MyMedR

Fulltext Can COVID-19 vaccines improve cardiovascular outcomes?

Kow CS, Ramachandram DS, Hasan SS

Travel Med Infect Dis, 2022;48:102350.

PMID: 35500844 DOI: 10.1016/j.tmaid.2022.102350

Thus far, the investigations on the efficacy of the COVID-19 vaccines in randomized trials [8,9] have been centered around reducing the risk of severe infection and mortality. We opine investigations on the efficacy of the COVID-19 vaccines to reduce the risk of cardiovascular outcomes should be performed to understand if COVID-19 vaccination has cardiovascular benefits. Such investigations could also develop more confidence toward the acceptance of COVID-19 vaccines by the public, especially when some of the COVID-19 vaccines (particularly the mRNA vaccines such as BNT162b2 and mRNA-1273 vaccines) have been associated with the rare occurrence of cardiovascular complications, including myocarditis and pericarditis [10,11]. While the infrequency and the mild nature of the myocarditis and pericarditis cases after vaccination greatly exceed the small increased risk, specious reports on social media are still fueling the COVID-19 vaccine hesitancy. Therefore, we urge the performance of prospective investigations to establish the relationship between COVID-19 vaccines and cardiovascular outcomes.

Matched MeSH terms: Pericarditis*

Diagnosis and management of purulent pericarditis. Experience with pericardiectomy

Majid AA, Omar A

J. Thorac. Cardiovasc. Surg., 1991 Sep;102(3):413-7.

PMID: 1881180

Twelve cases of purulent pericarditis seen over 6 years are described. Staphylococcus aureus was the most common causative organism (six patients), and a respiratory infection was the most common preceding illness. The chest radiograph and echocardiogram were useful pointers to the diagnosis, but the electrocardiogram was not reliable. Antibiotics, surgical drainage, and pericardiectomy were used in all 12 cases. There was one death (8.3%), which occurred in a patient who was seen late. A review of the literature dealing with the diagnosis and management of this condition is presented. The importance of early diagnosis before a significant degree of cardiac tamponade occurs is noted. Although there is general agreement that surgical drainage is mandatory, the approach, methods of drainage, and extent of pericardial resection have been the subject of some discussion, and at least seven techniques are available. We conclude that pericardiectomy has a definite place in the management of purulent pericarditis.

Matched MeSH terms: Pericarditis/diagnosis*; Pericarditis/microbiology; Pericarditis/surgery*

Fulltext Mediastinal abscess and pericarditis complicating retropharyngeal abscess--a case report

Elango S, Edward R, Purohit GN

Med J Malaysia, 1989 Dec;44(4):348-50.

PMID: 2520047

A case of retropharyngeal abscess complicated is reported and its management is outlined. Key words: Retropharyngeal abscess,Complication, Pericardities, Mediastinal abscess

Matched MeSH terms: Pericarditis/complications*

Tuberculous pericardial disease

Chia BL, Yap MH, Goh YS

Med J Malaya, 1970 Jun;24(4):267-72.

PMID: 4248347

Matched MeSH terms: Pericarditis/etiology*

A Case of Constrictive Pericarditis Associated with Melioidosis in an Immunocompetent Patient Treated by Pericardiectomy

Lu HT, Ramsamy G, Lee CY, Syed Hamid SRG, Kan FK, Nordin RB

Am J Case Rep, 2018 Mar 19;19:314-319.

PMID: 29551765

BACKGROUND Melioidosis is a rare tropical bacterial infection caused by the Gram-negative soil saprophyte, Burkholderia pseudomallei. Melioidosis can mimic a variety of diseases due to its varied presentation, and unless it is treated rapidly, it can be fatal. A rare case of melioidosis, with pericarditis and pericardial effusion, is described, which demonstrates the value of early diagnosis with echocardiography and pericardiocentesis. CASE REPORT A 38-year-old native (Iban) East Malaysian man presented with shortness of breath and tachycardia. Transthoracic echocardiography (TTE) showed cardiac tamponade. Urgent pericardiocentesis drained a large amount of purulent pericardial fluid that grew Burkholderia pseudomallei. Despite appropriate dose and duration of intravenous treatment with ceftazidime followed by meropenem, the patient developed recurrent pericardial effusion and right heart failure due to constrictive pericarditis. The diagnosis of constrictive pericarditis was confirmed by computed tomography (CT) and surgical exploration. Following pericardiectomy, his symptoms resolved, but patient follow-up was recommended for possible sequelae of constrictive pericarditis. CONCLUSIONS After the onset of melioidosis pericarditis, the authors recommend follow-up and surveillance for possible complication of constrictive pericarditis.

Matched MeSH terms: Pericarditis, Constrictive/etiology*; Pericarditis, Constrictive/microbiology; Pericarditis, Constrictive/surgery

Successful surgical management of a case of pulmonary and pericardial melioidosis

Majid AA

Aust N Z J Surg, 1990 Feb;60(2):139-41.

PMID: 2327916

A 35 year old diabetic presented with features of septicaemia and developed cardiac tamponade. He was found to have pulmonary, acute septicaemic and pericardial melioidosis. Some initial improvement was achieved with medical therapy but only with surgical intervention was a successful outcome achieved.

Matched MeSH terms: Pericarditis/etiology; Pericarditis/radiography; Pericarditis/surgery*

Constrictive pericarditis following necrotising pneumococcal pneumonia in an immunocompetent child

Yubbu P, Kaur J, Jamaluddin JA

Cardiol Young, 2019 Aug;29(8):1101-1103.

PMID: 31239005 DOI: 10.1017/S1047951119001458

Purulent pericarditis leading to constrictive pericarditis is a rare but serious complication following invasive pneumococcal infection. Early recognition of this complication is crucial to prevent mortality. Here, we report a previously healthy child who developed constrictive pericarditis due to purulent pericarditis following necrotising pneumococcal pneumonia, which is not common in this current antibiotic and pneumococcal vaccine era. The child was successfully treated with pericardiectomy.

Matched MeSH terms: Pericarditis, Constrictive/etiology*; Pericarditis, Constrictive/microbiology; Pericarditis, Constrictive/surgery

Fulltext Atrial flutter and pericarditis--a rare complication of right lobe amoebic liver abscess

Murali A, Balu K, Paari V, Rajendiran G

Med J Malaysia, 2011 Dec;66(5):499-500.

PMID: 22390111

A 38 year old gentleman presented with fever and right hypochondrial pain. On further evaluation he was detected to have an amoebic liver abscess (ALA) in the right lobe of the liver. The abscess yielded anchovy sauce pus on percutaneous drainage. Following the percutaneous drainage the patient developed tachycardia. Electrocardiogram revealed atrial flutter with rapid ventricular rate and ST elevation in all leads suggestive of pericarditis. The atrial flutter was reverted to sinus rhythm by cardioversion. The patient then had an uncomplicated convalescence. Amoebic pericarditis, though rare, is a serious complication of amoebic liver abscess. Pericardial complications are usually seen with left lobe liver abscess due to its proximity. Both pericarditis and cardiac arrhythmias due to amoebic liver abscess especially from right lobe are very rare.

Matched MeSH terms: Pericarditis/diagnosis; Pericarditis/parasitology*

Fulltext Risk of serious adverse events after the BNT162b2, CoronaVac, and ChAdOx1 vaccines in Malaysia: A self-controlled case series study

Ab Rahman N, Lim MT, Lee FY, Lee SC, Ramli A, Saharudin SN, et al.

Vaccine, 2022 Jul 30;40(32):4394-4402.

PMID: 35667917 DOI: 10.1016/j.vaccine.2022.05.075

BACKGROUND: Rapid deployment of COVID-19 vaccines is challenging for safety surveillance, especially on adverse events of special interest (AESIs) that were not identified during the pre-licensure studies. This study evaluated the risk of hospitalisations for predefined diagnoses among the vaccinated population in Malaysia.

METHODS: Hospital admissions for selected diagnoses between 1 February 2021 and 30 September 2021 were linked to the national COVID-19 immunisation register. We conducted self-controlled case-series study by identifying individuals who received COVID-19 vaccine and diagnosis of thrombocytopenia, venous thromboembolism, myocardial infarction, myocarditis/pericarditis, arrhythmia, stroke, Bell's Palsy, and convulsion/seizure. The incidence of events was assessed in risk period of 21 days postvaccination relative to the control period. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI) with adjustment for calendar period.

RESULTS: There was no increase in the risk for myocarditis/pericarditis, Bell's Palsy, stroke, and myocardial infarction in the 21 days following either dose of BNT162b2, CoronaVac, and ChAdOx1 vaccines. A small increased risk of venous thromboembolism (IRR 1.24; 95% CI 1.02, 1.49), arrhythmia (IRR 1.16, 95% CI 1.07, 1.26), and convulsion/seizure (IRR 1.26; 95% CI 1.07, 1.48) was observed among BNT162b2 recipients. No association between CoronaVac vaccine was found with all events except arrhythmia (IRR 1.15; 95% CI 1.01, 1.30). ChAdOx1 vaccine was associated with an increased risk of thrombocytopenia (IRR 2.67; 95% CI 1.21, 5.89) and venous thromboembolism (IRR 2.22; 95% CI 1.17, 4.21).

CONCLUSION: This study shows acceptable safety profiles of COVID-19 vaccines among recipients of BNT162b2, CoronaVac, and ChAdOx1 vaccines. This information can be used together with effectiveness data for risk-benefit analysis of the vaccination program. Further surveillance with more data is required to assess AESIs following COVID-19 vaccination in short- and long-term.

Matched MeSH terms: Pericarditis/chemically induced; Pericarditis/epidemiology

Fulltext An Unusual Presentation of Tuberculosis

Low, Qin Jian, Cheo, Seng Wee

Borneo Journal of Medical Sciences, 2019;13(2):45-48.

MyJurnal

The normal pericardium is a fibroelastic sac containing a thin layer of fluid that surrounds the heart. Cardiac tamponade, which may be acute or subacute, is characterized by the accumulation of pericardial fluid under pressure. Tuberculous pericarditis is a complication of tuberculosis which is often diagnose late due to the difficulty in establishing this diagnosis. We present a case of pericardial tuberculosis diagnosed in a 20-year-old young retroviral disease patient who presented with signs of cardiac tamponade. His clinical condition improved post-pericardial tapping and he was discharged with anti tuberculosis medications. This case highlight the importance of having a high level of suspicion as this condition is easily curable.

Matched MeSH terms: Pericarditis, Tuberculous

Massive pericardial effusion - An uncommon initial presentation of systemic lupus erythematosus (SLE)

Cheo SW, Low QJ

Med J Malaysia, 2019 Oct;74(5):439-440.

PMID: 31649224

Systemic lupus erythematosus (SLE) is a common autoimmune disease that we see in our daily clinical practice. It can involve almost every organs in the body. Cardiac manifestations of SLE include pericarditis, myocarditis, heart block, coronary artery disease and others. Here, we report a case of SLE with an uncommon presentation of massive pericardial effusion as initial presentation. Here we also highlight that massive pericardial effusion can also be associated with other complications of SLE such as heart failure and lupus nephritis.

Matched MeSH terms: Pericarditis

Fulltext A Rare Case of Purulent Pericardial TB

Johari MI, Ramli AW, Mat Lawi F, Bin Fouzi MAH, Suardi KPS

Cureus, 2019 Aug 09;11(8):e5356.

PMID: 31608191 DOI: 10.7759/cureus.5356

Pericardial effusion is a common disease and tuberculosis (TB) accounts up to 4% of acute pericarditis with up to 7% of tamponade case. Accurate diagnosis is important while quick intervention can be life-saving. A case was reported involving a 73-year-old man who presented with reduced effort tolerance for one-month duration. During hospitalization, further workup revealed the presence of massive purulent pericardial effusion with evidence of tamponade. TB gene expert was positive in aspirated pericardial fluid and the patient was treated promptly using a combination of anti-TB drugs with the addition of steroid therapy.

Matched MeSH terms: Pericarditis

Fulltext A case of successful extracorporeal membrane oxygenation for right ventricular failure following pericardiectomy

Karthigesu A, Hamdan L, Arif M, Haslan G

Med J Malaysia, 2015 Dec;70(6):369-70.

PMID: 26988215 MyJurnal

Extracorporeal membrane oxygenation (ECMO) is a useful but less commonly used technique in right ventricular failure post cardiac surgery in our region. We report a case of successful use of ECMO for right ventricular failure post cardiac surgery. Our patient is a 27-year-old male presented with constrictive pericarditis post completion of treatment for disseminated Tuberculosis. He underwent pericardiectomy that was complicated with acute right ventricular failure. He was placed on extracorporeal membrane oxygenation after few hours post op that lasted for five days. The patient survived to hospital discharge and remained well on follow-up. From our experience, this aggressive management approach is beneficial in right ventricular failure and can be safely utilised in all cardiothoracic centres.

Matched MeSH terms: Pericarditis, Constrictive

Fulltext Trapped heart in heavily calcified pericardium

Zaimi MA, Mamat AZ, Ghazali MZ, Zakaria AD, Sahid NA, Hayati F

Oxf Med Case Reports, 2020 Oct;2020(10):omaa083.

PMID: 33133617 DOI: 10.1093/omcr/omaa083

Constrictive pericarditis is a disabling disease of the heart, which causes cardiac diastolic dysfunction. We present a case of a 44-year-old gentleman with a history of blunt chest trauma who presented with constrictive pericarditis with right-sided heart failure. Imaging studies revealed a calcified pericardium. He underwent an uneventful pericardiectomy. Calcification is common yet rare if it involves the pericardium. It normally occurs following fibrosis and adhesion which are associated with the chronicity of the disease, hence creating more challenge to the operating surgeon in the pericardiectomy procedure.

Matched MeSH terms: Pericarditis, Constrictive

Pericardial abscess: The corollary of disseminated Methicillin-resistant Staphylococcus aureus following diabetic foot ulcer infection

Tan TL, Lim SH, Ruslan Mustapa M, Ganeswary R

Med J Malaysia, 2020 11;75(6):742-744.

PMID: 33219189

Methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis, characterised by frank pus collection or microscopic pyogenic effusion in the pericardium represents the most serious form of pericardial infection. The route of MRSA acquisition in pericardial abscess commonly occurs via the blood stream infection and it is more commonly observed among immunocompromised individuals. To date, diabetic foot ulcer infection rarely disseminates and becomes a nidus for pericardial infection. Herein, we report an unusual case of MRSA pericardial abscess in a 44-year-old man who presented at Hospital Seri Manjung, Malaysia with cardiac tamponade. Past medical history indicated that he was recently treated for infected diabetic foot ulcer with MRSA bacteraemia one week earlier. Despite adequate pericardial drainage and extended parenteral vancomycin therapy, this case ended in fatality on day 42 of admission due to nosocomial infection. It is hoped that this report serves to increase the vigilance among clinicians that diabetic foot ulcer infections have the potential to progress to pericardial abscess in the presence of MRSA bacteraemia, although they may appear seemingly innocuous at presentation. Systemic vancomycin must be instituted promptly when MRSA bacteraemia is confirmed in order to circumvent the propagation of MRSA.

Matched MeSH terms: Pericarditis

Disease Expression and HLA Types in Early and Late Onset Disease of Malaysian Patients with Systemic Lupus Erythematosus

Radzi AM, Huan KS, Yahaya N, Shahera A, Kong N, Mohd Noah R

Malays J Med Sci, 2001 Jul;8(2):32-9.

PMID: 22893758

Age has been suggested to modify systemic lupus erythematosus expression. In this study we have attempted to study 13 patients with late onset (40 years and above) and 90 with early onset disease (below 40 years) to determine whether age-related differences in disease expression exist and whether the genetic make-up influences the age of disease onset. We found that patients with late onset disease initially presented with pericarditis (31% vs 3%, P<0.005) and a lower incidence of malar rash (31% vs 57%, p<0.05). During the disease course, there was a lower incidence of mucocutaneous symptoms especially malar rash (p<0.005) and psychosis (p<0.05) in the late onset group. Serological parameters were similar in both groups. There was a prevalence of HLA-DQA1*0103 in Chinese patients with late onset disease (pcorr=0.004). These findings suggest that a subgroup of late onset patients may experience milder disease and that the risk conferred by the HLA-DQA1*0103 may be significant among these patients.

Matched MeSH terms: Pericarditis

Angiosarcoma - a rare fatal cause of recurrent pericardial effusions

Ng BH, Tan YS, Pavitratha P, A Hing C, Zainul NH, Lim CH

Med J Malaysia, 2020 11;75(6):759-761.

PMID: 33219196

A 40-year-old man presented to the Hospital Sultanah Bahiyah, Alor Setar, Kedah, with constitutional and respiratory symptoms. Physical examination and echocardiogram demonstrated massive pericardial effusion. Patient required multiple attempts of pericardiocentesis due to recurrent pericardial effusion. Initial workup including pericardial fluids examination and computed tomography imaging did not reveal any apparent cause. Magnetic resonance imaging showed a suspicious mass infiltrating into the right atrium. Autoimmune screening was negative. Patient was subsequently treated as having tuberculous pericarditis. However, his disease progressed rapidly and he eventually passed away due to right atrial rupture. Postmortem revealed a ruptured right atrial tumour leading to massive haemothorax. Histopathological examination confirmed the diagnosis of primary pericardial angiosarcoma.

Matched MeSH terms: Pericarditis, Tuberculous

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