NEP Review Uremic pericarditis

M113 PGY1 高肇亨

VS 許育瑞 主任

uremic pericardial effusion

Pericardium is the membranous sac that surrounds the heart.DEA PICTURE LIBRARY/Getty Images

McGraw Hill Human Anatomy and Physiology, seventh edition.

•Fibrinous pericarditis

•Most in uremic case

Pericardium. (2019). Pathology of Heart Disease in the Fetus, Infant and Child, 243–251. doi:10.1017/9781316337073.011

• Fibrinous adhesions of uremic pericarditis

Etiology and pathophysiology

Uremic Cardiovascular disease (CVD)

High albuminuria endothelial permeability

Accumulation of Toxic metabolites, nitrogenous metabolic end products, deranged Ca levels,

High levels of free radical

Autoimmune diseases, SLE, Scleroderma, and ANCA

Infection [CMV], influenza, and coxsackie

Physiological changes on the heart in uremia

Left ventricular failure

Early pericarditis

Increase

Right ventricular insufficiency

Late pericarditis

Volume overload, absence of Arterial hypertension, pericarditis or pericardial effusion, decreased myocardial contractility, ejection fraction, increased end-diastolic pressures

lower creatinine clearance

Total peripheral resistance

Plasma volume

Cardiac output

Arterial pressure

Indicator of uremic cardiomyopathy

1. volume overload, 2. absence of arterial hypertension 3. Increase end-diastolic pressure

Injury of the myocardium acute nonuremic pericarditis

1. widespread concave ST elevation (I, II, V5, V6, augmented voltage right arm)

2. PR depression

Author: Leilah J Dare / Editor: Jason Kendall / Reviewer: Martin Dore / Codes: CAP7, HAP8 / Published: 12/11/2018 /

Author: Leilah J Dare / Editor: Jason Kendall / Reviewer: Martin Dore / Codes: CAP7, HAP8 / Published: 12/11/2018 / Review Date: 12/11/2021

Spodick’s sign

Perm J. 2014 Winter; 18(1): e122. doi: 10.7812/TPP/14-001

CXR

2020/01/27 2020/02/10

Laboratory investigations

• Pericardial fluid • albumin, protein, lactate dehydrogenase (LDH), white blood cell

• Serum • WBC with differential count, protein ratio, LDH ratio, and albumin

gradient.CRP, creatinine.

• Autoimmune: C3,C4,Anti-dsDNA.

No statistical difference in blood urea nitrogen levels in patients with or without uremic or dialysis pericardi-tis has been found.

•Prevalence of asymptomatic pericardial effusion: 70% to 100% uremic and dialysis pericarditis,

150*0.62=93

93*0.073=6.78有症狀

ECG or clinical signs of pericarditis

Icons made by Eucalyp from www.flaticon.com

Cardiac tamponade(3.1%).

Right heart failure

Dialysis-associated Hypotension

Hypovolemia

Paroxysmal tachyarrhythmia

Treatment 1. Intensified Dialysis

2. Medication:

1. NSAID + Colchicine(0.5-1.2mg daily, 3months)

2. Aspirin(750-1000mg Q8h 3 days)

Indomethacin(600 mg every 8 h for 1–2 weeks)

3. Low-dose corticosteroids (prednisone 0.2–0.5 mg/kg/d)

3. Surgical intervention: 1. Pericardiocentesis, with pericardial window

Level of Evidence B

Reference • 1. Uremic pericarditis, pericardial effusion, and constrictive pericarditis in end-stage

renal disease: Insights and pathophysiology

• 2. Publisher: Cambridge University Press

• DOI: https://doi.org/10.1017/9781316337073.011

• 3. Anatomy of the Heart: Pericardium

• 4. Lessons from the past: Uremic pericarditis Rosa Henriques de Gouveia

• 5. Perm J. 2014 Winter; 18(1): e122. doi: 10.7812/TPP/14-001

NEP PGY1 M113高肇亨