Pericarditis pathophysiology: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 1: Line 1:
{{Pericarditis}}
{{Pericarditis}}


{{CMG}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}


==Overview==
==Overview==

Revision as of 15:49, 26 June 2011

Pericarditis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

HIV
Post MI
Dressler's syndrome
Post-pericardiotomy
Radiation
Tuberculosis
Uremia
Malignancy

Differentiating Pericarditis from other Diseases

Epidemiology and Demographics

Screening

Natural History, Complications and Prognosis

Pericardial Effusion
Cardiac Tamponade
Constrictive Pericarditis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Pericardiocentesis
Pericardial Window
Pericardial Stripping

Treatment Related Videos

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Pericarditis pathophysiology On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Google Images

American Roentgen Ray Society Images of Pericarditis pathophysiology

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Pericarditis pathophysiology

CDC on Pericarditis pathophysiology

Pericarditis pathophysiology in the news

Blogs on Pericarditis pathophysiology

Directions to Hospitals Treating Type page name here

Risk calculators and risk factors for Pericarditis pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Pericarditis is inflammation of the pericardium, the double-walled sac that contains the heart and the roots of the great vessels. There can be an accompanying accumulation of fluid that can be either serous (free flowing fluid) or fibrinous (an exudate, which is a thick fluid composed of proteins, fibrin strands, inflammatory cells, cell breakdown products, and sometimes bacteria). Vascular congestion of the pericardium is also present. The underlying myocardium may or may not be inflammed as well. If the myocardium is involved in the inflammatory process, then this is called myopericarditis, and the CK and troponin may be elevated.

Classification

Pericarditis can be classified according to the composition of the inflammatory exudate or the composition of the fluid that accumulates around the heart.

Types include:

Acute Versus Chronic Pericarditis

Depending on the timing of presentation and duration, pericarditis is divided into "acute" and "chronic" forms. Clinically, acute pericarditis presents within 6 weeks of the disease onset; subacute pericarditis presents within 6 weeks to 6 months of the disease onset; and chronic pericarditis manifests after 6 months of the disease onset.Acute pericarditis is more common than chronic pericarditis, and often occurs as a complication of viral infections, immunologic conditions, or as a result of a heart attack (myocardial infarction). Chronic pericarditis is less common, which may manifest as scarring of the pericardium a condition known as constrictive pericarditis.

Cardiotropic viruses usually spread to the myocardium and pericardium hematogenously and cause acute inflammation with infiltration of polymorphonuclear (PMN) leukocytes and pericardial vascularization. This may cause pericardial effusion and fibrinous change of pericardium. Most patients with viral pericarditis recover completely with few developing recurrences[1][2]. Some patients develop constrictive pericarditis which could be disabling[3].

Bacterial pericarditis results from

  1. Contiguous spread of infection within the chest[4][5], either de novo or after surgery or trauma[6]
  2. Spread from infective endocarditis[7][8]
  3. Hematogenous spread of infection
  4. Direct inoculation as a result of penetrating injury or cardiothoracic surgery

Tuberculous pericarditis develop from lymphatic spread from peritracheal, peribronchial or mediastinal lymphnodes or by contiguous spread from a focus of infection in lung or pleura.

Gross Pathology Images

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Fibrinous pericarditis: Gross, natural color, an excellent example of bread and butter appearance. Uremia, chronic glomerulonephritis and sepsis.

    Fibrinous pericarditis: Gross, natural color, an excellent example of bread and butter appearance. Uremia, chronic glomerulonephritis and sepsis.

  • Fibrinous pericarditis: Gross, a good example (bread and butter appearance).

    Fibrinous pericarditis: Gross, a good example (bread and butter appearance).

  • Fibrinous pericarditis: Gross, an excellent example.

    Fibrinous pericarditis: Gross, an excellent example.


  • Fibrinous pericarditis: Gross, an excellent example, close-up view of fibrin.

    Fibrinous pericarditis: Gross, an excellent example, close-up view of fibrin.

  • Fibrinous pericarditis: Gross, an excellent example, close-up view.

    Fibrinous pericarditis: Gross, an excellent example, close-up view.

  • Fibrinous pericarditis: Gross, an excellent example.

    Fibrinous pericarditis: Gross, an excellent example.


  • Fibrinous pericarditis: Gross, external view of localized pericarditis over an acute infarction

    Fibrinous pericarditis: Gross, external view of localized pericarditis over an acute infarction

  • Fibrinous pericarditis: Gross, intact heart, good example

    Fibrinous pericarditis: Gross, intact heart, good example

  • Fibrinous pericarditis: Gross, good example, mild, with small amount of fibrin

    Fibrinous pericarditis: Gross, good example, mild, with small amount of fibrin


  • Fibrinous pericarditis: Gross, close-up, an excellent example of color and detail

    Fibrinous pericarditis: Gross, close-up, an excellent example of color and detail

  • Fibrinous pericarditis: Gross, a good example

    Fibrinous pericarditis: Gross, a good example

  • Fibrinous pericarditis: Gross, a good example, very mild case

    Fibrinous pericarditis: Gross, a good example, very mild case


  • Fibrinous pericarditis: Gross, an excellent example.

    Fibrinous pericarditis: Gross, an excellent example.

  • Fibrinous pericarditis: Gross, a close-up view, an excellent illustration of fibrinous exudate.

    Fibrinous pericarditis: Gross, a close-up view, an excellent illustration of fibrinous exudate.

  • Pericarditis in uremia

    Pericarditis in uremia


  • Fibrinous pericarditis: Gross, fixed tissue (note to color changes), a close-up view of fibrin on epicardial surface of heart. A typical example.

    Fibrinous pericarditis: Gross, fixed tissue (note to color changes), a close-up view of fibrin on epicardial surface of heart. A typical example.

  • Fibrinous pericarditis: Gross, natural color, large right atrial thrombus and fibrinous pericarditis. Normal tricuspid valve with some aging changes (good example)

    Fibrinous pericarditis: Gross, natural color, large right atrial thrombus and fibrinous pericarditis. Normal tricuspid valve with some aging changes (good example)

  • Fibrinous pericarditis: Gross, natural color

    Fibrinous pericarditis: Gross, natural color


  • Fibrinous pericarditis: Gross, natural color, an excellent example

    Fibrinous pericarditis: Gross, natural color, an excellent example

  • Fibrinous pericarditis: Gross, natural color, very close-up photo showing fibrinous exudate simulating frost (an excellent example)

    Fibrinous pericarditis: Gross, natural color, very close-up photo showing fibrinous exudate simulating frost (an excellent example)

  • Rheumatoid fibrinous pericarditis: Gross, natural color, a typical lesion in 22 years old white female due to juvenile rheumatoid arthritis.

    Rheumatoid fibrinous pericarditis: Gross, natural color, a typical lesion in 22 years old white female due to juvenile rheumatoid arthritis.


  • Fibrinous pericarditis: Gross, natural color, close-up view of minimal fibrinous exudate on epicardial surface due to terminal renal failure

    Fibrinous pericarditis: Gross, natural color, close-up view of minimal fibrinous exudate on epicardial surface due to terminal renal failure

  • Fibrinous pericarditis: Gross, natural color, anterior view of heart with mild fibrinous exudate over epicardium due to terminal renal failure

    Fibrinous pericarditis: Gross, natural color, anterior view of heart with mild fibrinous exudate over epicardium due to terminal renal failure

  • Tuberculous pericarditis: Gross, natural color, shaggy hemorrhagic exudate. This case is much more hemorrhagic than the typical tuberculous pericarditis.

    Tuberculous pericarditis: Gross, natural color, shaggy hemorrhagic exudate. This case is much more hemorrhagic than the typical tuberculous pericarditis.


  • Heart transplant: Gross, natural color, external view of heart. Two months after transplantation with fibrinous pericarditis

    Heart transplant: Gross, natural color, external view of heart. Two months after transplantation with fibrinous pericarditis

  • Neoplastic pericarditis: Gross, natural color, shaggy pericarditis. Primer is adenocarcinoma of the lung.

    Neoplastic pericarditis: Gross, natural color, shaggy pericarditis. Primer is adenocarcinoma of the lung.

  • Heart: Septic pericarditis

    Heart: Septic pericarditis


  • Hemopericardium: Gross, an excellent in situ view

    Hemopericardium: Gross, an excellent in situ view

  • Hemopericardium: Gross, in situ, unopened pericardium (a very good example)

    Hemopericardium: Gross, in situ, unopened pericardium (a very good example)

  • Hemopericardium: Gross, natural color, heart in situ with opened pericardium and filled with red blood clot (quite good example) dissecting aneurysm

    Hemopericardium: Gross, natural color, heart in situ with opened pericardium and filled with red blood clot (quite good example) dissecting aneurysm


  • Hemopericardium due to Needle Puncture: Gross, natural color, external view of heart covered by blood

    Hemopericardium due to Needle Puncture: Gross, natural color, external view of heart covered by blood

  • Needle Puncture Mark in Epicardium: Gross, natural color, close-up of needle puncture marks tap resulted in hemopericardium

    Needle Puncture Mark in Epicardium: Gross, natural color, close-up of needle puncture marks tap resulted in hemopericardium

  • Hemopericardium: Hemopericardium caused by pericardiocentesis: Gross, natural color, close-up view of apex of the heart. Needle apparently entered the distal posterior descending artery.

    Hemopericardium: Hemopericardium caused by pericardiocentesis: Gross, natural color, close-up view of apex of the heart. Needle apparently entered the distal posterior descending artery.


  • Hemopericardium: Hemopericardium caused by pericardiocentesis: Gross, natural color, view of apex of the heart. Needle apparently entered the distal posterior descending artery

    Hemopericardium: Hemopericardium caused by pericardiocentesis: Gross, natural color, view of apex of the heart. Needle apparently entered the distal posterior descending artery

  • Hemopericardium: Hemopericardium due to pericardiocentesis: Gross, fixed tissue, close-up view of slice through distal posterior descending artery showing periarterial hemorrhage

    Hemopericardium: Hemopericardium due to pericardiocentesis: Gross, fixed tissue, close-up view of slice through distal posterior descending artery showing periarterial hemorrhage

  • Hemopericardium: Liver: Gross, natural color, typical shock liver case of death due to hemopericardium secondary to pericardiocentesis

    Hemopericardium: Liver: Gross, natural color, typical shock liver case of death due to hemopericardium secondary to pericardiocentesis


  • Hemopericardium in newborn: Gross, natural color, opened body with large collection blood in pericardial sac. Cause uncertain. A 26 week premature with hyaline membrane disease and DIC

    Hemopericardium in newborn: Gross, natural color, opened body with large collection blood in pericardial sac. Cause uncertain. A 26 week premature with hyaline membrane disease and DIC

  • Hemopericardium: Myocardial Infarction and Ventricular Rupture

    Hemopericardium: Myocardial Infarction and Ventricular Rupture


  • Hemopericardium: Infarct rupture after 7 days of chest pain onset.

    Hemopericardium: Infarct rupture after 7 days of chest pain onset.

  • Hemopericardium in dissecting aneurysm: Gross, heart with root of aorta to show hemorrhage into pericardium (very good example)

    Hemopericardium in dissecting aneurysm: Gross, heart with root of aorta to show hemorrhage into pericardium (very good example)

Microscopic Pathology Images

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

  • Tuberculous pericarditis.

    Tuberculous pericarditis.

  • Tuberculous pericarditis.

    Tuberculous pericarditis.

  • Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen.

    Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen.


  • Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen.

    Tuberculous pericarditis: Micro oil acid fast stain. The organism easily seen.

  • Uremic pericarditis: Micro med mag, H&E. A good example

    Uremic pericarditis: Micro med mag, H&E. A good example

  • Tuberculous pericarditis: Micro med mag, H&E, a typical lesion

    Tuberculous pericarditis: Micro med mag, H&E, a typical lesion


  • Fibrinous pericarditis.

    Fibrinous pericarditis.

  • Pericarditis fibrinosa (Fibrinous pericarditis).

    Pericarditis fibrinosa (Fibrinous pericarditis).

  • Malignant Mesothelioma, Biphasic Type: Pericardium: This tumor has epithelioid cells (lower half) surrounded by spindled cells. The patient was a 46-year-old woman with constrictive pericarditis; the pericardium was studded with coalescing tumor nodules.

    Malignant Mesothelioma, Biphasic Type: Pericardium: This tumor has epithelioid cells (lower half) surrounded by spindled cells. The patient was a 46-year-old woman with constrictive pericarditis; the pericardium was studded with coalescing tumor nodules.


  • <Youtube v=AKS7kSl4x5k/>


  • Acute fibrinous pericarditis

<Youtube v=5fz_W1YxbC8/>

  1. ↑ Ilan Y, Oren R, Ben-Chetrit E (1991). "Acute pericarditis: etiology, treatment and prognosis. A study of 115 patients". Jpn Heart J. 32 (3): 315–21. PMID 1920818.
  2. ↑ Shabetai R (1990). "Acute pericarditis". Cardiol Clin. 8 (4): 639–44. PMID 2249218.
  3. ↑ Matthews JD, Cameron SJ, George M (1970). "Constrictive pericarditis following Coxsackie virus infection". Thorax. 25 (5): 624–6. PMC 472200. PMID 5489188.
  4. ↑ Klacsmann PG, Bulkley BH, Hutchins GM (1977). "The changed spectrum of purulent pericarditis: an 86 year autopsy experience in 200 patients". Am J Med. 63 (5): 666–73. PMID 930941.
  5. ↑ Kauffman CA, Watanakunakorn C, Phair JP (1973). "Purulent pneumococcal pericarditis. A continuing problem in the antibiotic era". Am J Med. 54 (6): 743–50. PMID 4200204.
  6. ↑ Rubin RH, Moellering RC (1975). "Clinical, microbiologic and therapeutic aspects of purulent pericarditis". Am J Med. 59 (1): 68–78. PMID 1138554.
  7. ↑ Ribeiro P, Shapiro L, Nihoyannopoulos P, Gonzalez A, Oakley CM (1985). "Pericarditis in infective endocarditis". Eur Heart J. 6 (11): 975–8. PMID 4076207.
  8. ↑ Roberts WC, Buchbinder NA (1972). "Right-sided valvular infective endocarditis. A clinicopathologic study of twelve necropsy patients". Am J Med. 53 (1): 7–19. PMID 4402567.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Pericarditis_pathophysiology&oldid=575278"