Tuberculous pericarditis natural history, complications and prognosis: Difference between revisions
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{{Tuberculous pericarditis}} | {{Tuberculous pericarditis}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}}{{sab}} | ||
==Overview== | ==Overview== | ||
If left untreated, [ | Tuberculous pericarditis does not have the typical classic presentation of an [[acute pericarditis]] (sudden-onset [[chest pain]] and typical [[The electrocardiogram|ECG]] changes). Instead, it most commonly presents with [[systemic]] [[Medical sign|signs]] and [[Symptom|symptoms]]. If left untreated, tuberculous pericarditis can be [[Complication|complicated]] by [[constrictive pericarditis]] which can then ultimately lead to [[heart failure]]. Common [[Complication (medicine)|complications]] of tuberculous pericarditis include [[acute pericarditis]], [[constrictive pericarditis]], [[cardiac tamponade]], and [[heart failure]]. Antituberculosis therapy has dramatically improved the [[prognosis]] of tuberculous pericarditis and it is evident from the decrease in [[mortality rate]] with time. | ||
Common complications of [ | |||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*Tuberculous pericarditis does not have the typical classic presentation of an acute pericarditis (sudden-onset chest pain and typical ECG changes). | *Tuberculous pericarditis does not have the typical classic presentation of an [[acute pericarditis]] (sudden-onset [[chest pain]] and typical [[The electrocardiogram|ECG]] changes). | ||
*Instead, it most commonly presents with systemic signs and symptoms:<ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref> | *Instead, it most commonly presents with [[systemic]] [[Medical sign|signs]] and [[Symptom|symptoms]]:<ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref> | ||
**Cough (94%) | **[[Cough]] (94%) | ||
**Dyspnea (88%) | **[[Dyspnea]] (88%) | ||
**Chest pain (76%) | **[[Chest pain]] (76%) | ||
**Fever (70%) | **[[Fever]] (70%) | ||
**Night sweats (56%) | **[[Night sweats]] (56%) | ||
**Orthopnea (53%) | **[[Orthopnea]] (53%) | ||
**Weight loss (48%) | **[[Weight loss]] (48%) | ||
*If left untreated, tuberculous pericarditis can be complicated by constrictive pericarditis which can then ultimately lead to heart failure.<ref name="pmid29025551">{{cite journal |vauthors=Chang SA |title=Tuberculous and Infectious Pericarditis |journal=Cardiol Clin |volume=35 |issue=4 |pages=615–622 |date=November 2017 |pmid=29025551 |doi=10.1016/j.ccl.2017.07.013 |url=}}</ref> | *If left untreated, tuberculous pericarditis can be [[Complication|complicated]] by [[constrictive pericarditis]] which can then ultimately lead to [[heart failure]].<ref name="pmid29025551">{{cite journal |vauthors=Chang SA |title=Tuberculous and Infectious Pericarditis |journal=Cardiol Clin |volume=35 |issue=4 |pages=615–622 |date=November 2017 |pmid=29025551 |doi=10.1016/j.ccl.2017.07.013 |url=}}</ref> | ||
===Complications=== | ===Complications=== | ||
*Common complications of tuberculous pericarditis include:<ref name="pmid290255512">{{cite journal |vauthors=Chang SA |title=Tuberculous and Infectious Pericarditis |journal=Cardiol Clin |volume=35 |issue=4 |pages=615–622 |date=November 2017 |pmid=29025551 |doi=10.1016/j.ccl.2017.07.013 |url=}}</ref> | *Common [[Complication (medicine)|complications]] of tuberculous pericarditis include:<ref name="pmid290255512">{{cite journal |vauthors=Chang SA |title=Tuberculous and Infectious Pericarditis |journal=Cardiol Clin |volume=35 |issue=4 |pages=615–622 |date=November 2017 |pmid=29025551 |doi=10.1016/j.ccl.2017.07.013 |url=}}</ref><ref name="Fowler19912">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref> | ||
**Constrictive pericarditis | **[[Acute pericarditis]] | ||
**Heart failure | **[[Constrictive pericarditis]] | ||
**[[Cardiac tamponade]] | |||
**[[Heart failure]] | |||
===Prognosis=== | ===Prognosis=== | ||
* | *Antituberculosis therapy has dramatically improved the [[prognosis]] of tuberculous pericarditis. | ||
* | *It is evident from the decrease in [[mortality rate]] with time: | ||
* | **30 - 40% in North America (1953 - 1970) and 12% (1970 - 1986)<ref name="pmid3109338">{{cite journal |vauthors=Quale JM, Lipschik GY, Heurich AE |title=Management of tuberculous pericarditis |journal=Ann. Thorac. Surg. |volume=43 |issue=6 |pages=653–5 |date=June 1987 |pmid=3109338 |doi=10.1016/s0003-4975(10)60243-3 |url=}}</ref> | ||
* | **16% in Cape Town (1952 - 1957)<ref name="pmid14443596">{{cite journal |vauthors=SCHRIRE V |title=Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period |journal=S. Afr. Med. J. |volume=33 |issue= |pages=810–7 |date=September 1959 |pmid=14443596 |doi= |url=}}</ref> | ||
* | **6.5% in Eastern Cape (1980 - 1984) | ||
** | |||
*Most untreated [[Patient|patients]] (up to 90% at 1 year) die from tuberculous dissemination or [[heart failure]], the average survival being 3 to 4 months. | |||
==References== | ==References== | ||
Latest revision as of 19:53, 10 February 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]
Overview
Tuberculous pericarditis does not have the typical classic presentation of an acute pericarditis (sudden-onset chest pain and typical ECG changes). Instead, it most commonly presents with systemic signs and symptoms. If left untreated, tuberculous pericarditis can be complicated by constrictive pericarditis which can then ultimately lead to heart failure. Common complications of tuberculous pericarditis include acute pericarditis, constrictive pericarditis, cardiac tamponade, and heart failure. Antituberculosis therapy has dramatically improved the prognosis of tuberculous pericarditis and it is evident from the decrease in mortality rate with time.
Natural History, Complications, and Prognosis
Natural History
- Tuberculous pericarditis does not have the typical classic presentation of an acute pericarditis (sudden-onset chest pain and typical ECG changes).
- Instead, it most commonly presents with systemic signs and symptoms:[1]
- Cough (94%)
- Dyspnea (88%)
- Chest pain (76%)
- Fever (70%)
- Night sweats (56%)
- Orthopnea (53%)
- Weight loss (48%)
- If left untreated, tuberculous pericarditis can be complicated by constrictive pericarditis which can then ultimately lead to heart failure.[2]
Complications
- Common complications of tuberculous pericarditis include:[3][4]
Prognosis
- Antituberculosis therapy has dramatically improved the prognosis of tuberculous pericarditis.
- It is evident from the decrease in mortality rate with time:
- Most untreated patients (up to 90% at 1 year) die from tuberculous dissemination or heart failure, the average survival being 3 to 4 months.
References
- ↑ Fowler, Noble O. (1991). "Tuberculous Pericarditis". JAMA: The Journal of the American Medical Association. 266 (1): 99. doi:10.1001/jama.1991.03470010103039. ISSN 0098-7484.
- ↑ Chang SA (November 2017). "Tuberculous and Infectious Pericarditis". Cardiol Clin. 35 (4): 615–622. doi:10.1016/j.ccl.2017.07.013. PMID 29025551.
- ↑ Chang SA (November 2017). "Tuberculous and Infectious Pericarditis". Cardiol Clin. 35 (4): 615–622. doi:10.1016/j.ccl.2017.07.013. PMID 29025551.
- ↑ Fowler, Noble O. (1991). "Tuberculous Pericarditis". JAMA: The Journal of the American Medical Association. 266 (1): 99. doi:10.1001/jama.1991.03470010103039. ISSN 0098-7484.
- ↑ Quale JM, Lipschik GY, Heurich AE (June 1987). "Management of tuberculous pericarditis". Ann. Thorac. Surg. 43 (6): 653–5. doi:10.1016/s0003-4975(10)60243-3. PMID 3109338.
- ↑ SCHRIRE V (September 1959). "Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period". S. Afr. Med. J. 33: 810–7. PMID 14443596.