="pmid16781213">Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16781213 Cardiovascular disease in HIV infection.] ''Am Heart J'' 151 (6):1147-55. [http://dx.doi.org/10.1016/j.ahj.2005.07.030 DOI:10.1016/j.ahj.2005.07.030] PMID: [http://pubmed.gov/16781213 16781213]</ref><ref name="pmid12408791">Harmon WG, Dadlani GH, Fisher SD, Lipshultz SE (2002) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12408791 Myocardial and Pericardial Disease in HIV.] ''Curr Treat Options Cardiovasc Med'' 4 (6):497-509. PMID: [http://pubmed.gov/12408791 12408791]</ref>
| | ==[[HIV induced pericarditis causes|Causes]]== |
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| *The incidence of [[pericardial effusion]] in patients with asymptomatic AIDS was '''11% per year before''' the introduction of effective [[highly active antiretroviral therapy]] (HAART). The 6 month survival rate of AIDS patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of [[CD4 count]] and albumin level<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref>.
| | ==[[HIV induced pericarditis differential diagnosis|Differentiating HIV induced pericarditis from other Diseases]]== |
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| *The incidence of AIDS-related cardiac disease is very high in Africa in comparison to that seen in the developed countries. In the period from 1993 to 1999 in Burkina Faso, '''79%''' of AIDS patients exhibited cardiac involvement, whereas in an Italian study during the period 1992 to 1995, the incidence of AIDS-related cardiac disease was '''6.5%'''<ref name="pmid15124176">{{cite journal| author=Pugliese A, Gennero L, Vidotto V, Beltramo T, Petrini S, Torre D| title=A review of cardiovascular complications accompanying AIDS. | journal=Cell Biochem Funct | year= 2004 | volume= 22 | issue= 3 | pages= 137-41 | pmid=15124176 | doi=10.1002/cbf.1095 | pmc= | url= }} </ref>.
| | ==[[HIV induced pericarditis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Pathophysiology== | | ==[[HIV induced pericarditis risk factors|Risk Factors]]== |
| Patients with advanced [[HIV]] have pericardial involvement at some point and the most common abnormality is [[pericardial effusion]]<ref name="pmid14533546">{{cite journal| author=Barbaro G| title=Pathogenesis of HIV-associated cardiovascular disease. | journal=Adv Cardiol | year= 2003 | volume= 40 | issue= | pages= 49-70 | pmid=14533546 | doi= | pmc= | url= }} </ref>.
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| :*Asymptomatic effusions are mostly small and '''idiopathic'''.
| | ==[[HIV induced pericarditis screening|Screening]]== |
| :*In advanced HIV disease, effusions are a part of '''generalized seroeffusive process''' (capillary leak) involving pleural and peritoneal surfaces, possibly related to enhanced cytokine expression, resulting in moderate to large effusions.
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| :*[[Congestive heart failure]], [[Kaposi sarcoma]], and [[Tuberculosis]] are '''independently''' associated with moderate to large effusions.
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| ==Etiology== | | ==[[HIV induced pericarditis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| It is often difficult to identify the etiology of [[pericardial effusion]] in HIV-infected patients.
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| The common organisms isolated are:
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| :*[[Mycobacterium tuberculosis]] which is the most common etiology for pericardial effusion in African HIV-infected patients<ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref><ref name="pmid16781213">{{cite journal| author=Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF| title=Cardiovascular disease in HIV infection. | journal=Am Heart J | year= 2006 | volume= 151 | issue= 6 | pages= 1147-55 | pmid=16781213 | doi=10.1016/j.ahj.2005.07.030 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16781213 }} </ref>
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| :*[[Staphylococcus aureus]] <ref name="pmid3467225">Stechel RP, Cooper DJ, Greenspan J, Pizzarello RA, Tenenbaum MJ (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3467225 Staphylococcal pericarditis in a homosexual patient with AIDS-related complex.] ''N Y State J Med'' 86 (11):592-3. PMID: [http://pubmed.gov/3467225 3467225]</ref> <ref name="pmid8306779">Decker CF, Tuazon CU (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8306779 Staphylococcus aureus pericarditis in HIV-infected patients.] ''Chest'' 105 (2):615-6. PMID: [http://pubmed.gov/8306779 8306779]</ref>
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| :*[[Cryptococcus neoformans]] <ref name="pmid4045235">Schuster M, Valentine F, Holzman R (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4045235 Cryptococcal pericarditis in an intravenous drug abuser.] ''J Infect Dis'' 152 (4):842. PMID: [http://pubmed.gov/4045235 4045235]</ref>
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| :*[[Herpes simplex]] <ref name="pmid3035442">Freedberg RS, Gindea AJ, Dieterich DT, Greene JB (1987) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3035442 Herpes simplex pericarditis in AIDS.] ''N Y State J Med'' 87 (5):304-6. PMID: [http://pubmed.gov/3035442 3035442]</ref>
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| '''Supportive trial data:'''
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| *A retrospective study <ref name="pmid7781340">Flum DR, McGinn JT, Tyras DH (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7781340 The role of the 'pericardial window' in AIDS.] ''Chest'' 107 (6):1522-5. PMID: [http://pubmed.gov/7781340 7781340]</ref> of 29 patients with AIDS-related pericardial effusion who underwent fluid cultures and pericardial biopsy, etiology was established only in 7% patients. The causes included:
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| ::*Mycobacterium tuberculosis (1%),
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| ::*Staphylococcus aureus(1%), and
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| ::*Neoplasms (2% adenocarcinoma and 3% [[lymphoma]])
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| *Another study that evaluated pericardial effusions in 17 patients with HIV <ref name="pmid8017317">Hsia J, Ross AM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8017317 Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection.] ''Am J Cardiol'' 74 (1):94-6. PMID: [http://pubmed.gov/8017317 8017317]</ref>, revealed etiologic evidence in 5 patients of which 2 were found to have lymphoma, and 1 each had staphylococcus aureus, mycobacterium tuberculosis, and fungal infection.
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[HIV induced pericarditis diagnostic study of choice|Diagnostic study of choice]] | [[HIV induced pericarditis history and symptoms|History and Symptoms]] | [[HIV induced pericarditis physical examination|Physical Examination]] | [[HIV induced pericarditis laboratory findings|Laboratory Findings]] | [[HIV induced pericarditis electrocardiogram|Electrocardiogram]] | [[HIV induced pericarditis x ray|X-Ray Findings]] | [[HIV induced pericarditis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[HIV induced pericarditis CT scan|CT-Scan Findings]] | [[HIV induced pericarditis MRI|MRI Findings]] | [[HIV induced pericarditis other imaging findings|Other Imaging Findings]] | [[HIV induced pericarditis other diagnostic studies|Other Diagnostic Studies]] |
| ====History and symptoms:====
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| The frequency and severity of the symptoms varies with the stage of infection and the degree of [[pericardium|pericardial]] involvement.
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| *Majority of the patients may be '''asymptomatic''', presenting with an increase in the cardiac silhouette on chest x-ray.
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| *Symptomatic patients present with the following:
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| ::*[[Chest pain]]: characteristically sharp and pleuritic in nature, exacerbated by inspiration and relieved by sitting up and leaning forward.
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| ::*[[breathlessness]]
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| ::*[[Malaise]]
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| ::*[[Fever]]
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| ::*[[Cough]]
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| ::*[[Ankle edema]] and/or [[ascites]]
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| ====Physical Examination:====
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| '''Vitals:'''
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| *[[Tachycardia]],
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| *[[pulsus paradoxus]] and
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| *[[hypotension]] (in [[cardiac tamponade]]),
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| '''Neck:'''
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| *[[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]] may be present.
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| <youtube v=uB1c2zvkaew/>
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| '''Chest:'''
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| *[[Ewart's sign]]: Dullness to percussion beneath the angle of left scapula from compression of the left lung by pericardial fluid may be present.
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| *'''Pericardial knock'''
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| <youtube v=Jtk2vVgQuU0/>
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| *'''[[Pericardial rub]]'''
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| <youtube v=EUCp_3_vwtw/>
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| '''Abdomen:'''
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| *[[Hepatomegaly]]
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| *[[Ascites]]
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| *[[Hepatojugular reflux]] may be present
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| <youtube v=B8OX3T4c7PU/>>
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| '''Extremities:''' [[Ankle edema]]
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| ====Electrocardiography====
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| The presence of micro-voltage and [[electrical alternans]]suggests pericardial effusion and tamponade.
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| [[Image:PulsusAlternans.jpg|thumb|500px|left|Micro-voltage with electrical alternans]]
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| <br clear="left"/>
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| ====CXR:====
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| An '''increase in the cardiac silhouette''' may be seen in asymptomatic patients. Symptomatic patients may present with [[pericardial effusion]]<ref name="pmid8017317">Hsia J, Ross AM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8017317 Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection.] ''Am J Cardiol'' 74 (1):94-6. PMID: [http://pubmed.gov/8017317 8017317]</ref>
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| [[Image:Pericardial effusion 4.jpg]]
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| ====Echocardiography:====
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| *Approximately one third of the patients with symptomatic [[pericardial effusion]] can develop [[cardiac tamponade]].<ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref>
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| *A baseline echocardiography is indicated in [[HIV]] patients regardless of the stage of the disease, or in patients with evidence of [[heart failure]], [[Kaposi's sarcoma]], [[tuberculosis]].<ref name="pmid12870537">Lipshultz SE, Fisher SD, Lai WW, Miller TL (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12870537 Cardiovascular risk factors, monitoring, and therapy for HIV-infected patients.] ''AIDS'' 17 Suppl 1 ():S96-122. PMID: [http://pubmed.gov/12870537 12870537]</ref>
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| The echocardiogram below demonstrates '''swinging motion of the heart''' in [[cardiac tamponade]].<ref name="pmid2721281">{{cite journal| author=Stotka JL, Good CB, Downer WR, Kapoor WN| title=Pericardial effusion and tamponade due to Kaposi's sarcoma in acquired immunodeficiency syndrome. | journal=Chest | year= 1989 | volume= 95 | issue= 6 | pages= 1359-61 | pmid=2721281 | doi= | pmc= | url= }} </ref><ref name="pmid1582323">{{cite journal| author=Karve MM, Murali MR, Shah HM, Phelps KR| title=Rapid evolution of cardiac tamponade due to bacterial pericarditis in two patients with HIV-1 infection. | journal=Chest | year= 1992 | volume= 101 | issue= 5 | pages= 1461-3 | pmid=1582323 | doi= | pmc= | url= }} </ref>
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| <youtube v=U4xQ3-VRiNg/>
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| ==Treatment== | | ==Treatment== |
| | [[HIV induced pericarditis medical therapy|Medical Therapy]] | [[HIV induced pericarditis interventions|Interventions]] | [[HIV induced pericarditis surgery|Surgery]] | [[HIV induced pericarditis primary prevention|Primary Prevention]] | [[HIV induced pericarditis secondary prevention|Secondary Prevention]] | [[HIV induced pericarditis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[HIV induced pericarditis future or investigational therapies|Future or Investigational Therapies]] |
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| *'''Asymptomatic with mild to moderate pericardial effusion:'''
| | ==Case Studies== |
| ::*Mostly idiopathic and resolves spontaneously.
| | [[HIV induced pericarditis case study one|Case #1]] |
| ::*However, asymptomatic effusions in [[HIV]] occurs in advanced stages of the disease or heralds the onset of full-blown [[AIDS]] and hence requires treatment to improve survival.<ref name="pmid14533546">Barbaro G (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14533546 Pathogenesis of HIV-associated cardiovascular disease.] ''Adv Cardiol'' 40 ():49-70. PMID: [http://pubmed.gov/14533546 14533546]</ref> [[HAART]] therapy has significantly reduced the incidence and severity of cardiac complications associated with [[HIV]].<ref name="pmid16330702">Ntsekhe M, Hakim J (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16330702 Impact of human immunodeficiency virus infection on cardiovascular disease in Africa.] ''Circulation'' 112 (23):3602-7. [http://dx.doi.org/10.1161/CIRCULATIONAHA.105.549220 DOI:10.1161/CIRCULATIONAHA.105.549220] PMID: [http://pubmed.gov/16330702 16330702]</ref> <ref name="pmid16781213">Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16781213 Cardiovascular disease in HIV infection.] ''Am Heart J'' 151 (6):1147-55. [http://dx.doi.org/10.1016/j.ahj.2005.07.030 DOI:10.1016/j.ahj.2005.07.030] PMID: [http://pubmed.gov/16781213 16781213]</ref>
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| *'''Symptomatic large effusions without [[cardiac tamponade]]:''' requires [[pericardiocentesis]] for both therapeutic and diagnostic purposes, to identify possible etiology.
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| *'''Pericarditis with [[cardiac tamponade]]:''' occurs in 33-40% patients.<ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref> This warrants immediate [[pericardiocentesis]] and a catheter is placed in the pericardial sac for the next 48 hours to continuously drain fluid by underwater-seal suction.
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| *'''Recurrent pericardial effusion:''' Either [[Pericardial window|subxiphoid pericardiotomy with creation of a pericardial window]] <ref name="pmid7781340">Flum DR, McGinn JT, Tyras DH (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7781340 The role of the 'pericardial window' in AIDS.] ''Chest'' 107 (6):1522-5. PMID: [http://pubmed.gov/7781340 7781340]</ref> <ref name="pmid9583822">Gouny P, Lancelin C, Girard PM, Hocquet-Cheynel C, Rozenbaum W, Nussaume O (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9583822 Pericardial effusion and AIDS: benefits of surgical drainage.] ''Eur J Cardiothorac Surg'' 13 (2):165-9. PMID: [http://pubmed.gov/9583822 9583822]</ref> or balloon [[pericardiotomy]] can be considered.<ref name="pmid8417048">Ziskind AA, Pearce AC, Lemmon CC, Burstein S, Gimple LW, Herrmann HC et al. (1993) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8417048 Percutaneous balloon pericardiotomy for the treatment of cardiac tamponade and large pericardial effusions: description of technique and report of the first 50 cases.] ''J Am Coll Cardiol'' 21 (1):1-5. PMID: [http://pubmed.gov/8417048 8417048]</ref> <ref name="pmid15662494">Marcy PY, Bondiau PY, Brunner P (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15662494 Percutaneous treatment in patients presenting with malignant cardiac tamponade.] ''Eur Radiol'' 15 (9):2000-9. [http://dx.doi.org/10.1007/s00330-004-2611-y DOI:10.1007/s00330-004-2611-y] PMID: [http://pubmed.gov/15662494 15662494]</ref>
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| *'''Large pericardial effusions with unknown etiology:''' [[Tuberculous pericarditis#AAnti-tuberculosis chemotherapy|Empiric antituberculous therapy]] for M.tuberculosis have shown some benefit in patients with AIDS. <ref name="pmid1898769">Small PM, Schecter GF, Goodman PC, Sande MA, Chaisson RE, Hopewell PC (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1898769 Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.] ''N Engl J Med'' 324 (5):289-94. [http://dx.doi.org/10.1056/NEJM199101313240503 DOI:10.1056/NEJM199101313240503] PMID: [http://pubmed.gov/1898769 1898769]</ref> <ref name="pmid3723722">Sunderam G, McDonald RJ, Maniatis T, Oleske J, Kapila R, Reichman LB (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3723722 Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS).] ''JAMA'' 256 (3):362-6. PMID: [http://pubmed.gov/3723722 3723722]</ref> <ref name="pmid17976506">Syed FF, Mayosi BM (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17976506 A modern approach to tuberculous pericarditis.] ''Prog Cardiovasc Dis'' 50 (3):218-36. [http://dx.doi.org/10.1016/j.pcad.2007.03.002 DOI:10.1016/j.pcad.2007.03.002] PMID: [http://pubmed.gov/17976506 17976506]</ref>
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| *'''Other causes''' of pericarditis such as bacterial or fungal infections also should be identified and treated accordingly.
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| *'''Pericarditis due to [[lymphoma]]:''' radiation and chemotherapy have been tried. <ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref> <ref name="pmid17325873">Licci S, Narciso P, Morelli L, Brenna A, Cione A, Abbate I et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17325873 Primary effusion lymphoma in pleural and pericardial cavities with multiple solid nodal and extra-nodal involvement in a human immunodeficiency virus-positive patient.] ''Leuk Lymphoma'' 48 (1):209-11. [http://dx.doi.org/10.1080/10428190601019880 DOI:10.1080/10428190601019880] PMID: [http://pubmed.gov/17325873 17325873]</ref> The response however has been transient <ref name="pmid9760158">Sanna P, Bertoni F, Zucca E, Roggero E, Passega Sidler E, Fiori G et al. (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9760158 Cardiac involvement in HIV-related non-Hodgkin's lymphoma: a case report and short review of the literature.] ''Ann Hematol'' 77 (1-2):75-8. PMID: [http://pubmed.gov/9760158 9760158]</ref> and the associated chemotherapy has significantly increased the risk of death secondary to opportunistic infections.<ref name="pmid1727539">Levine AM (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1727539 AIDS-associated malignant lymphoma.] ''Med Clin North Am'' 76 (1):253-68. PMID: [http://pubmed.gov/1727539 1727539]</ref>
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| ==Prognosis==
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| *Pericarditis in patients with [[HIV]] occurs in advanced stages of the disease or heralds the onset of full-blown [[AIDS]] and hence is a '''bad prognostic sign'''. <ref name="pmid7586308">Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7586308 Pericardial effusion in AIDS. Incidence and survival.] ''Circulation'' 92 (11):3229-34. PMID: [http://pubmed.gov/7586308 7586308]</ref> <ref name="pmid12934767">Gowda RM, Khan IA, Mehta NJ, Gowda MR, Sacchi TJ, Vasavada BC (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12934767 Cardiac tamponade in patients with human immunodeficiency virus disease.] ''Angiology'' 54 (4):469-74. PMID: [http://pubmed.gov/12934767 12934767]</ref> <ref name="pmid1826690">Blanchard DG, Hagenhoff C, Chow LC, McCann HA, Dittrich HC (1991) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1826690 Reversibility of cardiac abnormalities in human immunodeficiency virus (HIV)-infected individuals: a serial echocardiographic study.] ''J Am Coll Cardiol'' 17 (6):1270-6. PMID: [http://pubmed.gov/1826690 1826690]</ref> <ref name="pmid9579818">Longo-Mbenza B, Seghers KV, Phuati M, Bikangi FN, Mubagwa K (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9579818 Heart involvement and HIV infection in African patients: determinants of survival.] ''Int J Cardiol'' 64 (1):63-73. PMID: [http://pubmed.gov/9579818 9579818]</ref>
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| *Pericarditis in [[HIV]] patients is also associated with '''shortened survival'''. <ref name="pmid14533546">Barbaro G (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14533546 Pathogenesis of HIV-associated cardiovascular disease.] ''Adv Cardiol'' 40 ():49-70. PMID: [http://pubmed.gov/14533546 14533546]</ref>
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| '''Supportive trial data:'''
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| *The incidence of [[pericardial effusion]] in patients with asymptomatic AIDS was 11% per year before the introduction of effective [[highly active antiretroviral therapy]] (HAART). The 6 month survival rate of AIDS patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of [[CD4]] count and [[albumin]] level<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref>.
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| ==References==
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| {{reflist|2}}
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| [[Category:Cardiology]]
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| [[Category:Diseases involving the fasciae]]
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| [[Category:Inflammations]]
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| [[Category:Emergency medicine]]
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| [[Category:Infectious disease]]
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