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The onset of purulent pericarditis is usually acute, with most individuals presenting to a medical facility approximately 3 days following the onset of symptoms. [4] As a subtype of pericarditis, purulent pericarditis often presents with substernal chest pain that is exacerbated by deep breathing and lying in the supine position. [5]
Uremic pericarditis is associated with azotemia, and occurs in about 6-10% of kidney failure patients. BUN is normally >60 mg/dL (normal is 7–20 mg/dL). However, the degree of pericarditis does not correlate with the degree of serum BUN or creatinine elevation. The pathogenesis is poorly understood. [2]
[4] [5] Diagnosis is based on the presence of chest pain, a pericardial rub, specific electrocardiogram (ECG) changes, and fluid around the heart. [6] A heart attack may produce similar symptoms to pericarditis. [1] Treatment in most cases is with NSAIDs and possibly the anti-inflammatory medication colchicine. [6]
For acute pericarditis to formally be diagnosed, two or more of the following criteria must be present: chest pain consistent with a diagnosis of acute pericarditis (sharp chest pain worsened by breathing in or a cough), a pericardial friction rub, a pericardial effusion, and changes on electrocardiogram (ECG) consistent with acute pericarditis ...
The diagnosis may be further supported by specific electrocardiogram (ECG) changes, chest X-ray, or an ultrasound of the heart. [2] If fluid increases slowly the pericardial sac can expand to contain more than 2 liters; however, if the increase is rapid, as little as 200 mL can result in tamponade. [2] Tamponade is a medical emergency. [5]
Initial tests include electrocardiography (ECG) and chest x-ray. Chest x-ray: is non-specific and may not help identify a pericardial effusion but a very large, chronic effusion can present as "water-bottle sign" on an x-ray, which occurs when the cardiopericardial silhouette is enlarged and assumes the shape of a flask or water bottle. [2]
With cardiac tamponade, jugular veins are distended and typically show a prominent x descent and an absent y descent as opposed to patients with constrictive pericarditis (prominent x and y descent); see Beck's triad. [1] Other possible causes of Kussmaul's sign include: [2] [citation needed] Right ventricular infarction - low ventricular ...
There are multiple locations that pericardiocentesis can be performed without puncturing the lungs. [9] In the past, the standard location was through the infrasternal angle and is also called subxiphoid approach. [5] [9] The needle is inserted at an angle between 30 and 45 degrees to the chest 1 cm inferior to the left xiphocostal angle. [2] [10]