Tag Archives: pericarditis

Case A 35-year-old man, with no past medical history, self-presented to the emergency department at 20:00 with sharp central chest pain across his sternum, worse on inspiration. This was associated with a temperature of 39.1°C and sweating, and had been preceded by a two-day history of viral head-cold symptoms. He had no history of foreign travel, headache, photophobia, or features suggestive of meningism. On examination he looked pale, but was comfortable and alert with a heart rate of 84 beats per minute and a blood pressure of 115/75 mmHg. Routine blood tests showed C-reactive protein (CRP) 39 mg/L, white blood cell count (WBC) 15.9 × 10

On admission to the tertiary centre, he had evidence of pulsus paradoxus, raised jugular venous pressure, and muffled heart sounds, but no murmurs. Subsequently, he underwent pericardiocentesis, which drained 600 ml of turbid straw-coloured fluid with immediate improvement in the haemodynamic status. Figure 1. Computed tomography (CT) scan showing pericardial thickening and bilateral pleural effusions The patient was commenced on regular colchicine and ibuprofen. The initial blood tests showed raised inflammatory markers. The biochemical, microbiological and histopathological analysis of the pericardial fluid was normal, including viral serol

HEAT-PPCI: heparin outperforms bivalirudin in primary PCI The major talking point of this year’s American College of Cardiology meeting was without doubt the aptly named HEAT-PPCI trial which generated more heat than has been seen at such conferences for quite some time. The trial acronym stands for How Effective Are Antithrombotic Therapies in Primary PCI (percutaneous coronary intervention), and the study – conducted in the UK under the leadership of Dr Rod Stables (Liverpool Heart and Chest Hospital) – compared unfractionated heparin with bivalirudin (Angiomax®, the Medicines Company) in patients with ST-elevation myoca

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Case report A 76-year-old diabetic male presented with a three-day history of central chest pain and breathlessness. Liver ultrasound performed two months previously due to abnormal liver function tests had shown two cysts but no action was taken. On examination, he looked unwell with a raised venous pressure. Computed tomography (CT) scan showed a 2 cm pericardial effusion and a large multi-locular cyst 12 cm x 9 cm arising from the left lobe of the liver and extending to the base of the heart (figure 1). Figure 1. Computed tomography (CT) scan showing the hepatic abscess and pericardial effusion Half-an-hour later, the patient went into tam