Abstract:Pericardial involvement in end-stage renal disease (ESRD) is manifested most commonly as acute uremic or dialysis pericarditis and infrequently as chronic constrictive pericarditis (CCP). We report a 27-year-old patient with a history of uncontrolled hypertension, end-stage-renal disease on hemodialysis, who presented with recurrent ascites, dyspnea, and hypotension. After diagnosis with CCP, a partial pericardiectomy was performed; however, the patient did not improve and a salvage total pericardiectomy soon … Show more
“…Tuberculosis which was once recognized as the most common cause of CP was declined. Other causes, although less common, were connective tissue disorders, fungal infections, malignancy, trauma, asbestosis, drug-induced causes and ESRD in hemodialysis [1,4]. In the present case, past CABG and ESRD on hemodialysis were probable causes of CP.…”
A 72-year-old man, with a history of coronary artery bypass grafting (CABG) undergone19 years previously and end-stage renal disease (ESRD) on hemodialysis since 1 year before, was admitted for evaluation of dropping arterial pressure down 1 hour after starting hemodialysis. On a computed tomography on chest scan, markedly calcified pericardium on the posterior and diaphragmatic sides of the heart was revealed. Pericardium was mostly not calcified 2 years before admission, pre-initiation of hemodialysis, and the thickness of calcified pericardium was obviously increased after initiation of hemodialysis. Constrictive pericarditis (CP) was diagnosed and subsequent pericardiectomy was underwent, and dropping atrial pressure down during hemodialysis disappeared. The main cause of CP was not cardiac surgery undergone previously (postoperative CP). It is probable that secondary hyperparathyroidism in ESRD provoked dystrophic calcification of pericardium, which was injured by past CABG, subsequent rigid and thickness of pericardium, and constrictive physiology became obvious.
“…Tuberculosis which was once recognized as the most common cause of CP was declined. Other causes, although less common, were connective tissue disorders, fungal infections, malignancy, trauma, asbestosis, drug-induced causes and ESRD in hemodialysis [1,4]. In the present case, past CABG and ESRD on hemodialysis were probable causes of CP.…”
A 72-year-old man, with a history of coronary artery bypass grafting (CABG) undergone19 years previously and end-stage renal disease (ESRD) on hemodialysis since 1 year before, was admitted for evaluation of dropping arterial pressure down 1 hour after starting hemodialysis. On a computed tomography on chest scan, markedly calcified pericardium on the posterior and diaphragmatic sides of the heart was revealed. Pericardium was mostly not calcified 2 years before admission, pre-initiation of hemodialysis, and the thickness of calcified pericardium was obviously increased after initiation of hemodialysis. Constrictive pericarditis (CP) was diagnosed and subsequent pericardiectomy was underwent, and dropping atrial pressure down during hemodialysis disappeared. The main cause of CP was not cardiac surgery undergone previously (postoperative CP). It is probable that secondary hyperparathyroidism in ESRD provoked dystrophic calcification of pericardium, which was injured by past CABG, subsequent rigid and thickness of pericardium, and constrictive physiology became obvious.
“…Rapid fluid accumulation, even if it is small, can lead to tamponade, while large fluid accumulations occurring over a longer period of time, even as large as 2 liters, may not cause tamponade [ 11 ]. Once tamponade develops, urgent treatment is necessary to avoid death [ 12 ] or long-term morbidity [ 13 , 14 ].…”
Case seriesPatient: Male, 71 • Male, 69 • Female, 49Final Diagnosis: Uremic pericarditisSymptoms: —Medication: —Clinical Procedure: HemodialysisSpecialty: NephrologyObjective:Rare diseaseBackground:Uremic pericarditis, common at one time among dialysis patients, has become a rare entity in recent years. Due to its low incidence, its recognition has gained importance among internists, cardiologists, and nephrologists. It can be seen in predialysis patients and in dialysis patients who are on hemodialysis or peritoneal dialysis.Case Report:We report 3 cases of uremic pericarditis and their presenting manifestations and review 30 cases we have treated. Among these patients, the traditional findings among patients with acute pericarditis such as chest pain, fever, electrocardiographic changes, and leukocytosis are uncommon. Pericardial friction rub has a relatively high incidence but its differentiation by an untrained ear, especially by a non-cardiologist, could be a major problem. Not infrequently, it is complicated by pre-tamponade or tamponade, requiring pericardiocentesis or pericardial surgery.Conclusions:Uremic pericarditis is a treatable, but not always a preventable, condition. Timely recognition of its presence and its efficient management are essential elements of successful treatment.
“…V tomto smyslu j však přesnější CT vyšetření [29]. Ztluštění perikardu může mít vliv na plnění komor, byla popsána i konstriktivní perikarditida [30].…”
Většina pacientů s chronickým onemocněním ledvin umírá na kardiovaskulární komplikace. Echokardiografi e je základní metoda k odhalení většiny z nich. Zahrnují především dilataci a dysfunkce levé komory i levé síně, hypertrofi i levé komory, diastolickou dysfunkci levé komory, kalcifi kační postižení srdce, které může vést až k rozvoji stenotických vad, dysfunkci pravé komory a plicní hypertenzi. Zvláštností pacientů s chronickým selháním ledvin je cyklicky se měnící stav hydratace a přítomnost nízkoodporového dialyzačního zkratu (přístupu pro hemodialýzu). Tyto faktory zásadně ovlivňují aktuální echokardiografi cký nález.
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