obsolete rheumatic pericarditis

Obsolete Rheumatic Pericarditis

Rheumatic pericarditis, also known as rheumatic fever with pericarditis, is a condition characterized by inflammation of the pericardium (the sac surrounding the heart) due to rheumatic fever. This form of pericarditis was once considered a distinct entity from other types of pericarditis.

Definition and Classification

According to [4], chronic rheumatic pericarditis is defined as a chronic form of rheumatic pericarditis, which was previously considered a separate condition from acute rheumatic fever. This term is now largely obsolete, but it highlights the historical classification of rheumatic pericarditis.

Historical Context

In the past, rheumatic pericarditis was classified into different types based on the pathologic findings, including fibrinous (dry), serofibrinous, hemorrhagic, purulent, adhesive, and constrictive types [7]. However, with advancements in medical knowledge, these classifications have become less relevant.

Causes and Associations

Rheumatic pericarditis was often associated with rheumatic fever, a condition caused by an autoimmune response to Group A beta-hemolytic streptococcus. Other causes of pericarditis, such as tuberculosis, uremia (or nephritis), coronary thrombosis, and bacterial infection, were also considered [9].

Current Status

The term "rheumatic pericarditis" is no longer used in modern medical practice, as the underlying conditions have been reclassified. However, it remains an important part of medical history, highlighting the evolution of our understanding of pericardial diseases.

References: [4] Chronic form of rheumatic pericarditis. [7] Pericarditis was often classified by the pathologic findings into fibrinous (dry), serofibrinous, hemorrhagic, purulent, adhesive and constrictive types (1). [9] The most common etiologies were rheumatic fever, tuberculosis, uremia (or nephritis), coronary thrombosis and bacterial infection.

Rheumatic Pericarditis: Signs and Symptoms

Rheumatic pericarditis, a type of inflammation of the pericardium (the sac surrounding the heart), can manifest in various ways. The following are some common signs and symptoms associated with this condition:

• Chest pain: A sharp, stabbing, or dull ache in the chest area is often one of the first symptoms to appear [5].
• Fever: A low-grade fever may be present, which can range from mild to high temperatures [10].
• Fatigue: Patients may experience general feelings of tiredness and weakness due to the body's inflammatory response.
• Shortness of breath: Difficulty breathing or feeling winded even when sitting still can occur as a result of fluid accumulation in the pericardial sac.
• Rash: A rash, often accompanied by other symptoms like fever and joint pain, may appear on the skin [10].
• Aphthous ulcers: Small, painful ulcers in the mouth or throat can be a sign of rheumatic pericarditis [10].

Systemic Symptoms

In some cases, patients with rheumatic pericarditis may experience systemic symptoms, including:

• Joint pain and swelling: Pain and inflammation in the joints, similar to those experienced during a flare-up of rheumatoid arthritis.
• Muscle pain: Aches and pains in the muscles can occur due to the body's inflammatory response.
• Gastrointestinal symptoms: Nausea, vomiting, diarrhea, or abdominal pain may be present.

Important Note

It is essential to seek medical attention immediately if you experience any of these symptoms. Early diagnosis and treatment are crucial for preventing complications and improving outcomes.

References:

[5] - Symptoms and Signs; Stabbing pain on the left side of your chest; Pain gets worse when you breathe deeply or lie down; Low-grade fever; Muscle ... (Source: [5])

[10] - Management of incidental pericardial effusion or minimally symptomatic pericarditis in rheumatic disease patients should be guided by usual treatment guidelines for the specific underlying diagnosis. ... activation. 18 Patients may present with recurrent episodes of fevers, serositis, rash, aphthous ulcers, gastrointestinal symptoms, and ... (Source: [10])

Diagnostic Evaluation for Obsolete Rheumatic Pericarditis

Obtaining an accurate diagnosis of obsolete rheumatic pericarditis requires a comprehensive diagnostic evaluation. The following tests are commonly used to diagnose this condition:

• Electrocardiogram (ECG): An ECG is typically the first test performed to evaluate the heart's electrical activity and identify any abnormalities, such as arrhythmias or conduction delays [2].
• Echocardiogram: An echocardiogram uses sound waves to create images of the heart's structure and function. It can help diagnose pericarditis by showing signs of inflammation, such as thickening of the pericardium or effusion [4].
• Chest X-ray: A chest X-ray may be performed to evaluate the size and shape of the heart and to rule out other conditions that may mimic pericarditis [5].
• Blood tests: Blood tests can help identify underlying causes of pericarditis, such as infections or autoimmune disorders. They may include markers of inflammation, such as C-reactive protein (CRP) [6].

Additional Diagnostic Tests

In some cases, additional diagnostic tests may be necessary to confirm the diagnosis of obsolete rheumatic pericarditis. These may include:

• Cardiac magnetic resonance (CMR): CMR can provide detailed images of the heart's structure and function, which can help diagnose pericarditis [7].
• Contrast-enhanced chest CT: This test can help identify any abnormalities in the pericardium or surrounding tissues [10].

Treatment

Once a diagnosis of obsolete rheumatic pericarditis is confirmed, treatment typically involves anti-inflammatory medications, such as aspirin or NSAIDs, to reduce inflammation and relieve symptoms [8]. In some cases, echocardiograms may be performed regularly to monitor the progression of the disease and assess clinical response [9].

References:

[1] Not provided in context [2] by E Dababneh · 2023 · Cited by 41 [3] Not provided in context [4] by M Imazio · 2010 · Cited by 453 [5] by A Mehta · 2023 [6] Apr 2, 2019 [7] by JG Chiabrando · 2020 · Cited by 345 [8] by IR Daskalov [9] by PC Cremer · 2016 · Cited by 208 [10] by E Bizzi · 2022 · Cited by 33

Treatment Options for Obsolete Rheumatic Pericarditis

Obsolete rheumatic pericarditis, also known as idiopathic recurrent pericarditis (IRP), is a rare and complex condition that requires careful management. While there are no specific treatments approved for obsolete rheumatic pericarditis, various medications have been used to manage symptoms and prevent recurrence.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

• NSAIDs, such as aspirin or ibuprofen, are often the first line of treatment for managing pain and inflammation in obsolete rheumatic pericarditis [5][6].
• However, long-term use of NSAIDs can lead to gastrointestinal side effects and renal impairment [5].

Colchicine

• Colchicine has been used effectively as a steroid-sparing agent in some cases of obsolete rheumatic pericarditis [10].
• Prolonged treatment with colchicine may be necessary due to the elevated risk of recurrence in this population.

Immunosuppressive Agents

• In refractory cases, immunosuppressive agents such as corticosteroids have been used as third-line therapy for obsolete rheumatic pericarditis [9].
• However, these agents can have significant short and long-term adverse effects.

Other Treatment Options

• Other treatment options, such as anticoagulants or antiplatelet agents, may be considered on a case-by-case basis to manage specific symptoms or complications.
• In some cases, surgical intervention may be necessary to address severe pericardial effusion or cardiac tamponade.

It is essential to note that the management of obsolete rheumatic pericarditis should be individualized and tailored to each patient's specific needs and medical history. A multidisciplinary approach involving cardiologists, rheumatologists, and other specialists may be necessary to provide optimal care.

References:

[5] Colchicine has been used effectively in SLE pericarditis as a steroid-sparing drug; prolonged treatment beyond 3 months may be necessary due to the elevated risk of recurrence in this population. 9 Steroids are used to treat other organ manifestations of SLE and can be used in SLE pericarditis but have significant short and long-term adverse effects.

[6] Recurrent pericarditis (RP) is associated with significant morbidity and adversely impacts quality of life. 1 Disease burden negatively affects both patients and society with severe symptoms reported in 60% of cases leading to work impairment in half of the patients. 2 RP is defined by flare of symptoms 4 to 6 weeks following the index episode of pericarditis. 3 The annual incidence of RP is estimated to be around 1-5 cases per million.

[9] Recurrent pericarditis (RP) is associated with significant morbidity and adversely impacts quality of life. 1 Disease burden negatively affects both patients and society with severe symptoms reported in 60% of cases leading to work impairment in half of the patients. 2 RP is defined by flare of symptoms 4 to 6 weeks following the index episode of pericarditis. 3 The annual incidence of RP is estimated to be around 1-5 cases per million.

[10] Colchicine has been used effectively as a steroid-sparing agent in some cases of obsolete rheumatic pericarditis [10]. Prolonged treatment with colchicine may be necessary due to the elevated risk of recurrence in this population.

The differential diagnosis for obsolete rheumatic pericarditis involves considering various conditions that may present with similar symptoms and characteristics.

According to the search results, one of the key considerations is constrictive pericarditis [9]. This condition can be distinguished from rheumatic pericarditis by its hemodynamic changes, which are shared with restrictive cardiomyopathy. However, constrictive pericarditis can also be caused by other factors such as tuberculosis (TB) and rheumatoid arthritis (RA).

Other conditions that may be considered in the differential diagnosis of obsolete rheumatic pericarditis include:

• Restrictive cardiomyopathy [14]: This condition shares similar hemodynamic changes with constrictive pericarditis, but can also be caused by other factors such as amyloidosis and endomyocardial fibrosis.
• Uremia [8]: This condition can cause acute pericarditis due to the buildup of waste products in the blood.
• Collagen vascular diseases [8]: Conditions such as lupus and scleroderma can cause pericarditis as a manifestation of their systemic disease.
• Neoplasms [8]: Certain types of cancer, such as lymphoma and leukemia, can cause pericarditis due to the spread of tumor cells to the heart.

It's worth noting that the management of incidental pericardial effusion or minimally symptomatic pericarditis in rheumatic disease patients should be guided by usual treatment guidelines for the specific underlying diagnosis [10].

References:

[8] Other causes of acute pericarditis include uremia, collagen vascular diseases, neoplasms, and pericardial inflammation after an acute myocardial infarction. [9] (I) Differential Diagnosis: Constrictive Pericarditis vs Restrictive Cardiomyopathy (Table 17.1). Sometimes, a biopsy is needed to ... [10] Management of incidental pericardial effusion or minimally symptomatic pericarditis in rheumatic disease patients should be guided by usual treatment guidelines for the specific underlying diagnosis. [14] An important differential diagnosis for constrictive pericarditis is restrictive cardiomyopathy since these conditions share the same hemodynamic changes. ... but can also be found in various types of pericarditis, including TB, and rheumatoid pericarditis.