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Pericarditis: Characteristics of a pediatric population
Pericardite: Apresentação e características numa população pediátrica
José Carlos Areias
Pediatria e Cardiologia Pediátrica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Idiopathic, presumed viral, causes are responsible for 80-90% of cases.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Acute pericarditis may occur secondary to collagen vascular disease, cardiac surgery or drug therapy, as a manifestation of rheumatic fever, or in association with chronic renal failure and dialysis. However, worldwide, the most common cause of acute pericarditis is tuberculosis, due to its high frequency in developing countries, where it is often associated with human immunodeficiency virus infection.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis is based on clinical criteria, including chest pain, pericardial rub, high temperature, electrocardiographic and echocardiographic changes and, in some cases, pericardial effusion.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> In children, clinical recognition will depend heavily on the type and severity of the pericardial reaction. Of physical findings, a pericardial friction rub is pathognomonic of acute pericarditis. This is a scratching sound caused by abrading of inflamed pericardial surfaces with cardiac motion. However, in the presence of a large pericardial effusion the rub may disappear.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In children, the predominant symptom of acute pericarditis is precordial chest pain, frequently exacerbated by breathing, coughing or movement.</p><p id="par0020" class="elsevierStylePara elsevierViewall">There are few characteristic radiographic findings, and these vary depending on the nature of the pericardial disease. If effusion is absent, the cardiac silhouette may be normal. In borderline cases, comparison with a previous radiograph can be helpful.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Changes in the electrocardiogram associated with pericarditis depend on the effect of the injured pericardium on the underlying myocardium, and may include changes in the QRS complex, ST segment or T wave. In the initial stage of the disease the ST segment is elevated in most leads except for V1 and aVR, which often remain unaltered.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Cross-sectional echocardiography is the most important diagnostic technique. In pericardial effusion, echocardiography will show an echo-free space surrounding the heart. Tamponade caused by fluid accumulation may present with cardiac wall motion abnormalities.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The treatment of pericarditis depends on its origin. Antibiotic therapy is used to treat bacterial pericarditis and other drugs are used according to the etiology. Treatment of pericardial tamponade includes drainage of the pericardial fluid in patients with hypotension or low cardiac output.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Perez-Brandão et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> review the clinical presentation and characteristics of a pediatric population with pericarditis, performing a retrospective analysis of children admitted to a pediatric cardiology unit with pericarditis between 2003 and 2015. In agreement with published studies, the predominant symptom of acute pericarditis was precordial chest pain, in 70% of the patients. Forty-eight percent of children presented with infectious pericarditis, and postpericardiotomy syndrome was diagnosed in five cases. Pericardiocentesis was performed in 12 patients, 11 of them with cardiomegaly identified on the chest X-ray. Seventeen children had myocarditis accompanied by viral pericarditis. A variety of symptoms ranging from mild to overt heart failure and shock were observed.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Treatment of viral pericarditis is predominantly symptomatic, including bed rest. Medical therapy may include nonsteroidal anti-inflammatory drugs and colchicine. In their review, the authors emphasize the use of colchicine as a useful drug in recurrent cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, pericarditis in children is relatively rare. A judicious analysis of the clinical findings, treatment and follow-up are mandatory.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation and treatment of pericarditis: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Imazio" 1 => "F. Gaita" 2 => "M. LeWinter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2015.12763" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2015" "volumen" => "314" "paginaInicial" => "1498" "paginaFinal" => "1506" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26461998" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute and recurrent pericarditis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Imazio" 1 => "F. Gaita" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccl.2017.07.004" "Revista" => array:6 [ "tituloSerie" => "Cardiol Clin" "fecha" => "2017" "volumen" => "35" "paginaInicial" => "505" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29025542" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation of echocardiographic and clinical findings in patients with pericardial effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P.A. Vignola" 1 => "G.M. Pohost" 2 => "G.D. Curfman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0002-9149(76)90363-5" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "1976" "volumen" => "37" "paginaInicial" => "701" "paginaFinal" => "707" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1266739" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pericardite – Apresentação e características numa população pediátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Perez-Brandão" 1 => "C. Trigo" 2 => "F.F. 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| 2022 Agosto | 27 | 38 | 65 |
| 2022 Julho | 27 | 52 | 79 |
| 2022 Junho | 16 | 31 | 47 |
| 2022 Maio | 23 | 49 | 72 |
| 2022 Abril | 31 | 38 | 69 |
| 2022 Maro | 32 | 48 | 80 |
| 2022 Fevereiro | 59 | 47 | 106 |
| 2022 Janeiro | 29 | 29 | 58 |
| 2021 Dezembro | 23 | 37 | 60 |
| 2021 Novembro | 25 | 43 | 68 |
| 2021 Outubro | 22 | 57 | 79 |
| 2021 Setembro | 36 | 35 | 71 |
| 2021 Agosto | 43 | 45 | 88 |
| 2021 Julho | 23 | 27 | 50 |
| 2021 Junho | 26 | 33 | 59 |
| 2021 Maio | 41 | 35 | 76 |
| 2021 Abril | 30 | 43 | 73 |
| 2021 Maro | 56 | 21 | 77 |
| 2021 Fevereiro | 46 | 24 | 70 |
| 2021 Janeiro | 35 | 23 | 58 |
| 2020 Dezembro | 30 | 18 | 48 |
| 2020 Novembro | 21 | 18 | 39 |
| 2020 Outubro | 21 | 32 | 53 |
| 2020 Setembro | 26 | 11 | 37 |
| 2020 Agosto | 28 | 11 | 39 |
| 2020 Julho | 31 | 25 | 56 |
| 2020 Junho | 28 | 23 | 51 |
| 2020 Maio | 21 | 21 | 42 |
| 2020 Abril | 27 | 22 | 49 |
| 2020 Maro | 31 | 34 | 65 |
| 2020 Fevereiro | 28 | 27 | 55 |
| 2020 Janeiro | 23 | 20 | 43 |
| 2019 Dezembro | 29 | 11 | 40 |
| 2019 Novembro | 23 | 16 | 39 |
| 2019 Outubro | 33 | 22 | 55 |
| 2019 Setembro | 49 | 34 | 83 |
| 2019 Agosto | 22 | 23 | 45 |
| 2019 Julho | 18 | 27 | 45 |
| 2019 Junho | 74 | 57 | 131 |
| 2019 Maio | 31 | 34 | 65 |
| 2019 Abril | 56 | 37 | 93 |
| 2019 Maro | 29 | 33 | 62 |
Mostrar tudo
