Uremic pericarditis: Difference between revisions
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==Overview== | ==Overview== | ||
[[Renal failure]] | [[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 pericaritis can be further divided as: | Uremic pericaritis can be further divided as: | ||
#Uremic pericarditis in patients not undergoing dialysis. | #Uremic pericarditis in patients not undergoing dialysis. | ||
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Patients undergoing dialysis may also develop [[pericarditis]]. In a series, 13% of patients undergoing hemodialysis developed pericarditis<ref name="pmid3605080">{{cite journal| author=Rutsky EA, Rostand SG| title=Treatment of uremic pericarditis and pericardial effusion. | journal=Am J Kidney Dis | year= 1987 | volume= 10 | issue= 1 | pages= 2-8 | pmid=3605080 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3605080 }} </ref> | Patients undergoing dialysis may also develop [[pericarditis]]. In a series, 13% of patients undergoing hemodialysis developed pericarditis<ref name="pmid3605080">{{cite journal| author=Rutsky EA, Rostand SG| title=Treatment of uremic pericarditis and pericardial effusion. | journal=Am J Kidney Dis | year= 1987 | volume= 10 | issue= 1 | pages= 2-8 | pmid=3605080 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3605080 }} </ref> | ||
Uremic pericarditis can occur as serous or hemorrhagic effusion with considerable overlapping. Hemorrhagic effusions are more common secondary to uremia induced platelet dysfunction and the use of [[anticoagulation]] during [[hemodialysis]]. | Uremic pericarditis can occur as a [[serous]] or a hemorrhagic effusion with considerable overlapping. Hemorrhagic effusions are more common secondary to uremia induced platelet dysfunction and the use of [[anticoagulation]] during [[hemodialysis]]. | ||
[[Dialysis]] associated pericarditis may also be secondary to volume overload and bacterial or viral infections<ref name="pmid11172559">{{cite journal| author=Gunukula SR, Spodick DH| title=Pericardial disease in renal patients. | journal=Semin Nephrol | year= 2001 | volume= 21 | issue= 1 | pages= 52-6 | pmid=11172559 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11172559 }} </ref>. | [[Dialysis]] associated pericarditis may also be secondary to volume overload and bacterial or viral infections<ref name="pmid11172559">{{cite journal| author=Gunukula SR, Spodick DH| title=Pericardial disease in renal patients. | journal=Semin Nephrol | year= 2001 | volume= 21 | issue= 1 | pages= 52-6 | pmid=11172559 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11172559 }} </ref>. | ||
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==Physical examination== | ==Physical examination== | ||
Patients present with [[fever]], [[cachexia]] and varying | Patients may present with [[fever]], [[cachexia]] and varying levels of [[consciousness]]. | ||
'''Vitals:''' [[Hypotension]] | '''Vitals:''' [[Hypotension]]and [[pulsus paradoxus]] are present in [[cardiac tamponade]]. The heart rate may be slow due to autonomic impairment or an [[arrhythmia]] such as atrial fibrillation, atrial flutter, heart block or a ventricular arrhythmia may be present due to an [[electrolyte]] imbalance. | ||
'''Neck:''' [[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]] | '''Neck:''' [[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]] | ||
'''Chest:''' [[Ewart's sign]] | '''Chest:''' [[Ewart's sign]] may be present. This includes a pericardial knock, [[pericardial rub]](heard best while leaning forwards) and distant [[heart sounds]] | ||
'''Abdomen:''' [[Hepatomegaly]], [[ascites]] | '''Abdomen:''' [[Hepatomegaly]], [[ascites]] | ||
Revision as of 19:30, 29 June 2011
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Pericarditis Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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Uremic pericarditis On the Web |
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American Roentgen Ray Society Images of Uremic pericarditis |
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]. Uremic pericaritis can be further divided as:
- Uremic pericarditis in patients not undergoing dialysis.
- Uremic pericarditis in patients on maintenance dialysis.
Etiology
- Absence of dialysis in renal failure
- Inadequate dialysis in renal failure
- Volume overload during dialysis
- Infections
Pathophysiology
The pathophysiology of uremic pericarditis is not fully understood. However, there is a correlation observed with levels of blood urea nitrogen(usually >60 mg/dL) and creatinine. In renal failure, the absence or inadequate dialysis can lead to accumulation of these toxins in the body which may cause inflammation of pericardium and development of adhesions between the two pericardial layers.
Patients undergoing dialysis may also develop pericarditis. In a series, 13% of patients undergoing hemodialysis developed pericarditis[2]
Uremic pericarditis can occur as a serous or a hemorrhagic effusion with considerable overlapping. Hemorrhagic effusions are more common secondary to uremia induced platelet dysfunction and the use of anticoagulation during hemodialysis.
Dialysis associated pericarditis may also be secondary to volume overload and bacterial or viral infections[3].
Presence of a large pericardial effusion that persists for >10 days after intensive dialysis has a high likelihood of development of cardiac tamponade
History and symptoms
Patients may present with the following symptoms:
- Fever
- Chest pain that improves on leaning forward and worsens on inspiration
- Breathlessness
- Dizziness
- Malaise
- Ankle edema
Physical examination
Patients may present with fever, cachexia and varying levels of consciousness.
Vitals: Hypotensionand pulsus paradoxus are present in cardiac tamponade. The heart rate may be slow due to autonomic impairment or an arrhythmia such as atrial fibrillation, atrial flutter, heart block or a ventricular arrhythmia may be present due to an electrolyte imbalance.
Neck: Jugular venous distension with a prominent Y descent and Kussmaul's sign
Chest: Ewart's sign may be present. This includes a pericardial knock, pericardial rub(heard best while leaning forwards) and distant heart sounds
Abdomen: Hepatomegaly, ascites
Extremities: Ankle edema
References
- ↑ Bailey GL, Hampers CL, Hager EB, Merrill JP (1968). "Uremic pericarditis. Clinical features and management". Circulation. 38 (3): 582–91. PMID 5673609.
- ↑ Rutsky EA, Rostand SG (1987). "Treatment of uremic pericarditis and pericardial effusion". Am J Kidney Dis. 10 (1): 2–8. PMID 3605080.
- ↑ Gunukula SR, Spodick DH (2001). "Pericardial disease in renal patients". Semin Nephrol. 21 (1): 52–6. PMID 11172559.