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  • Dressler’s syndrome

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  • 420 Acute pericarditis
  • 420.0 Acute pericarditis in diseases classified elsewhere
  • 420.90 Acute pericarditis, unspecified
  • 420.91 Acute idiopathic pericarditis
  • 420.99 Other acute pericarditis
  • 423 Other diseases of pericardium
  • 423.0 Hemopericardium
  • 423.1 Adhesive pericarditis
  • 423.2 Constrictive pericarditis
  • 423.3 Cardiac tamponade
  • 423.8 Other specified diseases of pericardium
  • 423.9 Unspecified disease of pericardium

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  • I30 Acute pericarditis
  • I30.0 Acute nonspecific idiopathic pericarditis
  • I30.1 Infective pericarditis
  • I30.8 Other forms of acute pericarditis
  • I30.9 Acute pericarditis, unspecified
  • I31 Other diseases of pericardium
  • I31.0 Chronic adhesive pericarditis
  • I31.1 Chronic constrictive pericarditis
  • I31.4 Cardiac tamponade
  • I31.8 Other specified diseases of pericardium
  • I31.9 Disease of pericardium, unspecified
  • I32 Pericarditis in diseases classified elsewhere

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Description

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  • Inflammation of the pericardium (fibrous sac surrounding the heart)
  • Can be acute or chronic

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Essentials of Diagnosis

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  • Chest pain can be relieved by sitting up and leaning forward
  • Stethoscope: pericardial rub sound
  • Bacterial infection: mycobacterium tuberculosis
  • Acute to chronic
    • Acute < 6 weeks
    • Subacute 6 weeks to 6 months
    • Chronic > 6 months
  • Classification secondary to type of fluid
    • Serous
    • Purulent
    • Fibrinous
    • Caseous
    • Hemorrhagic
    • Post infarction (from a heart attack)

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General Considerations

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  • Can be misdiagnosed as a heart attack
  • Often the result of an infection
  • No change with exertion
  • Often unknown etiology

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Demographics

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  • Mostly men ages 20 to 50 years of age

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Signs and Symptoms

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  • Cardiac tamponade
  • Sharp stabbing chest pain
  • Pain can radiate into the upper trapezius muscle
  • Shortness of breath
  • Fatigue weakness
  • Swelling in the lower extremities
  • Anxiety
  • Diaphoresis
  • Dry cough
  • Fever
  • Crackles in the lungs
  • Heart sounds
    • Decreased breath sounds
    • Pericardial rub sound

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Functional Implications

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  • New York Heart Association functional status
    • Class I: a patient who is not limited with normal physical activity by symptoms
    • Class II: occurs when ordinary physical activity results in fatigue, dyspnea, or other symptoms
    • Class III: characterized by a marked limitation in normal physical activity
    • Class IV: defined by symptoms at rest or with any physical activity
  • Depending on the severity
    • Decreased activity tolerance
    • Decreased exercise tolerance
    • Dyspnea on exertion
    • Hypoxia
    • Muscle weakness
    • Cardiac arrhythmia

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Possible Contributing Causes1

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  • Infections
    • Viral infection: coxsackievirus
    • Bacterial infection: tuberculosis, purulent (staphylococcal, pneumococcal)
    • Fungal infection
    • Protozoal: ambiasis
    • Mycotic: actinomycosis, coccidiodomycosis
  • Collagen vascular disease
    • Systemic lupus erythematosus
    • Scleroderma
    • Rheumatoid arthritis
  • Heart attack
  • Medications: tetracyclines
  • Radiation
  • Trauma
  • Rheumatic fever
  • Metabolic
    • Kidney failure
  • Neoplasm: cancer
  • HIV infection
  • Idiopathic
  • Auto-immune (Dressler’s syndrome)

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  • Cardiac pump dysfunction
  • Angina pectoris
  • Aortic dissection
  • Aortic stenosis
  • Gastritis
  • Gastroesophageal reflux disease (GERD)
  • Myocardial infarction
  • Myocardial ischemia
  • Pulmonary embolism

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Laboratory Tests

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  • Antinuclear antibody (ANA)
  • Complete blood count (CBC)
  • C-reactive protein

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Imaging

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  • Chest x-ray
  • EKG
  • Echocardiogram
  • Radionucletide ...

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