Uremic pericarditis overview: Difference between revisions
No edit summary |
|||
| (2 intermediate revisions by the same user not shown) | |||
| Line 6: | Line 6: | ||
==Overview== | ==Overview== | ||
[[Renal failure]] can be associated with the development of a [[pericardial effusion]] and [[pericarditis]], a condition known as uremic pericarditis. The underlying pathophysiology is not entirely clear, but it is hypothesized that uremic pericarditis is due to a build up of metabolic toxins such as [[urea]], [[creatinine]], [[methylguanidine]] which cause inflammation of pericardium. With the introduction of [[dialysis]], the incidence of uremic pericarditis has dropped<ref name="pmid5673609">{{cite journal| author=Bailey GL, Hampers CL, Hager EB, Merrill JP| title=Uremic pericarditis. Clinical features and management. | journal=Circulation | year= 1968 | volume= 38 | issue= 3 | pages= 582-91 | pmid=5673609 | doi= | pmc= | url= }} </ref>. | [[Renal failure]] can be associated with the development of a [[pericardial effusion]] and [[pericarditis]], a condition known as uremic pericarditis. The underlying pathophysiology is not entirely clear, but it is hypothesized that uremic pericarditis is due to a build up of metabolic toxins such as [[urea]], [[creatinine]], [[methylguanidine]] which cause inflammation of pericardium. With the introduction of [[dialysis]], the incidence of uremic pericarditis has dropped<ref name="pmid5673609">{{cite journal| author=Bailey GL, Hampers CL, Hager EB, Merrill JP| title=Uremic pericarditis. Clinical features and management. | journal=Circulation | year= 1968 | volume= 38 | issue= 3 | pages= 582-91 | pmid=5673609 | doi= | pmc= | url= }} </ref>. | ||
Uremic | ==Differentiating Uremic Pericarditis from other Diseases== | ||
Signs and symptoms of [[pericarditis]] may be similar to several other conditions including [[myocardial infarction]], [[aortic dissection]] and [[pulmonary embolism]] which are life threatening and therefore it is important to differentiate them. [[Pain]] along the [[trapezius]] ridge, which is unresponsive to [[vasodilator]] therapy and varies with position, is a specific sign of [[pericarditis]]. | |||
==Diagnosis== | |||
===Laboratory Findings=== | |||
Non-specific markers of [[inflammation]] are generally elevated in [[pericarditis]]. These include the [[leukocyte]] count, [[C-reactive protein]], and [[ESR]]. The [[cardiac troponin]] is elevated if there is an injury to the underlying [[myocardium]], a condition termed as myopericarditis. Diagnostic [[pericardiocentesis]] and [[biopsy]] help in identifying an underlying infectious or malignant process. | |||
===Echocardiography=== | |||
Echocardiogram may show presence of fluid surrounding the heart in pericardial effusion. Loculated effusions secondary to adhesions in pericardial cavity may also be visualized as shown in the video below. | |||
Swinging motion of the heart may be seen in patients with [[cardiac tamponade]]. | |||
===CT=== | |||
On [[CT]], pericardial fluid adds to the thickness of [[pericardium]] as both have the similar signal intensities. In [[pericarditis]], [[pericardium]] can generate an intermediate signal intensity and may enhance after [[gadolinium]] administration. In [[pericardial effusion]], hemorrhagic effusions can be differentiated from a [[transudate]] or an [[exudate]] based on signal characteristics (high signal on T1-weighted images) or density (high-density clot on CT). [[CT]] is superior to [[MRI]] in the visualization of [[pericardial calcification]] which is often seen in the patient with [[pericardial constriction]]. CT imaging also helps in detecting the presence of [[tumor]]s and the extent of [[metastasis]] of the [[neoplasm]]. | |||
===MRI=== | |||
On [[MRI]], normal [[pericardium]] appears as a thin dark band that is bordered by a bright band on both sides on T1 weighted spin imaging. These surrounding bright bands are associated with the surrounding epicardial and pericardial fat. Following the administration of [[gadolinium]], pericardium may appear thick and inflamed in the setting of [[pericarditis]]. Lower intensity signal is observed in [[constrictive pericarditis]] than in acute [[pericarditis]]. Comprehensive visualization of the [[LV]] [[endocardium]] and the physiologic consequences of abnormal pericardial thickening can also be obtained without exposure to ionizing [[radiation]].<ref name="pmid2914352">{{cite journal| author=Hatle LK, Appleton CP, Popp RL| title=Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. | journal=Circulation | year= 1989 | volume= 79 | issue= 2 | pages= 357-70 | pmid=2914352 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2914352 }} </ref> | |||
===Cardiac Catheterization=== | |||
In presence '''Cardiac tamponade''', there is equalization of pressures in all four chambers of heart. The right atrial pressure equals the right ventricular end diastolic pressure equals the pulmonary artery diastolic pressure. | |||
==References== | ==References== | ||
| Line 18: | Line 30: | ||
[[Category:Nephrology]] | [[Category:Nephrology]] | ||
[[Category:Diseases involving the fasciae]] | [[Category:Diseases involving the fasciae]] | ||
[[Category:Best pages]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 19:22, 6 February 2013
|
Uremic pericarditis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Pericarditis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Surgery |
|
Case Studies |
|
Uremic pericarditis overview On the Web |
|
American Roentgen Ray Society Images of Uremic pericarditis overview |
|
Risk calculators and risk factors for Uremic pericarditis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.
Overview
Renal failure can be associated with the development of a pericardial effusion and pericarditis, a condition known as uremic pericarditis. The underlying pathophysiology is not entirely clear, but it is hypothesized that uremic pericarditis is due to a build up of metabolic toxins such as urea, creatinine, methylguanidine which cause inflammation of pericardium. With the introduction of dialysis, the incidence of uremic pericarditis has dropped[1].
Differentiating Uremic Pericarditis from other Diseases
Signs and symptoms of pericarditis may be similar to several other conditions including myocardial infarction, aortic dissection and pulmonary embolism which are life threatening and therefore it is important to differentiate them. Pain along the trapezius ridge, which is unresponsive to vasodilator therapy and varies with position, is a specific sign of pericarditis.
Diagnosis
Laboratory Findings
Non-specific markers of inflammation are generally elevated in pericarditis. These include the leukocyte count, C-reactive protein, and ESR. The cardiac troponin is elevated if there is an injury to the underlying myocardium, a condition termed as myopericarditis. Diagnostic pericardiocentesis and biopsy help in identifying an underlying infectious or malignant process.
Echocardiography
Echocardiogram may show presence of fluid surrounding the heart in pericardial effusion. Loculated effusions secondary to adhesions in pericardial cavity may also be visualized as shown in the video below. Swinging motion of the heart may be seen in patients with cardiac tamponade.
CT
On CT, pericardial fluid adds to the thickness of pericardium as both have the similar signal intensities. In pericarditis, pericardium can generate an intermediate signal intensity and may enhance after gadolinium administration. In pericardial effusion, hemorrhagic effusions can be differentiated from a transudate or an exudate based on signal characteristics (high signal on T1-weighted images) or density (high-density clot on CT). CT is superior to MRI in the visualization of pericardial calcification which is often seen in the patient with pericardial constriction. CT imaging also helps in detecting the presence of tumors and the extent of metastasis of the neoplasm.
MRI
On MRI, normal pericardium appears as a thin dark band that is bordered by a bright band on both sides on T1 weighted spin imaging. These surrounding bright bands are associated with the surrounding epicardial and pericardial fat. Following the administration of gadolinium, pericardium may appear thick and inflamed in the setting of pericarditis. Lower intensity signal is observed in constrictive pericarditis than in acute pericarditis. Comprehensive visualization of the LV endocardium and the physiologic consequences of abnormal pericardial thickening can also be obtained without exposure to ionizing radiation.[2]
Cardiac Catheterization
In presence Cardiac tamponade, there is equalization of pressures in all four chambers of heart. The right atrial pressure equals the right ventricular end diastolic pressure equals the pulmonary artery diastolic pressure.
References
- ↑ Bailey GL, Hampers CL, Hager EB, Merrill JP (1968). "Uremic pericarditis. Clinical features and management". Circulation. 38 (3): 582–91. PMID 5673609.
- ↑ Hatle LK, Appleton CP, Popp RL (1989). "Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography". Circulation. 79 (2): 357–70. PMID 2914352.