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The register of pericarditis in the university therapeutic clinic: nosological spectrum, approaches to diagnosis and treatment

Session Poster Session 3

Speaker Olga Blagova

Congress : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Myocardial Disease - Clinical
  • Session type : Poster Session
  • FP Number : P1807

Authors : O V Blagova (Moscow,RU), AV Nedostup (Moscow,RU), EA Kogan (Moscow,RU), GY Sorokin (Moscow,RU), VP Sedov (Moscow,RU), ND Sarkisova (Moscow,RU)

Authors:
O V Blagova1 , AV Nedostup1 , EA Kogan1 , GY Sorokin1 , VP Sedov1 , ND Sarkisova1 , 1I.M.Sechenov I Moscow State Medical University - Moscow - Russian Federation ,

Citation:

Purpose: to analyze the register of pericarditis in the therapeutic clinic, to evaluate their nosological spectrum, approaches to diagnosis and treatment.

Methods. In 2007-2018, seventy-one patients from 20 to 85 years (52.5±16.1 years), 42 women, were diagnosed with pericarditis. Patients with congestive effusion and isolated hypothyroidism were not included. Diagnostic puncture of the pericardium was carried out in 4 patients, pleural puncture - in 10 patients. Morphological diagnostics included endomyocardial / intraoperative myocardial biopsy (n = 4), thoracoscopic / operative biopsy of the pericardium (n = 5), pleura (n = 5), intrathoracic and supraclavicular lymph nodes (n = 3), lung (n = 1), salivary gland (n = 1), fat (n = 5). Also carried out investigation of viral DNA, the anti-heart antibodies, CRP, ANA, rheumatoid factor, anti-CCP, ANCA, ENA, immunophoresis of proteins, CT, MRI, phthisiatric study, oncological search. The follow-up was 12 [2; 36] months (up to 10 years).

Results. Pericarditis with a large effusion (from 2 cm) was diagnosed in 18 patients, with an average (10-19 mm) in 22, with a small one in 26, and without effusion in 5. The following forms of pericarditis were verified: tuberculosis (14.1%), viral-immune (14.1%, incl. 5.6% with hypertrophic cardiomyopathy) and infectious-immune (36.6%, incl. 26.8% with myocarditis), due to lymphoma and heart tumor (2.8%), sarcoidosis (2.8%), systemic diseases (lupus erythematosus, rheumatoid arthritis, polymyositis, Horton's, Takayasu, Sjogren's diseases, 12.7%, incl. with myocarditis in 56%, virus-positive in two patients), in patients with CHD (after punctures for Dressler's syndrome, bypass surgery and stenting, 4.2%). Pericarditis due to AL-amyloidosis, Loeffler's endocarditis, leukoclastic vasculitis, thrombotic microangiopathy, after ablation, aortic valve replacement, radiation and chemotherapy had one patient each (1.4%). In one case the diagnosis remained unclear. The signs of constriction were diagnosed in 13 patients (18.3%), its leading causes were tuberculosis (38%). The main types of treatment were steroids (n = 23), their combination with cytostatics (n = 12), tuberculostatics (n = 10), acyclovir / ganciclovir (n = 7), hydroxychloroquine (n = 15), colchicine (n = 9), NSAIDs (n = 8), incl. combined treatment in 27 patients. Excellent results (disappearance of effusion, absence of relapses and constriction) were achieved in 51.9% of patients, stable results - in 32.7%, and no result - in 15.4% (in 6 patients pericardectomy was performed). The mortality rate was 12.7% (9 patients) due to heart failure, surgery, PE, tumors. The conclusion. The nature of pericarditis can be established in most patients. Due to low availability of the pericardial puncture the role of other methods of cytological and morphological diagnostics is significantly increased. The predominant forms of pericarditis were tubercular, infectious-immune and pericarditis in systemic immune diseases.

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