This document discusses the treatment of acute pericarditis. It notes that the goals of treatment are relieving pain, resolving inflammation and preventing recurrence. The general approach involves ambulatory care for low-risk patients and hospitalization for high-risk patients. Treatment typically involves a combination of NSAIDs and colchicines, with glucocorticoids as an alternative. Activity restriction is also recommended until symptoms resolve. Factors that increase risk and may require hospitalization include fever, large pericardial effusions, and failure to improve with NSAIDs/colchicines.
This document discusses pericardial diseases, including their diagnosis and management. It covers several conditions such as acute pericarditis, pericardial effusion, and cardiac tamponade. It describes the signs, symptoms, diagnostic criteria, and treatment approaches for each condition. The document provides detailed information on evaluating, diagnosing, and managing common pericardial diseases.
The document provides information on pericarditis, including its causes, classification, diagnosis, and treatment recommendations. It discusses the pericardium and different pericardial syndromes such as pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis. For acute pericarditis, it recommends ECG for diagnosis and NSAIDs for treatment. It provides treatment durations and tapering schedules for recurrent pericarditis. The document also discusses pericardial effusion classifications, diagnosis, and management recommendations. It outlines diagnostic criteria and treatment for cardiac tamponade and constrictive pericarditis.
This document discusses pericardial diseases. It begins by defining the pericardium and its layers. The main types of pericardial syndromes encountered in clinical practice are then summarized as pericarditis, pericardial effusion, cardiac tamponade, constrictive pericarditis, and pericardial masses. Epidemiology, aetiology, classification, and specific syndromes like acute pericarditis are then explored in more detail over several sections. Therapies for different conditions are discussed, including acute pericarditis, recurrent pericarditis, and pericarditis associated with myocardial involvement.
This document provides information on dental management of patients with cardiac conditions. It begins by outlining intended learning objectives which are to recognize systemic diseases requiring special consideration before dental treatment, collect relevant medical data from patients, differentiate between cardiac and cardiovascular diseases, and determine appropriate dental management for patients with cardiovascular diseases. It then discusses classifying a patient's physical status using ASA classifications. The document provides details on management of specific cardiac conditions like ischemic heart disease, valvular diseases, congestive heart failure, and infections like infective endocarditis. It also discusses conditions like rheumatic fever, heart murmurs, hypertension, and the use of pacemakers. Guidelines are provided for preoperative investigations, classifications of diseases, dental treatment modifications
The document discusses different types of shock including their causes, pathogenesis, and management. It defines shock as an imbalance between oxygen supply and demand resulting in organ dysfunction. The main types are distributive, cardiogenic, obstructive, and hypovolemic shock. Septic shock is discussed in depth including its pathogenesis involving an inflammatory response to infection, diagnostic criteria using SOFA and qSOFA scores, and elements of care including resuscitation, infection control, and supportive therapies. Cardiogenic shock is defined as a low cardiac output state resulting from various cardiac causes such as myocardial infarction. Hypovolemic shock reduces cardiac output through a decrease in preload from losses such as hemorrhage.
Periodontal treatment for medically compromised patientsDr.IA.AYISHA TALAT
A detailed and very accurately explained the treatment of periodontal diseases in medically compromised patients.
And explains the connection between the various systems of the human body and oral health.
1. Hypovolemic shock is caused by a reduction in blood volume from bleeding, dehydration, or fluid shifts. It results in decreased cardiac output and blood pressure leading to low tissue perfusion. Treatment involves replacing fluid and blood volume.
2. Cardiogenic shock occurs when the heart cannot adequately pump blood, often due to a heart attack. It causes low blood pressure and tissue hypoxia. Treatment focuses on correcting the underlying cause and supporting hemodynamics.
3. Septic shock results from a widespread infection that activates an inflammatory response impairing tissue perfusion. Treatment involves antibiotics, fluid resuscitation, and controlling the infection.
This document discusses pericardial diseases, including their diagnosis and management. It covers several conditions such as acute pericarditis, pericardial effusion, and cardiac tamponade. It describes the signs, symptoms, diagnostic criteria, and treatment approaches for each condition. The document provides detailed information on evaluating, diagnosing, and managing common pericardial diseases.
The document provides information on pericarditis, including its causes, classification, diagnosis, and treatment recommendations. It discusses the pericardium and different pericardial syndromes such as pericarditis, pericardial effusion, cardiac tamponade, and constrictive pericarditis. For acute pericarditis, it recommends ECG for diagnosis and NSAIDs for treatment. It provides treatment durations and tapering schedules for recurrent pericarditis. The document also discusses pericardial effusion classifications, diagnosis, and management recommendations. It outlines diagnostic criteria and treatment for cardiac tamponade and constrictive pericarditis.
This document discusses pericardial diseases. It begins by defining the pericardium and its layers. The main types of pericardial syndromes encountered in clinical practice are then summarized as pericarditis, pericardial effusion, cardiac tamponade, constrictive pericarditis, and pericardial masses. Epidemiology, aetiology, classification, and specific syndromes like acute pericarditis are then explored in more detail over several sections. Therapies for different conditions are discussed, including acute pericarditis, recurrent pericarditis, and pericarditis associated with myocardial involvement.
This document provides information on dental management of patients with cardiac conditions. It begins by outlining intended learning objectives which are to recognize systemic diseases requiring special consideration before dental treatment, collect relevant medical data from patients, differentiate between cardiac and cardiovascular diseases, and determine appropriate dental management for patients with cardiovascular diseases. It then discusses classifying a patient's physical status using ASA classifications. The document provides details on management of specific cardiac conditions like ischemic heart disease, valvular diseases, congestive heart failure, and infections like infective endocarditis. It also discusses conditions like rheumatic fever, heart murmurs, hypertension, and the use of pacemakers. Guidelines are provided for preoperative investigations, classifications of diseases, dental treatment modifications
The document discusses different types of shock including their causes, pathogenesis, and management. It defines shock as an imbalance between oxygen supply and demand resulting in organ dysfunction. The main types are distributive, cardiogenic, obstructive, and hypovolemic shock. Septic shock is discussed in depth including its pathogenesis involving an inflammatory response to infection, diagnostic criteria using SOFA and qSOFA scores, and elements of care including resuscitation, infection control, and supportive therapies. Cardiogenic shock is defined as a low cardiac output state resulting from various cardiac causes such as myocardial infarction. Hypovolemic shock reduces cardiac output through a decrease in preload from losses such as hemorrhage.
Periodontal treatment for medically compromised patientsDr.IA.AYISHA TALAT
A detailed and very accurately explained the treatment of periodontal diseases in medically compromised patients.
And explains the connection between the various systems of the human body and oral health.
1. Hypovolemic shock is caused by a reduction in blood volume from bleeding, dehydration, or fluid shifts. It results in decreased cardiac output and blood pressure leading to low tissue perfusion. Treatment involves replacing fluid and blood volume.
2. Cardiogenic shock occurs when the heart cannot adequately pump blood, often due to a heart attack. It causes low blood pressure and tissue hypoxia. Treatment focuses on correcting the underlying cause and supporting hemodynamics.
3. Septic shock results from a widespread infection that activates an inflammatory response impairing tissue perfusion. Treatment involves antibiotics, fluid resuscitation, and controlling the infection.
Pathophysiology of shock and its managementBipulBorthakur
This document discusses different types of shock including distributive, cardiogenic, obstructive, hypovolemic, and stages of shock. It provides details on sepsis and septic shock including pathogenesis, diagnostic criteria, and elements of care. Specific types of shock like neurogenic shock, anaphylactic shock, and cardiogenic shock are also summarized. The document emphasizes early recognition and treatment of shock.
1) The document discusses pericardial diseases, beginning with the anatomy and functions of the pericardium.
2) It then covers pericarditis, including classifications, presentations, and management. Empirical anti-inflammatory therapy including NSAIDs and colchicine is recommended for acute idiopathic pericarditis.
3) Recurrent pericarditis is identified as the most common complication, occurring in 15-30% of cases, and requiring prolonged anti-inflammatory treatment.
Pericardial diseases can present as pericarditis, pericardial effusion, tamponade, constrictive pericarditis, or effusive-constrictive pericarditis. The document discusses the anatomy and functions of the pericardium, pericarditis including its classification, presentations, investigations, and management. It also covers pericardial effusion and tamponade discussing their pathophysiology, clinical features, diagnostic workup including echocardiography, and management focusing on pericardiocentesis for tamponade cases. Recurrent pericarditis and its treatment strategies are also summarized.
The document discusses pericarditis, which is inflammation of the pericardium. Acute pericarditis is the most common disorder and presents with sudden onset chest pain that worsens with breathing or coughing. A pericardial friction rub may be heard on examination. ECG findings include ST segment elevations. Treatment involves NSAIDs which typically resolves symptoms in 2 weeks. Complications include cardiac tamponade and constrictive pericarditis from scarring.
This document provides guidelines for the treatment of severe sepsis and septic shock. It discusses initial resuscitation efforts such as fluid resuscitation, vasopressor therapy, and inotropic support to achieve hemodynamic targets. It also covers antimicrobial therapy, source control measures, and infection prevention strategies that should be implemented within the first hours and days for patients with severe sepsis.
Medically compromised patients have systemic diseases or conditions that impact dental treatment. This document discusses management of common conditions like diabetes, hypertension, cardiovascular diseases, liver disorders, and respiratory diseases. For all conditions, consultation with the patient's physician is important. Procedures should be minimally invasive and avoid general anesthesia when possible. Vital signs must be monitored closely due to risk of infection or complications from medications.
1. Pericarditis is inflammation of the pericardium and is usually caused by viral or bacterial infections. It can occur acutely or become chronic.
2. The main symptoms are sudden onset of sharp chest pain that worsens with breathing or coughing. A pericardial friction rub may also be heard on examination.
3. Treatment focuses on relieving pain and inflammation, usually with NSAIDs. Corticosteroids may be used for refractory cases or certain causes like connective tissue diseases.
This document provides an overview of stroke management. It discusses the general management of ischemic stroke, intracerebral hemorrhage (ICH), and cerebral venous thrombosis (CVT). For ischemic stroke, it outlines pre-hospital management, supportive care including blood pressure and glucose control, IV thrombolysis, mechanical thrombectomy, and antiplatelet/anticoagulant treatment. For ICH, it discusses supportive care, blood pressure control, complications management, surgical treatment, and recurrence prevention. For CVT, it notes anticoagulation is the mainstay of treatment.
This document discusses gastrointestinal bleeding, focusing on upper GI bleeding (UGIB) and lower GI bleeding (LGIB). It covers the typical presentation, evaluation, and management of acute UGIB and LGIB. For UGIB, initial management involves hemodynamic stabilization, upper endoscopy to identify the source within 12 hours, and endoscopic therapy if possible. For high risk lesions, angiography or surgery may be needed. For LGIB, initial steps are the same while colonoscopy is preferred for evaluation once stable, though angiography can be used if bleeding is ongoing. Most episodes of UGIB and LGIB stop spontaneously without intervention.
Acute rheumatic fever is an autoimmune disease that can occur after a streptococcal throat infection. It commonly affects children ages 5-15 and involves the heart, joints, skin, and brain. Joint pain and heart valve damage are among the main clinical manifestations. Diagnosis is based on the Jones criteria of symptoms and a prior streptococcal infection. Treatment involves antibiotics to eliminate the bacteria, anti-inflammatory drugs like aspirin to reduce symptoms, and long-term antibiotic prophylaxis to prevent recurrence of the disease from future streptococcal infections. Those with carditis have a risk of developing rheumatic heart disease.
This document discusses guidelines for providing dental treatment to patients with various medical conditions. It covers cardiovascular diseases like hypertension, ischemic heart disease, congestive heart failure, and infective endocarditis. It also discusses renal disease, liver disease, immunosuppression, pulmonary disease, cerebrovascular accidents, and endocrine disorders like diabetes. For each condition, it provides recommendations on evaluation, risk assessment, medical consultation, anesthesia techniques, appointment length and timing, and post-operative care.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
MUCLecture_2022_12319533. Medical surgical nursing pptxssuser47b89a
1. The document discusses hypertension and coronary artery diseases. It defines hypertension and describes its pathophysiology, causes, signs and symptoms, assessment, and treatment including lifestyle changes and medications.
2. Coronary artery disease and angina pectoris are explained. Angina is caused by reduced blood flow to the heart. Its clinical manifestations and treatment including medications are outlined.
3. Myocardial infarction is summarized including its causes, clinical manifestations involving different body systems, diagnostic tests such as ECG and cardiac biomarkers, and treatment with thrombolytics, analgesics, and invasive procedures.
This document provides information on endocarditis, including:
- Endocarditis is inflammation of the inner lining of the heart caused usually by bacterial infection.
- Common causes are various bacteria and fungi transmitted through dental procedures, IV drug use, and other means.
- Risk factors include heart defects, artificial heart valves, and past endocarditis.
- Symptoms can include fever, chest pain, murmurs, and signs of heart failure.
- Treatment involves antibiotics, sometimes for 6 weeks or more, and possibly surgery for complicated cases.
- Nursing care focuses on pain management, monitoring for heart failure and embolism, giving medications and treatments correctly, and health teaching.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
1) Coronary artery disease and myocardial infarction are caused by atherosclerosis and plaque buildup in the arteries leading to ischemia. Unstable angina is a change in a previously stable pattern of chest pain and is part of the acute coronary syndrome continuum.
2) Myocardial infarction is caused by a blockage of blood flow to the heart muscle leading to cell death. It is diagnosed through electrocardiogram changes and cardiac biomarker levels. Complications include arrhythmias and heart failure.
3) Heart failure occurs when the heart can no longer pump sufficiently to meet the body's needs. It can be caused by conditions like coronary artery disease damaging the heart muscle. Types include left or right ventricular failure and
Acute coronary syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. ACS is usually caused by rupture of atherosclerotic plaque and subsequent thrombus formation, which occludes coronary arteries. Treatment involves antiplatelet therapy such as aspirin and a P2Y12 inhibitor, anticoagulation with heparin, fibrinolytic therapy for STEMI if PCI is not available, and revascularization when possible. Goals are to restore blood flow, prevent complications, and control symptoms.
1) The document discusses the anaesthetic management of patients with ischemic heart disease undergoing non-cardiac surgery. It covers preoperative evaluation and risk stratification, intraoperative management focusing on preventing myocardial ischemia, and postoperative monitoring and care.
2) Key points addressed include identifying risk factors for ischemic heart disease, evaluating functional capacity and surgical risk, optimizing hemodynamics under anesthesia, using regional anesthesia when possible, and monitoring for signs of perioperative myocardial ischemia.
3) Perioperative myocardial ischemia is often silent, but can be detected by ECG changes, hemodynamic instability, or elevated cardiac enzymes. Careful management is needed to minimize the risk of perioperative cardiac events in these high-risk patients.
This document provides an overview of rheumatic fever, including its causes, risk factors, manifestations, diagnosis, treatment, and nursing management. Rheumatic fever is an inflammatory disease that occurs after a streptococcal throat infection, usually within 2-6 weeks. It commonly affects the heart, joints, skin, and brain in children ages 5-15. The main risk is permanent heart damage known as rheumatic heart disease. Treatment involves antibiotics to eliminate strep bacteria, anti-inflammatory drugs, and long-term preventative antibiotics to reduce the risk of recurrence. Nursing care focuses on treatment compliance, recovery support, education, and prevention.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Pathophysiology of shock and its managementBipulBorthakur
This document discusses different types of shock including distributive, cardiogenic, obstructive, hypovolemic, and stages of shock. It provides details on sepsis and septic shock including pathogenesis, diagnostic criteria, and elements of care. Specific types of shock like neurogenic shock, anaphylactic shock, and cardiogenic shock are also summarized. The document emphasizes early recognition and treatment of shock.
1) The document discusses pericardial diseases, beginning with the anatomy and functions of the pericardium.
2) It then covers pericarditis, including classifications, presentations, and management. Empirical anti-inflammatory therapy including NSAIDs and colchicine is recommended for acute idiopathic pericarditis.
3) Recurrent pericarditis is identified as the most common complication, occurring in 15-30% of cases, and requiring prolonged anti-inflammatory treatment.
Pericardial diseases can present as pericarditis, pericardial effusion, tamponade, constrictive pericarditis, or effusive-constrictive pericarditis. The document discusses the anatomy and functions of the pericardium, pericarditis including its classification, presentations, investigations, and management. It also covers pericardial effusion and tamponade discussing their pathophysiology, clinical features, diagnostic workup including echocardiography, and management focusing on pericardiocentesis for tamponade cases. Recurrent pericarditis and its treatment strategies are also summarized.
The document discusses pericarditis, which is inflammation of the pericardium. Acute pericarditis is the most common disorder and presents with sudden onset chest pain that worsens with breathing or coughing. A pericardial friction rub may be heard on examination. ECG findings include ST segment elevations. Treatment involves NSAIDs which typically resolves symptoms in 2 weeks. Complications include cardiac tamponade and constrictive pericarditis from scarring.
This document provides guidelines for the treatment of severe sepsis and septic shock. It discusses initial resuscitation efforts such as fluid resuscitation, vasopressor therapy, and inotropic support to achieve hemodynamic targets. It also covers antimicrobial therapy, source control measures, and infection prevention strategies that should be implemented within the first hours and days for patients with severe sepsis.
Medically compromised patients have systemic diseases or conditions that impact dental treatment. This document discusses management of common conditions like diabetes, hypertension, cardiovascular diseases, liver disorders, and respiratory diseases. For all conditions, consultation with the patient's physician is important. Procedures should be minimally invasive and avoid general anesthesia when possible. Vital signs must be monitored closely due to risk of infection or complications from medications.
1. Pericarditis is inflammation of the pericardium and is usually caused by viral or bacterial infections. It can occur acutely or become chronic.
2. The main symptoms are sudden onset of sharp chest pain that worsens with breathing or coughing. A pericardial friction rub may also be heard on examination.
3. Treatment focuses on relieving pain and inflammation, usually with NSAIDs. Corticosteroids may be used for refractory cases or certain causes like connective tissue diseases.
This document provides an overview of stroke management. It discusses the general management of ischemic stroke, intracerebral hemorrhage (ICH), and cerebral venous thrombosis (CVT). For ischemic stroke, it outlines pre-hospital management, supportive care including blood pressure and glucose control, IV thrombolysis, mechanical thrombectomy, and antiplatelet/anticoagulant treatment. For ICH, it discusses supportive care, blood pressure control, complications management, surgical treatment, and recurrence prevention. For CVT, it notes anticoagulation is the mainstay of treatment.
This document discusses gastrointestinal bleeding, focusing on upper GI bleeding (UGIB) and lower GI bleeding (LGIB). It covers the typical presentation, evaluation, and management of acute UGIB and LGIB. For UGIB, initial management involves hemodynamic stabilization, upper endoscopy to identify the source within 12 hours, and endoscopic therapy if possible. For high risk lesions, angiography or surgery may be needed. For LGIB, initial steps are the same while colonoscopy is preferred for evaluation once stable, though angiography can be used if bleeding is ongoing. Most episodes of UGIB and LGIB stop spontaneously without intervention.
Acute rheumatic fever is an autoimmune disease that can occur after a streptococcal throat infection. It commonly affects children ages 5-15 and involves the heart, joints, skin, and brain. Joint pain and heart valve damage are among the main clinical manifestations. Diagnosis is based on the Jones criteria of symptoms and a prior streptococcal infection. Treatment involves antibiotics to eliminate the bacteria, anti-inflammatory drugs like aspirin to reduce symptoms, and long-term antibiotic prophylaxis to prevent recurrence of the disease from future streptococcal infections. Those with carditis have a risk of developing rheumatic heart disease.
This document discusses guidelines for providing dental treatment to patients with various medical conditions. It covers cardiovascular diseases like hypertension, ischemic heart disease, congestive heart failure, and infective endocarditis. It also discusses renal disease, liver disease, immunosuppression, pulmonary disease, cerebrovascular accidents, and endocrine disorders like diabetes. For each condition, it provides recommendations on evaluation, risk assessment, medical consultation, anesthesia techniques, appointment length and timing, and post-operative care.
This document discusses hypertensive crises, including definitions, epidemiology, pathophysiology, assessment, diagnosis, and management. It defines hypertensive emergencies as elevated blood pressure with acute end-organ damage, while hypertensive urgencies involve impending end-organ damage. The typical patient presenting with crisis is middle-aged, noncompliant with medications, and may use substances. Treatment of emergencies requires immediate blood pressure reduction in the ICU to prevent further damage, while urgencies can be treated gradually as uncontrolled hypertension. Nitroprusside is very effective but has limitations like toxicity risks with prolonged use.
MUCLecture_2022_12319533. Medical surgical nursing pptxssuser47b89a
1. The document discusses hypertension and coronary artery diseases. It defines hypertension and describes its pathophysiology, causes, signs and symptoms, assessment, and treatment including lifestyle changes and medications.
2. Coronary artery disease and angina pectoris are explained. Angina is caused by reduced blood flow to the heart. Its clinical manifestations and treatment including medications are outlined.
3. Myocardial infarction is summarized including its causes, clinical manifestations involving different body systems, diagnostic tests such as ECG and cardiac biomarkers, and treatment with thrombolytics, analgesics, and invasive procedures.
This document provides information on endocarditis, including:
- Endocarditis is inflammation of the inner lining of the heart caused usually by bacterial infection.
- Common causes are various bacteria and fungi transmitted through dental procedures, IV drug use, and other means.
- Risk factors include heart defects, artificial heart valves, and past endocarditis.
- Symptoms can include fever, chest pain, murmurs, and signs of heart failure.
- Treatment involves antibiotics, sometimes for 6 weeks or more, and possibly surgery for complicated cases.
- Nursing care focuses on pain management, monitoring for heart failure and embolism, giving medications and treatments correctly, and health teaching.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
1) Coronary artery disease and myocardial infarction are caused by atherosclerosis and plaque buildup in the arteries leading to ischemia. Unstable angina is a change in a previously stable pattern of chest pain and is part of the acute coronary syndrome continuum.
2) Myocardial infarction is caused by a blockage of blood flow to the heart muscle leading to cell death. It is diagnosed through electrocardiogram changes and cardiac biomarker levels. Complications include arrhythmias and heart failure.
3) Heart failure occurs when the heart can no longer pump sufficiently to meet the body's needs. It can be caused by conditions like coronary artery disease damaging the heart muscle. Types include left or right ventricular failure and
Acute coronary syndrome (ACS) refers to a spectrum of conditions caused by reduced blood flow in the coronary arteries. This includes ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. ACS is usually caused by rupture of atherosclerotic plaque and subsequent thrombus formation, which occludes coronary arteries. Treatment involves antiplatelet therapy such as aspirin and a P2Y12 inhibitor, anticoagulation with heparin, fibrinolytic therapy for STEMI if PCI is not available, and revascularization when possible. Goals are to restore blood flow, prevent complications, and control symptoms.
1) The document discusses the anaesthetic management of patients with ischemic heart disease undergoing non-cardiac surgery. It covers preoperative evaluation and risk stratification, intraoperative management focusing on preventing myocardial ischemia, and postoperative monitoring and care.
2) Key points addressed include identifying risk factors for ischemic heart disease, evaluating functional capacity and surgical risk, optimizing hemodynamics under anesthesia, using regional anesthesia when possible, and monitoring for signs of perioperative myocardial ischemia.
3) Perioperative myocardial ischemia is often silent, but can be detected by ECG changes, hemodynamic instability, or elevated cardiac enzymes. Careful management is needed to minimize the risk of perioperative cardiac events in these high-risk patients.
This document provides an overview of rheumatic fever, including its causes, risk factors, manifestations, diagnosis, treatment, and nursing management. Rheumatic fever is an inflammatory disease that occurs after a streptococcal throat infection, usually within 2-6 weeks. It commonly affects the heart, joints, skin, and brain in children ages 5-15. The main risk is permanent heart damage known as rheumatic heart disease. Treatment involves antibiotics to eliminate strep bacteria, anti-inflammatory drugs, and long-term preventative antibiotics to reduce the risk of recurrence. Nursing care focuses on treatment compliance, recovery support, education, and prevention.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdf
pericard rx.pdf
1.
2. • IntroductionThe pericardium is a fibroelastic sac made up of visceral and parietal layers separated by
a (potential) space, the pericardial cavity. In healthy individuals, the pericardial cavity contains 15 to
50 mL of an ultrafiltrate of plasma.
• Diseases of the pericardium present clinically in one of several ways:
• ●Acute and recurrent pericarditis
• ●Pericardial effusion without major hemodynamic compromise
• ●Cardiac tamponade
• ●Constrictive pericarditis
• ●Effusive-constrictive pericarditis
• Acute pericarditis refers to inflammation of the pericardial sac. The term myopericarditis, or
perimyocarditis, is used for cases of acute pericarditis that also demonstrate myocardial
inflammation; myopericarditis is used for cases with predominant pericarditis and normal ventricular
function, and perimyocarditis is used for cases with predominant myocarditis and/or ventricular
dysfunction (ie, new wall motion abnormalities or reduced left ventricular ejection fraction).
(See "Myopericarditis".)
• The treatment and prognosis of acute pericarditis will be reviewed here. The etiology, clinical
presentation, and diagnostic evaluation of acute pericarditis and other pericardial disease processes
are discussed separately. (See "Etiology of pericardial disease" and "Acute pericarditis: Clinical
presentation and diagnosis" and "Recurrent pericarditis" and "Myopericarditis" and "Cardiac
tamponade" and "Constrictive pericarditis: Diagnostic evaluation and management" and "Diagnosis
and treatment of pericardial effusion".)
3. • IntroductionThe pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a (potential) space, the pericardial cavity. In healthy individuals, the pericardial cavity contains 15 to 50 mL of an ultrafiltrate of plasma.
• Diseases of the pericardium present clinically in one of several ways:
• ●Acute and recurrent pericarditis
• ●Pericardial effusion without major hemodynamic compromise
• ●Cardiac tamponade
• ●Constrictive pericarditis
• ●Effusive-constrictive pericarditis
• Acute pericarditis refers to inflammation of the pericardial sac. The term myopericarditis, or perimyocarditis, is used for cases of acute pericarditis that also demonstrate myocardial inflammation; myopericarditis is used for cases with predominant pericarditis and normal ventricular function, and perimyocarditis is
used for cases with predominant myocarditis and/or ventricular dysfunction (ie, new wall motion abnormalities or reduced left ventricular ejection fraction). (See "Myopericarditis".)
• The treatment and prognosis of acute pericarditis will be reviewed here. The etiology, clinical presentation, and diagnostic evaluation of acute pericarditis and other pericardial disease processes are discussed separately. (See "Etiology of pericardial disease" and "Acute pericarditis: Clinical presentation and
diagnosis" and "Recurrent pericarditis" and "Myopericarditis" and "Cardiac tamponade" and "Constrictive pericarditis: Diagnostic evaluation and management" and "Diagnosis and treatment of pericardial effusion".)
• TreatmentThe therapy of acute pericarditis should be targeted as much as possible to the underlying etiology (table 1) [1-5]. However, in resource-abundant countries, most cases of acute pericarditis in immunocompetent patients are due to viral infection or are idiopathic; it is generally assumed that most cases of
"idiopathic" pericarditis are viral in etiology. Because of the relatively benign course associated with the most common causes of pericarditis (>80 percent of cases), it is not necessary to search for the etiology in all patients. As such, most patients are treated for a presumptive viral cause with nonsteroidal
antiinflammatory drugs (NSAIDs) and colchicine. (See "Pericardial disease associated with malignancy" and "Tuberculous pericarditis" and "Purulent pericarditis".)
• In acute viral or idiopathic pericarditis, no therapy has been rigorously proven to prevent serious sequelae, such as cardiac tamponade and constrictive pericarditis. Fortunately, however, these complications are rare [6,7]. (See "Constrictive pericarditis: Diagnostic evaluation and management" and "Cardiac
tamponade".)
• General approach to treatment — In the treatment of acute pericarditis, the goals of therapy are the relief of pain, resolution of inflammation (and, if present, pericardial effusion), and the prevention of recurrence. Our general approach to treatment is as follows (algorithm 1):
• ●Ambulatory versus inpatient treatment – Most low-risk patients with acute pericarditis can be managed effectively in an ambulatory setting, while high-risk patients should be admitted to initiate treatment and continue the diagnostic evaluation. (See 'Which patients require hospitalization?' below.)
• ●Activity restriction – Patients should be instructed to restrict strenuous physical activity until symptoms have resolved and biomarkers have normalized. (See 'Activity restriction' below.)
• ●Initial treatment
• •For nearly all patients with acute idiopathic or viral pericarditis, we recommend combination therapy with colchicine plus NSAIDs. (See 'Nonsteroidal antiinflammatory drugs' below and 'Colchicine' below.)
• •For patients with an identified cause other than viral infection, specific therapy appropriate to the underlying disorder is indicated.
• •Glucocorticoids should be used for initial treatment of acute pericarditis only in patients with contraindications to NSAIDs (eg, renal failure or pregnancy at ≥20 weeks gestation), or for specific indications (eg, systemic inflammatory diseases), and should be used at the lowest effective dose.
(See 'Glucocorticoids' below.)
• ●Tapering treatment – Following the resolution of symptoms, we taper the dose of the antiinflammatory agent weekly in an attempt to reduce the subsequent recurrence rate. Colchicine is continued for a total duration of three months. (See 'NSAID dosing' below and 'Glucocorticoid dosing' below and 'Colchicine
dosing' below.)
• ●Refractory or recurrent symptoms – Most patients whose symptoms worsen or recur following the initial course of therapy can still be managed effectively with medical therapy alone, and outpatient management remains feasible in almost all cases. (See "Recurrent pericarditis".)
• Which patients require hospitalization? — High-risk patients with acute pericarditis (algorithm 1) should be admitted to the hospital in order to initiate appropriate therapy and expedite a thorough initial evaluation. Conversely, patients with uncomplicated (ie, low-risk) acute pericarditis can usually be evaluated and
sent home, with outpatient follow-up to assess the efficacy of treatment.
• Features of acute pericarditis associated with a higher risk include [8,9]:
• ●Fever (>38°C [100.4°F])
• ●Subacute course (without acute onset of chest pain)
• ●Evidence suggesting cardiac tamponade (eg, hemodynamic compromise) (see "Cardiac tamponade")
• ●A large pericardial effusion (ie, an end-diastolic echo-free space of more than 20 mm)
• ●Immunosuppression and immunodepressed patients
• ●Anticoagulant use (eg, vitamin K antagonists [eg, warfarin] or novel oral anticoagulants)
• ●Acute trauma
• ●Failure to show clinical improvement following seven days of appropriately dosed NSAID and colchicine therapy
4. • General approach to treatment — In the treatment of acute pericarditis, the
goals of therapy are the relief of pain, resolution of inflammation (and, if
present, pericardial effusion), and the prevention of recurrence. Our general
approach to treatment is as follows (algorithm 1):
• ●Ambulatory versus inpatient treatment – Most low-risk patients with acute
pericarditis can be managed effectively in an ambulatory setting, while high-risk
patients should be admitted to initiate treatment and continue the diagnostic
evaluation. (See 'Which patients require hospitalization?' below.)
• ●Activity restriction – Patients should be instructed to restrict strenuous
physical activity until symptoms have resolved and biomarkers have normalized.
(See 'Activity restriction' below.)
5. • Initial treatment
• •For nearly all patients with acute idiopathic or viral pericarditis, we recommend
combination therapy with colchicine plus NSAIDs.(See 'Nonsteroidal antiinflammatory
drugs' below and 'Colchicine' below.)
• •For patients with an identified cause other than viral infection, specific therapy
appropriate to the underlying disorder is indicated.
• •Glucocorticoids should be used for initial treatment of acute pericarditis only in
patients with contraindications to NSAIDs (eg, renal failure or pregnancy at ≥20 weeks
gestation),or for specific indications (eg, systemicinflammatory diseases),and should
be used at the lowest effective dose. (See 'Glucocorticoids' below.)
• ●Tapering treatment – Following the resolution of symptoms,we taper the dose of
the antiinflammatory agent weekly in an attempt to reduce the subsequent
recurrence rate. Colchicine is continued for a total duration of three months.
(See 'NSAID dosing' below and 'Glucocorticoid dosing' below and 'Colchicine
dosing' below.)
• ●Refractory or recurrent symptoms – Most patients whose symptoms worsen or
recur following the initial course of therapy can still be managed effectivelywith
medical therapy alone, and outpatient management remains feasible in almost all
cases.
6. • Which patients require hospitalization? — High-risk patients with acute pericarditis (algorithm 1)
should be admitted to the hospital in order to initiate appropriate therapy and expedite a thorough
initial evaluation. Conversely, patients with uncomplicated (ie, low-risk) acute pericarditis can usually
be evaluated and sent home, with outpatient follow-up to assess the efficacy of treatment.
• Features of acute pericarditis associated with a higher risk include [8,9]:
• ●Fever (>38°C [100.4°F])
• ●Subacute course (without acute onset of chest pain)
• ●Evidence suggesting cardiac tamponade (eg, hemodynamic compromise) (see "Cardiac tamponade")
• ●A large pericardial effusion (ie, an end-diastolic echo-free space of more than 20 mm)
• ●Immunosuppression and immunodepressed patients
• ●Anticoagulant use (eg, vitamin K antagonists [eg, warfarin] or novel oral anticoagulants)
• ●Acute trauma
• ●Failure to show clinical improvement following seven days of appropriately dosed NSAID
and colchicine therapy
• ●Elevated cardiac troponin, which suggests myopericarditis/perimyocarditis
• Patients with none of these high-risk features can be safely treated on an outpatient basis (algorithm
1). A full discussion of risk assessment and determining the need for hospitalization is presented
separately. (See "Acute pericarditis: Clinical presentation and diagnosis", section on 'Assessment of
risk and need for hospitalization'.)
7. • Activity restriction — Strenuous physical activity may trigger recurrence of symptoms;
therefore, such activity should be avoided until symptom resolution and normalization
of biomarkers. While there are little systematicdata to guide recommendations on
activity restriction, our experts' approach to activity restriction is consistentwith the
advice of professional societies [10]:
• ●Noncompetitive athletes should restrict activity until the resolution of symptoms
and normalization of biomarkers (this approach has been endorsed by the 2015 ESC
guidelines) [11].
• ●Competitive athletes should not participate in competitive sports for at least three
months following the resolution of symptoms and normalization of biomarkers, and
should be re-evaluated by a clinician prior to resuming training and competition. In
patients with milder symptoms which promptly resolve with treatment,a shorter
period or activity restriction (a minimum of one month) may be reasonable on a case-
by-case basis.
• ●In cases of myopericarditis or perimyocarditis,we recommend withdrawal from
competitive sports for six months and return to play only after normalization of
laboratory data (eg, markers of inflammation,electrocardiogram [ECG],and
echocardiogram). (See "Myopericarditis",section on 'Treatment'.)
8. • Medical Therapies
• Nonsteroidal antiinflammatorydrugs — For nearly all patients with acute idiopathicor viral pericarditis, we recommend NSAIDs (in combination
with colchicine)as the initial treatment (algorithm 1).There are two approaches to determine the durationofNSAID therapyand the proper time to
begin taperingtreatment;long-term data demonstratingsuperiorityofone method over the other are not available.
• ●Duration oftreatment is based upon the resolutionofsymptoms,which usuallyoccurs in two weeks or less, with taperingonce the patient is
symptom-free forat least 24 hours.
• ●Duration oftreatment is based upon the resolutionofsymptoms and normalization ofC-reactiveprotein (CRP).In this approach,CRPis assessed at
presentationand then weekly,using the antiinflammatorydose ofNSAIDs until complete resolution ofsymptoms (for at least 24 hours)and
normalization ofCRP,at which point taperingbegins [12].
• Failure to respond to aspirin orNSAID therapywithin one week (defined as persistence of fever, pleuriticchest pain,a new pericardial effusion,or
worseningof general illness)suggests that a cause other than idiopathicorviral pericarditis is present.In such instances,a thorough search for
the etiologyshould be performed.To expedite the diagnosticevaluation and for symptomcontrol,some patients may require admission to the
hospital.The main causes to be ruled out include tuberculous orother bacterial forms of pericarditis,cancer (especiallylungcancer, breast cancer,
and lymphomas and leukemias),post-cardiacinjurysyndromes,and systemicinflammatorydiseases.(See "Acute pericarditis:Clinical presentation
and diagnosis",section on 'Establishinga definite etiology'.)
• Based on the results of multiple cohort studies and one randomizedstudy,treatment with an antiinflammatory dose ofNSAIDs alone appears to be
effective in approximately70 to 80 percent of pericarditis cases presumed to be of viral or idiopathicorigin [7,8,13]. Primary therapyhas been the
administrationoforal NSAIDs, particularly ibuprofen or aspirin;ketorolac,a parenteral NSAID,is also effective (table 2) [14]. NSAIDs (includingaspirin)
function to both reduce inflammationand relieve pain in most patients [7,8,13,15-17]. Despite these benefits,however, there is no evidence that
NSAIDs alter the natural historyofacute pericarditis.
• In a series of 254 patients deemed to be at low risk who were treated with aspirin as outpatients,98percent of patients who responded to aspirin
were presumed to haveidiopathicorviral disease, while 2 percent of the patients who responded to aspirinwere subsequentlydiagnosedwith an
autoimmune disorder [8].By contrast,amongthe patients who did not respond to aspirin after seven days,only39 percent were deemed idiopathic,
while 43 percent were diagnosed with an autoimmune disorder and 18percent with tuberculous pericarditis.At follow-up,aspirin resistance was
associated with significant increases in the rates of recurrent pericarditis (61versus 10 percent)and constrictivepericarditis (9versus 1 percent).
• A theoretical concern is that the antiplatelet activityof aspirin (or another NSAID)might promote the development ofahemorrhagicpericardial
effusion.However, such a relationshiphas neverbeen convincinglyestablished,and the risk-benefit ratio seems to favor the use of these drugs.
(See 'Bleedingrisk of NSAIDs combined with other antithrombotics' below.)
9. • NSAID dosing — We agree with the 2015 ESC guidelines,which recommended the use of an NSAID for the treatment ofacute pericarditis [11]. One
of the followingNSAIDregimens is commonlyused (table 2):
• ●Ibuprofen – The ibuprofen dose is 600 to 800 mg three times per day(table 2). Followingthe resolutionofsymptoms, we taper the ibuprofen dose
weekly in an attempt to reduce the subsequent recurrence rate [8,18].
• ●Aspirin – The aspirin dose is 650 to 1000 mg three times per day(table 2). Followingthe resolutionofsymptoms,we taper the aspirin dose weekly
in an attempt to reduce the subsequentrecurrence rate [8].
• ●Indomethacin – The indomethacin dose is 25 to 50 mg three times per day(table 2). Followingthe resolution ofsymptoms, we taper the
indomethacindose weekly in an attempt to reduce the subsequent recurrence rate [8,18]. Indomethacinis associated with more side effects, and it is
usuallyconsidered forrecurrences.(See "Recurrent pericarditis",section on 'NSAID or aspirin'.)
• Anyof the listed NSAIDs can be continued fordays orweeks, if necessary,for recurrent or incessant attacks.(See "Recurrent pericarditis",section on
'NSAID or aspirin'.)
• In symptomaticpericarditis occurringwithin days after an acute myocardial infarction,we suggest aspirin plus colchicine rather than another NSAID
plus colchicine.The use of NSAIDs other than aspirin should be avoided,since antiinflammatorytherapymayimpair scar formation[19]. Aspirin may
also be the first choice in patients who require concomitantantiplatelettherapyfor anyreason.With either regimen, gastrointestinal protection
should be provided.(See "Pericardial complications ofmyocardialinfarction"and "NSAIDs (includingaspirin):Primaryprevention ofgastroduodenal
toxicity" and 'Gastrointestinalprotection' below.)
• Gastrointestinal protection — NSAIDs can lead to gastrointestinal toxicity(ie,gastritis,ulcers,etc), particularlywhen used in high doses or for
prolonged periods oftime.In addition to high doses orprolonged periods oftreatment,patient-relatedfactors associatedwith a higher risk of
gastrointestinal toxicityinclude:
• ●Historyof pepticulcer disease
• ●Age greater than 65 years
• ●Concurrent use of aspirin,corticosteroids,oranticoagulants
• Patients consideredat risk of gastrointestinal toxicityrelatedto NSAIDtreatment should be treated with NSAIDs for the shortest interval possible and
receive concomitant gastroprotectivetherapywhile takingNSAIDs. Proton pump inhibitors (eg, omeprazole,pantoprazole)are generallypreferred for
prevention ofgastrointestinaltoxicitydue to theirefficacy and favorablesafetyprofile. (See "NSAIDs (includingaspirin):Primaryprevention of
gastroduodenal toxicity".)
10. • Bleeding riskof NSAIDs combined with other antithrombotics — In patients who require more than one antiplateletor
anticoagulantas therapy for an underlyingcondition,there is a greater risk of bleeding complications.On occasion,
patients with acute pericarditistreated with NSAIDsmay also havean indication foran additional antiplateletor
anticoagulant,in which case the overallrisk of bleeding should be assessed. Because NSAIDs (especially aspirin) can impact
the metabolism of vitamin K antagonists,patientswill typicallyrequire close monitoring and dose adjustmentsfor the
durationof treatment for acute pericarditis.(See "Managementof warfarin-associatedbleeding or supratherapeuticINR",
section on 'Mitigatingbleedingrisk' and "Biologyof warfarin and modulatorsof INR control",section on 'Aspirin/NSAIDs'.)
• In patientswho require antiplatelettherapy for another indication(eg, following coronary stenting), there are no specific
contraindicationsor additional risksof bleeding when NSAIDs are used during acute pericarditis. In this
setting, however, aspirin is generallythe first choice to treat pericarditis, but doses should be increased to
reach antiinflammatoryeffects (from 100 to 300 mg to up to 650 to 1000 mg three times per day). (See 'NSAID
dosing' above.)
• Concomitantuse of heparinand anticoagulanttherapiesis often perceived as a possible risk factorfor the developmentof a
worsening or hemorrhagic pericardialeffusion that may result in cardiac tamponade,but the availableevidence does
not support this [20].
• ●An analysisof 453 consecutive cases of acute pericarditisdid not show a higher risk of hemorrhagic effusion in patients
on antithrombotics[9].
• ●In another study of 274 patientswith acute pericarditisor myopericarditis,the use of heparin or other anticoagulantswas
not associated with an increased risk of cardiac tamponade(odds ratio [OR] 1.1, 95% CI 0.3-3.5) [21].
• NSAIDs (includingaspirin) alterthe metabolism of vitamin K antagonists(eg, warfarin), thus enhancing the anticoagulant
effect. Consequently, careful monitoring and frequent dose adjustment are needed. Additionally,consideration should be
given to using alternativeantiinflammatoryoptions, such as glucocorticoids. Althoughglucocorticoids have the potentialfor
fewer bleeding-relateddrug interactionsin patientsrequiring both antiinflammatorydrugs and chronic anticoagulation
therapy, the potentialbenefits of reduced risk of bleeding should be weighed against potentialside effects and a higher rate
of recurrent pericarditisassociated with glucocorticoids.Because of these glucocorticoidconcerns, we generally prefer
therapy with NSAIDs, with additionalmonitoringfor drug interactionsand bleeding complications.(See "Majorside effects
of systemic glucocorticoids".)
• There are no significantreported interactionsbetween NSAIDs or other antiplatelettherapiesand colchicine
11. • Colchicine — For all patients with acute idiopathicorviral pericarditis (algorithm1),we recommend that colchicine be added to antiinflammatory
therapy(either NSAIDs or glucocorticoids)(table 2) [11,23]. Additionally,colchicine is generallyefficacious for pericarditis caused bysystemic
inflammatorydiseasesand post-cardiacinjurysyndromes.However,for patients with diagnosedbacterial pericarditis,colchicine has not been proven
efficacious and,on the contrary,maytheoreticallyimpair the clearance of the infectious agent.Colchicine is also not proven to be efficacious in
malignancy-related pericarditis and pericardial effusion.
• Colchicine, when used as an adjunct to NSAID therapy, reduces symptoms, decreases the rate of recurrent pericarditis, and is generallywell tolerated.
The 2015 ESC guidelines concluded that the weight of evidence supported the efficacy of colchicine, alone or in combination with NSAIDs,in the
treatment ofacute pericarditis [11]. Of note, colchicine is not approved forthe prevention ofrecurrent pericarditis in North America and most
European countries (as of 2019, it is approved for this indicationin Italyand Austria),as such its use is off-label.(See "Recurrent pericarditis",section
on 'Colchicine'.)
• The efficacy of colchicine in the primarymanagement of acute pericarditis has been evaluated in randomizedtrials:
• ●In the ICAP trial,a randomized,double-blind studyof colchicine versus placebo in addition to standard antiinflammatory therapyfor treatment ofa
first episode of acute pericarditis (77 percent idiopathic)in 240 patients,colchicine addedto standard antiinflammatory therapysignificantlyreduced
the risk of recurrence (17 versus 38 percent with antiinflammatory therapyalone;relativeriskreduction 0.56, 95% CI 0.30-0.72) [24]. In addition,
colchicine added to antiinflammatory treatment resultedin significantlybetter rates ofremission and fewer hospitalizations comparedwith
antiinflammatory treatment alone.No serious adverse events were observed.
• ●In the open label COPE trial of 120 patients with a first episode of acute pericarditis (84percent idiopathic),the recurrence rate of pericarditis within
18 months was significantlylower in the colchicine plus aspirin group (11 versus 32 percent with aspirin alone;number needed to treat to prevent one
recurrence equals five) [13].
• ●In a later open-label trial in 110 patients with a first episode of acute idiopathicpericarditis,the additionof colchicine to conventional
antiinflammatory treatment did not reduce the recurrence rate [25]. However, the studyhas important limitations to be acknowledged (eg, probably
underpowered to test colchicine efficacy,diagnosticcriteria forpericarditis not consistent with 2015 ESC guidelines,and possible significant delayin
the administrationofcolchicine from symptoms onset)that maylimit its clinical applicability[26].
• In the COPE and ICAP studies,adult patients were excluded iftheyhad elevated levels of aminotransferases,creatinine, or troponin and liverdiseases,
myopathy,blooddyscrasias,orinflammatorybowel disease.Pregnant orlactatingwomen were also excluded as well as patients with bacterial or
neoplasticpericarditis.
• The efficacy of colchicine in the treatment ofpericarditis has also been assessed in several systematicreviews and meta-analyses (which include
patients with both acute and recurrent pericarditis)[27-30]. In a 2014 systematicreviewand meta-analysis,which included four randomized,double-
blind trials (564 patients)ofcolchicine for both initial and recurrent episodes ofpericarditis,colchicine use was associated with a reduced risk of
recurrent pericarditis at 18 months in patients beingtreatedforacute (hazard ratio [HR]0.40, 95% CI 0.27-0.61) or recurrent(HR 0.37, 95% CI 0.24-
0.58) pericarditis [28]. There was no significant increase in adverse effects related to colchicine therapy[29]. (See "Recurrent pericarditis",section on
'Colchicine'.)
12. • Colchicinedosing — The 0.5 mg dose of colchicine is not available in many countries,
including the United States and Canada where 0.6 mg tablets are used empirically in
place of 0.5 mg tablets.
• Colchicine may be given with or without a loading dose. When a loading dose is
chosen, the loading dose is typically 0.5 to 1 mg (or 0.6 to 1.2 mg) twice daily on day
1, depending upon the patient’s body weight.
• The daily maintenance dose of colchicine is weight-based:
• ●Patients weighing ≥70 kg should receive 0.5 to 0.6 mg twice daily
• ●Patients weighing <70 kg should receive 0.5 to 0.6 mg once daily
• Colchicine should be administered for a total of three months for patients with an
initial episode of acute pericarditis. In ICAP, colchicine was given without a loading
dose as 0.5 mg twice daily for three months for patients weighing >70 kg or 0.5 mg
once daily for patients weighing ≤70 kg.
• Colchicineside effects — Colchicine is typically well tolerated. Side effects, most
commonly gastrointestinal (eg, diarrhea, nausea, vomiting), are uncommon at low
doses (0.5 to 1.2 mg per day), even when given continuously over years. Less common
(<1 percent) side effectsinclude bone marrow suppression, hepatotoxicity,and
myotoxicity. Chronic renal insufficiencyleading to increased colchicine levels appears
to be the major risk factor for side effects and other possible negative interactions. In
addition, colchicine has drug interactions and altered metabolism in certain patient
populations.
13. • Glucocorticoids— Glucocorticoidsshouldbe usedforinitial treatmentof acute pericarditisonlyinpatientswithcontraindicationstoNSAIDs (eg,renal failure orpregnancyat≥20 weeksgestation), orfor
specificindications(eg,systemicinflammatorydiseases),andshouldbe usedatthe lowesteffectivedose.The numberof suchpatientsrequiringglucocorticoidsshouldbe quitelow(10percentor less),as
illustratedintwostudiesbyanalmost90 percentresponse rate to aspirinalone withinsevendays,withmostof the nonresponders havinganautoimmune diseaseortuberculosis[8,13].Glucocorticoids
may alsobe usedinthe eventof failedinitialtherapywithaspirin/NSAIDplus colchicine,suggestingrecurrentorrefractorypericarditis.(See"Recurrentpericarditis".)
• Limiteddataare available onthe efficacyof glucocorticoidtherapyforacute pericarditis,assuchtherapyisgenerallylimitedtopatientswithnonresponse orcontraindicationstoNSAIDuse [25].
Observationalstudiessuggestthatglucocorticoidtherapyearlyinthe course of the disease ismore likelytobe associated withrecurrentepisodes[13,31-33].The bestdatacome fromthe COPE trial
of colchicine therapyinwhichglucocorticoidswere givenonlywhen aspirinwascontraindicatedornottolerated[13].Glucocorticoiduse wasasignificantpredictorof recurrence (OR4.30, 95% CI1.21-
15.25). The same effecthasbeenreportedforpatientswiththe firstrecurrence ormultiple recurrencesandmaybe due to promotionof viral replication[31,34-36]. Ina subsequentsystematicreview
whichincludedtworandomizedtrialscomparingsteroidtherapywithstandardNSAIDtherapyandone trial of low-dose versushigh-dosesteroidtherapy(withorwithoutothertherapywithNSAIDsor
colchicine),the administrationof steroidswasassociatedwithatrendtowardahigherrate of recurrentpericarditis(OR7.50,95% CI 0.62-90.65) [37].
• In additiontoconcernsaboutthe efficacyof glucocorticoidtherapyasinitialtreatmentof acute pericarditis,chronicuse of systemicglucocorticoidsisassociatedwithanumberof potentiallysignificantside
effects.Assuch,whenglucocorticoidsare required,theyshouldbe givenatthe lowestappropriateandeffectivedose.(See "Majorside effectsof systemicglucocorticoids".)
• Glucocorticoiddosing— While NSAIDsand colchicine remainthe preferredtreatmentoptionsforacute pericarditis,aminorityof patientswill have refractorysymptomsrequiring treatmentwithsystemic
steroidtherapy.There are conflictingdata,mostlyderivedfromobservational studies,regardingthe optimaldosingandtaperingof steroidtherapywhenusedtotreatpericarditis.
• Our approach to glucocorticoiddosing — For patientswhorequire glucocorticoidtherapyforacute pericarditis,we suggestthe use of moderate initialdosing(eg,0.2to 0.5 mg/kg/dayof prednisone)
followedbyaslowtaper(table 2) rather thanhighdoseswitha rapidtaper.We add colchicine duringglucocorticoidtherapyandcontinue colchicine forthree monthsforinitial casesof acute pericarditis
and six monthsinrecurrentcases.We introduce aspirinoranotherNSAIDtowardthe endof taperingorincase of recurrencesinsteadof increasingthe dose of the glucocorticoids. (See "Recurrent
pericarditis".)
• Resultsfromastudyof patientswithrecurrentpericarditissuggestthatlowerglucocorticoiddosesmayalsobe feasible in acute pericarditis,althoughthesepopulationsdiffer.Inanobservational study,
100 patientswithrecurrentpericarditiswere treatedwithglucocorticoids(51with prednisone1mg/kg/dayand49 withprednisone0.2to 0.5 mg/kg/day) [38].Afteradjustmentforpotentialconfounders,
onlyhighdosesof prednisone wereassociatedwithmore sideeffects,recurrences,andhospitalizations(HR3.61, 95% CI 1.96-6.63). In a systematicreviewof publishedstudiesonmedical therapyfor
pericarditis,datafromthree observational studiesof steroidtreatmentshowedthatsteroiduse wasassociatedwithatrend towardincreasedriskof recurrentpericarditis(OR7.50, 95% CI 0.62-90.65)
[37]. However, low-dosesteroidswere superiortohigh-dosesteroidsfortreatmentfailure orrecurrentpericarditis(OR0.29, 95% CI 0.13-0.66), rehospitalizationforpericarditis(OR0.19, 95% CI 0.06-
0.63), andadverse effects(OR0.07, 95% CI0.01-0.54).
• In ourexperience,rapidtaperingof systemicglucocorticoidsincreasesthe riskof treatmentfailureandrecurrence.Althoughhighdosesof glucocorticoids(eg,prednisone1mg/kg/day) have been
recommendedinthe ESCguidelines,use of lowerdoses(eg,prednisone 0.2to0.5 mg/kg/day) maybe equallyefficacious[11].These lowerdosesmaybe useful inreducingthe riskof steroidsideeffects,
whichhave beenreportedinupto25 percentof patientstreatedwithhighdoses.(See "Majorside effectsof systemicglucocorticoids".)
• We usuallybegintaperingglucocorticoidsattwoto fourweeksafterresolutionof symptomsandCRPnormalization.Eachdecrementinprednisone dose shouldproceedonlyif the patientisasymptomatic
and CRPremainsnormalized,particularlyfordoseslowerthan25 mg/day.A proposedtaperingschemefollows:
• ●Dailydose >50 mg – Taper 10 mg/dayeveryone totwo weeks
• ●Dailydose 25 to 50 mg– Taper 5 to10 mg/dayeveryone totwoweeks
• ●Dailydose 15 to 25 mg– Taper 2.5 mg/dayeverytwotofour weeks
• ●Dailydose <15 mg – Taper 1.25 to 2.5 mg/dayeverytwoto six weeks
14. • Other approaches — The 2015 ESC guidelines recommended that systemicsteroid therapy be restricted to
patients with the following conditions [11]:
• ●Patients with symptoms refractory to standardtherapy
• ●Acute pericarditis due to connective tissue disease
• ●Uremic pericarditis
• The 2015 ESC guidelines recommend use of low to moderate doses of glucocorticoids (eg, prednisone 0.2 to 0.5
mg/kg/day) when indicated. In contrast to our suggestions, the ESC guidelines recommend rapid tapering to
reduce the risk of systemicside effects [11,37]. In patients with a coexisting pericardial effusion, intrapericardial
steroid administration is an option that limits systemictoxicity [11].
• Adjunctive therapies — Most patients with uncomplicated low risk acute pericarditis are managed effectively
with medical therapy alone. On occasion, however, patients may require adjunctive therapies for:
• ●In patients with persistent symptoms and elevated heart rate (eg, heart rate >70 to 75 beats per minute)
despite full antiinflammatorytherapies, adjunctive use of betablockers, if not contraindicated, can be helpful to
improve symptom control by reducing heart rate and exacerbation of chest pain at higher heart rates [39].
• ●A moderate to large pericardial effusion, particularly if hemodynamically significant and causing cardiac
tamponade or symptomaticand refractory to medical therapy.
• ●Suspicion of a neoplastic or bacterial etiology and moderate to large pericardial effusion.
• ●Frequent, highly symptomaticrecurrences of acute pericarditis with pericardial effusion.
• ●Evidence of constrictive pericarditis (a late occurrence when present).
• Percutaneous and surgical techniques maybe considered for such patients.
15. • Pericardial drainage — Prolonged catheter drainage ofa pericardial effusion is an effective means of preventingfluidreaccumulation.The mechanism
by which this occurs is probablymore related to the obliterationofthe pericardial space followinginflammation provoked by the catheter,rather than
fluid drainage itself.Catheter drainage maybe required forseveral days,and the catheter should not be removed until drainage stops or is minimal.If
significant drainage continuesfor more than three to four days,a pericardial windowshouldbe considered.The management of pericardial effusions
with and without cardiac tamponade is discussed in detail separately.(See "Cardiactamponade" and "Diagnosis and treatment ofpericardial
effusion",section on 'Treatment'.)
• Pericardiectomy — Surgical removal of all or part of the pericardiumis virtuallynever required for the treatment ofacute pericarditis.The role of
pericardiectomyin patients with recurrent pericarditis is discussed separately.(See "Recurrent pericarditis",section on 'Role of pericardiectomy'.)
• Treatment in patients with chronic kidneydisease — Treatment forpericarditis in patientswith advanced chronickidneydisease involves initiation or
intensificationofdialysis when uremia is the underlyingcause, alongwith selective use of NSAIDs, colchicine, and corticosteroids.Patients with
uremic pericarditis who are not alreadyreceivingdialysis should initiate dialysis.In patients alreadyreceivingdialysis for over two months (dialysis-
associated pericarditis),the dialysis prescription is usuallyintensified.However,the frequencyof improvement in pericarditis in these patientsis
lower than in patients in whomdialysis was recently initiated,and medical therapies are often required.The approach to medical therapyis similar to
patients withoutchronickidneydisease.
• PrognosisPatients with acute idiopathicorviral pericarditis havea good long-term prognosis. Cardiactamponade rarelyoccurs in patients with acute
idiopathicpericarditis and is more common in patients with a specific underlying etiology such as malignancy,tuberculosis,or purulent pericarditis.
Constrictive pericarditis mayoccur in approximately1percent of patients with acute idiopathicpericarditis and is also more common in patientswith
a specific etiology.(See "Constrictive pericarditis:Diagnosticevaluation and management".)
• Approximately15to 30 percent of patients with idiopathicacute pericarditis who are not treated with colchicine develop either recurrent or incessant
disease.Immune mechanisms appearto be of primary importance in the majorityof cases, and the term "chronic autoreactive"pericarditis has been
used.Risk factors for recurrent pericarditis include lackof response to NSAIDs, the need for corticosteroid therapy,and creation ofa pericardial
window.The pathogenesis,course, and treatmentofrecurrent pericarditis are discussed separately.(See "Recurrent pericarditis".)
• Sex may also predict the likelihood ofcomplications.In a series of 453 consecutivecases of acute pericarditis,women were at increased risk of
complications(hazardratio1.65, 95% CI 1.08-2.52) [9]. A possible explanationofthis findingis the higher frequencyof autoimmune etiologies(eg,
connectivetissue diseases)in women.
•