Síndrome de Brugada asociado a pericarditis aguda / Brugada syndrome associated to acute pericarditis

Resumen Comunicamos el caso de un hombre de 56 años que ingresó por pericarditis aguda febril, probablemente de causa viral, que durante su evolución presentó una fibrilación auricular paroxística y taquicardia ventricular polimorfa recurrente. El análisis de la historia clínica y serie electrocardiográfica permitió el diagnóstico retrospectivo asociado de un síndrome de Brugada. Hubo buena respuesta inicial al tratamiento antiinflamatorio asociado a colchicina y se implantó un desfibrilador automático intracavitario para prevención de muerte súbita. Se discuten aspectos clínicos del síndrome de Brugada, la importancia de la fiebre y de la pericarditis como cuadro clínico asociado.

Abstract A 56-year-old patient was admitted for acute febrile pericarditis, probably viral, who presented with paroxysmal atrial fibrillation and recurrent polymorphic ventricular tachycardia during his clinical course. Analysis of the clinical and electrocardiographic findings allowed the retrospective diagnosis of Brugada syndrome in the context of pericarditis. An initial response to anti-inflammatory treatment associated with colchicine was good. An internal cardioverter defibrillator was implanted to prevent sudden death. Clinical aspects of the Brugada syndrome, the importance of fever and pericarditis as an associated clinical condition are discussed.

Pericarditis aguda complicada con derrame pericárdico: Caso clínico pediátrico / Acute pericarditis, complicated by pericardial effusion in a pediatric patient: case report

La pericarditis aguda es la enfermedad más común del pericardio en la práctica clínica. Supone el 0,1% de todos los ingresos hospitalarios y hasta un 5% de aquellos por dolor torácico. En países desarrollados, la causa suele ser benigna, y son más frecuentes las idiopáticas e infecciosas que las secundarias a pericardiotomía quirúrgica y neoplasias. La tuberculosis es la causa más importante en países en vías de desarrollo. Los síntomas más comunes son el dolor torácico característico y la fiebre. Debido a su benignidad y buena evolución con reposo y tratamiento médico, se puede controlar de forma ambulatoria, teniendo presentes aquellos signos de alarma para vigilar o pacientes de riesgo para evitar complicaciones (derrames importantes, taponamiento cardíaco, recurrencias, etc.). Presentamos un caso clínico de un niño de 7 años con antecedentes de comunicación interauricular cerrada quirúrgicamente 9 meses antes, con un cuadro de pericarditis aguda de evolución favorable.

Acute pericarditis is the most common disease of the pericardium encountered in clinical practice. It is diagnosed in 0.1% of all admissions and 5% of emergency room admissions for chest pain. In developed countries, it is usually due to a benign cause. Idiopathic and infectious pericarditis are more common than secondary to surgical pericardiotomy or neoplastic causes, whereas tuberculosis is the dominant cause in developing countries. The most common symptoms of pericarditis are characteristic chest pain and fever. Since pericarditis presents a benign outcome because of self-limiting and good response to conventional anti-inflammatory therapy, it can be safely managed on outpatient basis unless a specific cause is suspected or the patient has high-risk features to avoid complications such as pericardial effusion, cardiac tamponade or recurrent pericarditis. We report a case of pericarditis, diagnosed 9 months after surgical closure of an atrial septal defect, in a 7-year-old boy with favorable evolution.

Acute pericarditis / Pericardite aguda

Summary Acute pericarditis is a common disease caused by inflammation of the pericardium, usually benign and self-limited and can occur as an isolated or as a manifestation of a systemic disease entity. Represents 5% of all causes of chest pain in the emergency room. The main etiology are viral infections, although it can also be secondary to systemic diseases and infections. The main complication of acute pericarditis is pericardial effusion, triggering a cardiac tamponade. The first line of treatment is the use of anti-inflammatory and or acetylsalicylic acid. Most patients have a good initial response to an NSAID associated to colchicine and became asymptomatic within a few days. This review article seeks to contemplate the main clinical findings and armed investigation to optimize the diagnosis of this important disease, as well as addressing their therapeutic management.

Resumo A pericardite aguda é uma doença comum causada pela inflamação do pericárdio, geralmente benigna e autolimitada, podendo ocorrer como entidade isolada ou como manifestação de uma patologia sistêmica. Representa 5% de todas as causas de dor torácica na sala de emergência. A principal etiologia são as infecções virais, embora também possa ser secundária a afecções sistêmicas. A principal complicação da pericardite aguda é o derrame pericárdico, desencadeando um tamponamento. A primeira linha de tratamento é uso de anti-inflamatórios ou ácido acetilsalicílico. A maioria dos pacientes tem boa resposta inicial a um anti-inflamatório não esteroide (AINE) associado à colchicina e torna-se assintomática em poucos dias. Este artigo busca contemplar os principais achados clínicos e de propedêutica armada para otimizar o diagnóstico dessa patologia, bem como abordar o seu manejo terapêutico.

Primary Malignant Pericardial Mesothelioma Presenting as Acute Pericarditis

We report on a 21-year-old man with fever, dyspnea, and pleuritic chest pain. An electrocardiography showed ST elevation in multiple lead and thoracic echocardiography revealed moderate pericardial effusion. He was initially diagnosed with acute pericarditis, and treated with nonsteroidal anti-inflammatory drugs and colchicines with clinical and laboratory improvement. After 1 month of medication, his symptoms recurred. An echocardiography showed constrictive physiology and the patient was treated with steroid on the top of current medication. The patient had been well for 7 months until dyspnea and edema developed, when an echocardiography showed marked increased pericardial thickness and constriction. Pericardial biopsy was performed and primary malignant pericardial mesothelioma was diagnosed. Malignancy should be considered in the differential diagnosis of recurrent pericarditis.

Primary Malignant Pericardial Mesothelioma Presenting as Acute Pericarditis

We report on a 21-year-old man with fever, dyspnea, and pleuritic chest pain. An electrocardiography showed ST elevation in multiple lead and thoracic echocardiography revealed moderate pericardial effusion. He was initially diagnosed with acute pericarditis, and treated with nonsteroidal anti-inflammatory drugs and colchicines with clinical and laboratory improvement. After 1 month of medication, his symptoms recurred. An echocardiography showed constrictive physiology and the patient was treated with steroid on the top of current medication. The patient had been well for 7 months until dyspnea and edema developed, when an echocardiography showed marked increased pericardial thickness and constriction. Pericardial biopsy was performed and primary malignant pericardial mesothelioma was diagnosed. Malignancy should be considered in the differential diagnosis of recurrent pericarditis.

The usefulness of adenosine deaminase in the diagnosis of tuberculous pericarditis

The objective of this study was to evaluate the adenosine deaminase (ADA) activity usefulness in the diagnosis of tuberculous pericarditis (TP), comparing its value with pericardial effusions (PE) caused by other pericardial diseases. A retrospective case-control study was conducted with nine cases of TP and 39 other than TP diseases (12 neoplastic, 11 septic and 16 unknown origin). Every patient included in this study had PE samples submitted to ADA activity measures and microbiological analysis, and then had pericardial tissue samples submitted to microbiological and histopathological examination. Considering the value of 40 U/L as the cut-off for the diagnosis of TP, the specificity and sensitivity were respectively of 72 percent and 89 percent. The specificity of ADA activity for the TP was best applied in the differential diagnosis from PE of unknown origin. The present study demonstrates the clinical value of the measurement of ADA activity in PE in the diagnosis of TP.

O objetivo deste estudo foi avaliar a atividade da adenosina deaminase (ADA) como auxiliar no diagnóstico da tuberculose pericárdica (TP), comparando o seu valor no derrame pericárdico com outras doenças pericárdicas. Um estudo retrospectivo tipo caso-controle foi conduzido com nove casos de TP e 39 pacientes com outras doenças pericárdicas (12 neoplasias, 11 pericardites bacterianas e 16 pericardites de etiologia indeterminada). Cada paciente incluído no estudo teve sua amostra de tecido pericárdico encaminhada para estudo microbiológico e histopatológico. Considerando o valor de 40 U/L como corte para o diagnóstico de TP, a especificidade e sensibilidade foram respectivamente 72 e 89 por cento. A especificidade da atividade de ADA para a TP foi melhor aplicada no diagnóstico diferencial entre derrame pericárdico de origem indeterminada. O presente estudo demonstrou o valor clínico da mensuração da atividade de ADA no diagnóstico de TP.

A Case of Acute Pericarditis in Patient with Miliary Tuberculosis

Acute pericarditis usually presents with chest pain and diffuse ST segment elevation on ECG. Several reports indicate that large numbers of patients with a diagnosis of acute pericarditis have elevated troponin I, a sensitive and highly specific marker for cardiac injury, and this suggests a high incidence of concomitant, otherwise, silent myocarditis. This case patient had elevated troponin I which is a biomarker of myocardial injury and injury pattern of ST segment elevation on ECG accompanied in military tuberculosis.

A Case of Acute Pericarditis in Patient with Miliary Tuberculosis

Acute pericarditis usually presents with chest pain and diffuse ST segment elevation on ECG. Several reports indicate that large numbers of patients with a diagnosis of acute pericarditis have elevated troponin I, a sensitive and highly specific marker for cardiac injury, and this suggests a high incidence of concomitant, otherwise, silent myocarditis. This case patient had elevated troponin I which is a biomarker of myocardial injury and injury pattern of ST segment elevation on ECG accompanied in military tuberculosis.