Pericarditis laboratory studies: Difference between revisions
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | ||
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| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' ECG is recommended in all patients with suspected acute pericarditis. | | bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' [[ECG]] is recommended in all [[patients]] with suspected [[acute pericarditis]]. | ||
'''2.''' Transthoracic echocardiography is recommended in all patients with suspected acute pericarditis. | '''2.''' [[Transthoracic echocardiography]] is recommended in all [[patients]] with suspected [[acute pericarditis]]. | ||
'''3.''' Chest X-ray is recommended in all patients with suspected acute pericarditis. | '''3.''' [[Chest X-rays|Chest X-ray]] is recommended in all [[patients]] with suspected [[Acute pericarditis|acute pericarditis.]] | ||
'''4.''' Assessment of markers of inflammation (i.e. CRP) and myocardial injury (i.e. CK, troponin) is recommended in patients with suspected acute pericarditis. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | '''4.''' Assessment of markers of [[inflammation]] (i.e. [[CRP]]) and [[myocardial]] [[injury]] (i.e. [[CK]], [[troponin]]) is recommended in [[patients]] with suspected [[acute pericarditis]]. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | ||
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| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' Urgent pericardiocentesis is recommended for the diagnosis of purulent pericarditis. | | bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' [[Urgent care|Urgent]] [[pericardiocentesis]] is recommended for the [[diagnosis]] of [[purulent pericarditis]]. | ||
'''2.''' It is recommended that pericardial fluid be sent for bacterial, fungal and tuberculous studies and blood drawn for cultures. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | '''2.''' It is recommended that [[pericardial fluid]] be sent for [[bacterial]], [[fungal]] and [[tuberculous]] studies and [[blood]] drawn for cultures. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: C]])'' | ||
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[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Primary care]] | [[Category:Primary care]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Revision as of 01:07, 18 December 2019
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Pericarditis Microchapters |
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Diagnosis |
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Treatment |
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Surgery |
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Case Studies |
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Pericarditis laboratory studies On the Web |
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American Roentgen Ray Society Images of Pericarditis laboratory studies |
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Risk calculators and risk factors for Pericarditis laboratory studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S. Homa Najafi, M.D.[2]
Overview
Non-specific markers of inflammation are generally elevated in pericarditis. These include the leukocyte count, C-reactive protein, and ESR. The cardiac troponin is elevated if there is an injury to the underlying myocardium, a condition termed as myopericarditis. Diagnostic pericardiocentesis and biopsy help in identifying an underlying infectious or malignant process.
Inflammatory Markers
The following inflammatory markers are often elevated:
- CBC: Significant leukocytosis may be present.
- C-reactive protein
- Erythrocyte sedimentation rate (ESR)
Cardiac Biomarkers
The following markers of myonecrosis may be elevated if there is involvement of the underlying myocardium:
- Creatine kinase: Acute pericarditis may be associated with a modest increase in serum creatine kinase-MB (CK-MB) depending upon the extent of involvement of the underlying myocardium.[1][2]
- Cardiac troponin-I (cTnI)[3][4]: The troponin can be elevated if there is an underlying myositis, or a myopericarditis. In Europe, patients with pericarditis and an elevated troponin are hospitalized briefly to assure that the patient is stable.
- LDH: Serum LDH may be elevated depending upon the extent of myocardial involvement.
- Serum myoglobin
- SGOT (AST)
Autoimmune Markers
Following autoimmune markers may be checked in patients with recurrent or prolonged pericarditis:
Gallium-67 Imaging
Gallium-67 scanning may help identify inflammatory and leukemic infiltrations.
Diagnostic Pericardiocentesis
Pericardiocentesis is a relatively safe procedure when guided by echocardiography, especially when large free anterior pericardial effusion is present. Pericardial fluid should be aspirated and tested for the presence of malignant cells and tumor markers, particularly in patients with hemorrhagic effusion without preceding trauma.[5] However, hemorrhagic pericarditis in developing countries could be due to tuberculosis. Sensitivity of cytological analysis of pericardial fluid for malignant cells was 67%,[6] 75%,[7] and 92%[8] in different studies with specificity of 100%. Immunohistochemistry can be used to distinguish between the malignant cells and their possible origin.[9][10]
Aspirated fluid can also be used for the following tests:
- Gram staining
- Acid-fast staining
- Microbial culture
Pericardial Biopsy
If the clinical suspicion of malignancy is high, and if the results of cytology testing from the pericardiocentesis are negative, consideration should be given to performing a pericardial biopsy. This can be performed via either a subxiphoid or transthoracic pericardiostomy or alternatively by pericardioscopy. Advantages of pericardioscopy include helping to directly visualize the pericardium as well as helping to collect the biopsy sample. Pericardioscopy has an excellent sensitivity of 97%,[7][11] which compares quite favorably to a blind biopsy which has a low sensitivity of 55-65%.
2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)[12]
Recommendations for diagnosis of acute pericarditis
| Class I |
| 1. ECG is recommended in all patients with suspected acute pericarditis.
2. Transthoracic echocardiography is recommended in all patients with suspected acute pericarditis. 3. Chest X-ray is recommended in all patients with suspected acute pericarditis. 4. Assessment of markers of inflammation (i.e. CRP) and myocardial injury (i.e. CK, troponin) is recommended in patients with suspected acute pericarditis. (Level of Evidence: C)
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Recommendations for the diagnosis and therapy of viral pericarditis
| Class IIa |
| For the definited diagnosis of viral pericarditis, a comprehensive workup of histological, cytological, immunohistological and molecular investigations in pericardial fluid and peri-/epicardial biopsies should be considered. (Level of Evidence: C) |
| Class III |
| 1. Routine viral serology is not recommended, with the possible exception of HIV and HCV.
2. Corticosteroid therapy is not recommended in viral pericarditis. (Level of Evidence: C)
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Recommendations for the diagnosis of purulent pericarditis
| Class I |
| 1. Urgent pericardiocentesis is recommended for the diagnosis of purulent pericarditis.
2. It is recommended that pericardial fluid be sent for bacterial, fungal and tuberculous studies and blood drawn for cultures. (Level of Evidence: C)
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References
- ↑ Spodick DH (2003). "Acute pericarditis: current concepts and practice". JAMA. 289 (9): 1150–3. doi:10.1001/jama.289.9.1150. PMID 12622586.
- ↑ Karjalainen J, Heikkila J (1986). ""Acute pericarditis": myocardial enzyme release as evidence for myocarditis". Am Heart J. 111 (3): 546–52. doi:10.1016/0002-8703(86)90062-1. PMID 3953365.
- ↑ Bonnefoy E, Godon P, Kirkorian G, Fatemi M, Chevalier P, Touboul P (2000). "Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis". Eur Heart J. 21 (10): 832–6. doi:10.1053/euhj.1999.1907. PMID 10781355.
- ↑ Imazio M, Demichelis B, Cecchi E, Belli R, Ghisio A, Bobbio M, Trinchero R (2003). "Cardiac troponin I in acute pericarditis". J Am Coll Cardiol. 42 (12): 2144–8. doi:10.1016/j.jacc.2003.02.001. PMID 14680742.
- ↑ Atar S, Chiu J, Forrester JS, Siegel RJ (1999). "Bloody pericardial effusion in patients with cardiac tamponade: is the cause cancerous, tuberculous, or iatrogenic in the 1990s?". Chest. 116 (6): 1564–9. PMID 10593777.
- ↑ Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U (1991). "The diagnostic value of pericardial cytology. An analysis of 95 cases". Acta Cytol. 35 (2): 149–53. PMID 2028688.
- ↑ 7.0 7.1 Porte HL, Janecki-Delebecq TJ, Finzi L, Métois DG, Millaire A, Wurtz AJ (1999). "Pericardoscopy for primary management of pericardial effusion in cancer patients". Eur J Cardiothorac Surg. 16 (3): 287–91. PMID 10554845.
- ↑ Meyers DG, Meyers RE, Prendergast TW (1997). "The usefulness of diagnostic tests on pericardial fluid". Chest. 111 (5): 1213–21. PMID 9149572.
- ↑ Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW (2003). "Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep vs cell block". Diagn Cytopathol. 28 (1): 1–5. doi:10.1002/dc.10219. PMID 12508174.
- ↑ Mayall F, Heryet A, Manga D, Kriegeskotten A (1997). "p53 immunostaining is a highly specific and moderately sensitive marker of malignancy in serous fluid cytology". Cytopathology. 8 (1): 9–12. PMID 9068950.
- ↑ Nugue O, Millaire A, Porte H, de Groote P, Guimier P, Wurtz A; et al. (1996). "Pericardioscopy in the etiologic diagnosis of pericardial effusion in 141 consecutive patients". Circulation. 94 (7): 1635–41. PMID 8840855.
- ↑ Adler, Yehuda; Charron, Philippe; Imazio, Massimo; Badano, Luigi; Barón-Esquivias, Gonzalo; Bogaert, Jan; Brucato, Antonio; Gueret, Pascal; Klingel, Karin; Lionis, Christos; Maisch, Bernhard; Mayosi, Bongani; Pavie, Alain; Ristić, Arsen D.; Sabaté Tenas, Manel; Seferovic, Petar; Swedberg, Karl; Tomkowski, Witold (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.