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