Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

INTRODUCTION@#Despite reports suggesting an association between COVID-19 mRNA vaccination and pericarditis and myocarditis, detailed nationwide population-based data are sparsely available. We describe the incidence of pericarditis and myocarditis by age categories and sex after COVID-19 mRNA vaccination from a nationwide mass vaccination programme in Singapore.@*METHODS@#The incidence of adjudicated cases of pericarditis and myocarditis following COVID-19 mRNA vaccination that were reported to the vaccine safety committee between January to July 2021 was compared with the background incidence of myocarditis in Singapore.@*RESULTS@#As of end July 2021, a total of 34 cases were reported (9 pericarditis only, 14 myocarditis only, and 11 concomitant pericarditis and myocarditis) with 7,183,889 doses of COVID-19 mRNA vaccine administered. Of the 9 cases of pericarditis only, all were male except one. The highest incidence of pericarditis was in males aged 12-19 years with an incidence of 1.11 cases per 100,000 doses. Of the 25 cases of myocarditis, 80% (20 cases) were male and the median age was 23 years (range 12-55 years) with 16 cases after the second dose. A higher-than-expected number of cases were seen in males aged 12-19 and 20-29 years, with incidence rates of 3.72 and 0.98 case per 100,000 doses, respectively.@*CONCLUSION@#Data from the national registry in Singapore indicate an increased incidence of pericarditis and myocarditis in younger men after COVID-19 mRNA vaccination.

Tratamiento quirúrgico de la pericarditis purulenta: reporte de un caso / Surgical treatment of purulent pericarditis: report of a case

Resumen Introducción: La pericarditis es la enfermedad del pericardio más presente en la práctica médica. La pericarditis purulenta representa el 5% de ellas, con una mortalidad de hasta el 40%. Caso Clínico: Se presenta un paciente masculino, de 27 años de edad, con antecedentes de hipotiroidismo que ingresa con tos y expectoración amarillenta, asociado a fiebre, que resolvió con tratamiento antibiótico. Un mes después, reingresa con dolor abdominal, astenia y disnea intensa que no tolera el decúbito. Se indica ecocardiograma, que diagnostica derrame pericárdico severo, con colapso de cavidades derechas. Se procedió a pericardiocentesis de emergencia, donde se extrajeron 450 mililitros de líquido purulento. En el seguimiento ecocardiográfico a las 48 h, se observa aumento del derrame, por lo que se decide tratamiento quirúrgico, mediante toracotomía anterolateral izquierda, encontrando derrame purulento y engrosamiento pericárdico de 6 mm, con múltiples adherencias. Se indica pericardiectomía parcial. El paciente evolucionó favorablemente, egresándose 7 días posteriores a la cirugía.

Introduction: Pericarditis is frecuent pericardial disease in medical practice. The purulent pericarditis represents 5%, with a mortality of up to 40%. Case Report: We present a male patient, 27 years old, with a history of hypothyroidism that enters with cough and yellowish expectoration, associated with fever, resolved with antibiotic treatment. One month later, he reenters with abdominal pain, asthenia and intense dyspnea that does not tolerate decubitus. Echocardiogram diagnosed severe pericardial effusion, with collapse of right cavities. Emergency pericardiocentesis was performed and 450 milliliters of purulent fluid were extracted. In the echocardiographic follow-up at 48 hours, an increase in the effusion was observed, was decided surgical treatment by left anterolateral thoracotomy, finding purulent effusion and pericardial thickening of 6 mm, with multiple adhesions. Partial pericardiectomy is indicated. The patient evolved favorably, leaving 7 days after surgery.

Cardiac involvement in Sudanese children with connective tissue disease

Connective tissue diseases [CTD] are associated with a variable range of cardiac abnormalities. We identified all patients with CTD and cardiac involvement seen at Jafar Ibn Ouf Children's Hospital and the Sudan Heart Centre by one cardiologist between Jan 2005 and January 2010. Clinical and echocardiographic evaluations were done and arranged consultation with rheumatologist. Nine patients were identified, three males and six females. Five patients [62%] were initially seen by the cardiologist and CTD was suspected by clinical examination in four patients and in one patient diagnosed by routine screening during workup for pulmonary hypertension. Symptoms were present for one month to 3 years before presentation to the cardiologist. In three patients [30%] the cardiac symptoms preceded the rheumatological symptoms. In one patient, aortic valve replacement for presumed rheumatic aortic regurgitation preceded arthritis by 12 months. Patients with CTD may present first to the cardiologist with findings that mimic common cardiac lesions. All patients with CTD should have routine evaluation by the cardiologist so as to implement optimal early interventions

Hemorrhagic pericarditis with cardiac tamponade after percutaneous coronary intervention associated with the use of abciximab

Glycoprotein (GP) IIb/IIIa inhibitors, such as abciximab, are used as adjunctive therapy for percutaneous coronary intervention (PCI) in high-risk non-ST-elevation myocardial infarction (NSTEMI) and in ST-elevation myocardial infarction (STEMI), although their effects when used for STEMI are less clear. As the use of GP IIb/IIIa inhibitors becomes more widespread, determining the risks associated with them becomes more important. The major risks associated with the use of GP IIb/IIIa inhibitors are the potential for major bleeding and thrombocytopenia. This is the first reported case in Korea of hemorrhagic pericarditis resulting in cardiac tamponade associated with the use of abciximab, a commonly used GP Ilb/IIa inhibitor, following PCI.

Presentación clínica y evolución alejada de los derrames pericárdicos crónicos severos idiopáticos / Clinical presentation and long-term outcome of severe chronic idiopathic pericardial effusion

Objetivo: Determinar la frecuencia, la presentación clínica, los métodos diagnósticos, el tratamiento,la evolución y el pronóstico alejado en pacientes con derrame pericárdico crónico severo idiopático. Material y métodos: Se analizaron prospectivamente todos los pacientes con sospecha de derrame pericárdicosevero, desde junio de 1992 a abril de 2005. Fueron evaluados de acuerdo con un protocolo de enfermedad pericárdica que se aplica en nuestra Institución. De un total de 152 pacientes, 54 presentaron derrame crónico severo, de los cuales 28 (52 por ciento) fueron catalogados como idiopáticos e incluidos en el presente estudio. Resultados: La edad media fue de 67 ± 11 años, el 82 por ciento eran hombres, 25 (89,3 por ciento) se encontraban sintomáticos por disnea, 4 (16 por ciento) con taponamiento cardíaco y 10 (35,7 por ciento) con signos ecocardiográficos incipientes de taponamiento. El seguimiento promedio fue de 60 meses (3-128 meses). Los 3 pacientes asintomáticos no fueron drenados y tuvieron una evolución favorable (seguidos en promedio durante 42 meses). Los 25 pacientes sintomáticos se trataron con drenaje pericárdico y se realizó seguimiento en 23 (2 perdidos). En 14 (60,8 por ciento) de ellos no hubo recidiva de derrame, 3 (13 por ciento) presentaron derrame leve, 2 (8,6 por ciento) derrame moderado y 4 (17,2 por ciento) derrame severo. De estos últimos, 3 estaban con disnea III-IV, por lo que requirieron pericardiectomía, con buena evolución ulterior. El paciente restante permaneció asintomático. Conclusiones: Los pacientes con derrame pericárdico crónico severo idiopático pueden permanecer asintomáticos durante largo tiempo. El drenaje pericárdico es eficaz en la mayoría de los casos en los que se desarrollan síntomas graves. En los pacientes sintomáticos con recidivas de derrame severo posterior al drenaje, la pericardiectomía resulta una solución eficaz.

Objective: To assess the frequency, clinical presentation, diagnostic methods, treatment, outcome and long-term prognosis of patients with severe chronic idiopathic pericardial effusion. Material and Methods All patients in whom severe pericardial effusion was suspected were assessed prospectively from June 1992 to April 2005, using our Institution’s protocol for the evaluation of pericardial disease. Of a total of 152 patients, 54 had severe chronic pericardial effusion; in 28 of them (52%) the effusion was categorized as idiopathic and they were hence included in this study. Results Mean age was 67 ± 11 years and 82% were men; 25 (89.3%) were symptomatic due to dyspnea, 4 (16%) had cardiac tamponade and 10 (35.7%) had incipient echocardiographic signs of cardiac tamponade. Mean follow-up was 60 months (3- 128 months). The three asymptomatic patients were not drained and had a favorable outcome (mean follow-up, 42 months). The 25 symptomatic patients were treated with pericardial drainage and 23 were followed (2 patients were lost to follow-up). In 14 patients (60.8%) there was no evidenceof recurrent effusion, 3 (13%) had mild effusion, 2 (8.6%) had moderate effusion and 4 (17.2 %) had severe effusion. Of these 4 latter patients, 3 had dyspnea FC III-IV, and thus required pericardiectomy, with a good subsequent outcome. The other patient remained asymptomatic. Conclusions Patients with severe chronic idiopathic pericardial effusion may remain asymptomatic for long periods of time. In most patients who develop severe symptoms, pericardial drainage is effective. In symptomatic patients with recurrence of severe effusion after drainage, pericardiectomy offers an effective solution.

[Acute pericarditis: clinical and etiological aspects-about 35 cases]

This study is a retrospective one learning over 35 cases of a acute pericarditis accepted in the service of cardiology "B" of the CHU Ibn Sina in Rabat during a period spreaded between January 2002 to December 2003. The echocardiography has found a medium diameter of effusion of 30 +/- 13 mm with pre-tamponnad signs in 31% of cases. The tubercular etiology was the first cause of acute pericarditis, followed by the viral causes, after we find the idiopathic case. The tumoral etiology was found in three cases and in one of them a purulent pericarditis. The tuberculosis was suspected by strong arguments but the histological confirmation was only done on two patients. The treatment was abrove all etiologic, mean while the evacuation of the effusion was indicated like an urgence in the case of bad hemodynamical tolerance. The corticotherapy has been systematically associated to the antibacillary treatment even if its part is 'controversial. The evolution in the short run was positive in 71% of cases. Four deaths have been recorded. The evolution in the long term wasn't studied. The acute pericarditis is characterized by its non specific clinical aspect but by varied etiological profile turned up of infections tumoral metabolical causes, general or idiopathic, but in our context the tubercular cause remains the most frequent

Reporte de un caso de pericarditis hemorrágica y taponamiento cardíaco asociados a lupus eritematoso sistémico / Hemorrhagic pericarditis and cardiac tamponade in systemic lupus erythematosus. A case report

El lupus eritematoso sistémico es una enfermedad autoinmune inflamatoria capaz de afectar cualquier aparato y sistema. Aunque la pericarditis es la manifestación cardíaca más frecuentemente observada, usualmente no es una situación que comprometa la vida del paciente. El taponamiento cardíaco ocasionado por derrame pericárdico en el lupus es una situación extremadamente rara, con una incidencia no mayor al 2%. Informamos el caso de una mujer de 21 años de edad con taponamiento cardíaco por lupus eritematoso sistémico, asociado a glomerulonefritis rápidamente progresiva, pancreatitis aguda, colecistitis aguda acalculosa, derrame pleural y actividad lúpica hematológica, cutánea y neurológica. El reconocimiento oportuno de esta rara manifestación del lupus puede salvar la vida de un paciente.

Systemic lupus erythematosus is a chronic inflammatory autoimmune disorder that can affect any organ or system. Although pericarditis is the most frequent cardiac manifestation of this entity, usually is not a life threatening situation. Pericardial effusion causing cardiac tamponade is a very rare complication in lupus, with an incidence less than 2%. We report a case of pericardial tamponade due to SLE with severe hemodynamic involvement in a 21-year-old woman associated to rapidly progressive glomerulonephritis, acute pancreatitis, acute acalculous cholecystitis, pleural effusion, hematologic, cutaneous and neurologic lupus activity. Recognition of this rare manifestation of SLE may be life saving.

Pericardite: série de 84 casos consecutivos / Pericarditis: series of 84 consecutive cases

OBJETIVO: Identificar características clínicas, laboratoriais e ecocardiográficas diferenciais em indivíduos com diagnóstico de pericardite secundária e idiopática. MÉTODOS: De janeiro/1999 a dezembro/2001, foram identificados 84 pacientes com diagnóstico clínico e ecocardiográfico de pericardite em clínica de cardiologia. Foram estudados, retrospectivamente, quanto à idade, sexo, características antropométricas, hábitos, pressão arterial casual, causas potenciais, comorbidades, sinais e sintomas, medicação e complicações. Os indivíduos foram divididos em 2 grupos: grupo A constituído de 61 pacientes com causas potenciais conhecidas e grupo B com 23 casos considerados idiopáticos. Os grupos foram comparados, utilizando-se o teste do Qui-quadrado, considerando-se estatisticamente significativas as associações com p < 0,05. RESULTADOS: Os dois grupos foram semelhantes quanto à idade, sexo, medidas antropométricas, hábitos e pressão arterial casual. No grupo B, 23 (100 por cento) casos foram diagnosticados entre os meses de abril e agosto contra 24 (39,4 por cento) no mesmo período no grupo A (p<0,01). No grupo B, 23 (100 por cento) pacientes receberam vacina antiinfluenza previamente contra nenhum no grupo A. Dispnéia (p=0,02) e edema (p=0,01) foram mais freqüentes no grupo A, enquanto fadiga foi mais referida no grupo B (p=0,01). No manejo terapêutico, administrou-se antiinflamatórios não esteróides (AINE) em 5 (8,2 por cento) pacientes do grupo A e em 19 (82,6 por cento) do grupo B (p=0.01). CONCLUSAO: Os pacientes com pericardite idiopática receberam aplicação prévia de vacina antiinfluenza, apresentaram-se com distribuição sazonal, tiveram menor prevalência de comorbidades, sintomatologia menos exuberante e foram tratados principalmente com AINE.

Pericardite aguda pós-influenza ou pós-vacina antiinfluenza: atualização / Acute pericarditis following Influenza infection or vaccine: update

As pericardites com etiologias idiopática e viral se confundem. Nem sempre existem achados clínicos que distinguem uma da outra, e é provável que muitos casos de pericardite idiopática sejam causados por infecções virais não reconhecidas. A influenza, virose que acomete principalmente o trato respiratório, pode também desencadear complicações cardíacas, como miocardites e pericardites. Por sua potencialidade mórbida, tem sido, nos últimos anos, alvo de campanhas nacionais de imunização por vacina. A pericardite pós-influenza e a pericardite pósvacina antiinfluenza são doenças cada vez mais enfrentadas pelo médico. O presente trabalho objetiva revisar a literatura mundial, fazendo uma atualização do tema delimitado

Acute rheumatic fever in Jordanian children

Rheumatic fever remains a significant health problem in Jordan. We retrospectively reviewed medical charts of 28 boys and 22 girls [mean age at presentation 10.5 +/- 2.6 years] with confirmed diagnosis based on modified Jones criteria at Queen Alia Heart Institute from February 1999 to February 2002. Arthritis was the commonest major manifestation [88%; 68% migratory], carditis was second commonest [48%; 8% silent carditis] and chorea was seen in 6%. None had subcutaneous nodules or erythema marginatum. The mitral valve was most commonly affected [80%]; both mitral and aortic valves were affected in 25%. Pericarditis was seen in 12.5% and acute congestive heart failure in 4%. Practitioners should be aware of diverse clinical presentations and emphasize strict adherence to prophylaxis guidelines

Clinicopathological, ultrasonographic and pericardiocentesis findings in cattle and buffaloes with traumatic reticulo-peritonitis and pericarditis

Thirty animals [17 cows and 13 buffalos] with traumatic reticulo- peritonitis [TRP] and pericarditis [TP] and 10 apparently healthy animals [5 cows and 5 buffalos] [control group] were included in the present study. In cases suspected to have traumatic reticulo- pericarditis, ultrasonography and pericardiocentesis for pericardial fluid analysis were evaluated as ancillary diagnostic aids. The obtained findings were discussed. It was concluded that ultrasonography was the most safe, useful, reliable and confirmatory aid in the diagnosis of traumatic reticulo-peritonitis and pericarditis. Pericardiocentesis should also be considered as the last invasive diagnostic index

Endocarditis and pericarditis caused by Salmonella paratyphi A: two case reports and review of the literature.

We report on two children with paratyphoid fever and rare cardiac complications (endocarditis and pericarditis) during an outbreak of Salmonella paratyphi A infection in Bangkok, Thailand, in 1996. Both of the patients had underlying congenital heart disease. Two cases in the literatures of endocarditis and five cases of pericarditis caused by Salmonella paratyphi were reviewed. These rare cardiac complications should be considered among persons who reside in an endemic area of enteric fever or during disease outbreaks, especially in children with underlying heart diseases.

Pericardite por colesterol: uma causa específica, porém rara de doença pericárdica / Cholesterol pericarditis. A specific but rare cause of pericardial disease

During a diagnostic investigation in a 40-year-old male with pericardial effusion associated with hypothyroidism, cholesterol pericarditis was detected. We report a brief review on the etiopathogeny, clinical findings, and therapeutical possibilities of this entity