cardiovascular-agents and Pericarditis

This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease.. Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome. Despite the increased utilization of colchicine in cardiovascular medicine, safety concerns remains unsolved regarding the long-term use of colchicine in the cardiac patient. Moreover, recent evidence has demonstrated that numerous cardiovascular medications, ranging from antihypertensive medication to antiarrhythmics, are known to interact with the CYP3A4 and/or P-gp system increasing the toxicity potential of colchicine. The use of adjunctive colchicine in the management of inflammatory pericardial diseases is standard of care in current practice. It is advised that a careful medication reconciliation with emphasis on pharmacokinetic is completed before prescribing colchicine in order to avoid harmful interaction by finding an alternative regimen or adjusting colchicine dosing.

Topics: Cardiovascular Agents; Colchicine; Drug Interactions; Humans; Pericarditis; Postpericardiotomy Syndrome; Randomized Controlled Trials as Topic

Topics: Biomarkers; Cardiac Catheterization; Cardiac Surgical Procedures; Cardiovascular Agents; Diagnostic Imaging; Diagnostic Techniques, Cardiovascular; Electrocardiography; Humans; Patient Selection; Pericarditis; Predictive Value of Tests; Risk Assessment; Risk Factors; Treatment Outcome

An overview of pericarditis, cardiomyopathy, and acute myocarditis is presented. Clinical presentation, causes, physical signs, laboratory testing, and various imaging procedures are discussed. Established pharmacologic and mechanical therapies are reviewed. Short-term and long-term prognoses, when relevant, are discussed.

Topics: Acute Disease; Adrenergic beta-Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Inflammatory Agents, Non-Steroidal; Cardiac Resynchronization Therapy; Cardiomyopathies; Cardiovascular Agents; Defibrillators, Implantable; Echocardiography; Electrocardiography; Humans; Myocarditis; Pericardial Effusion; Pericarditis

The pericardium is composed of visceral and parietal components. In view of the pericardium's simple structure, pathologic processes involving it are understandably few. However, despite a limited number of clinical syndromes, the pericardium is affected by virtually every category of disease, including infectious, neoplastic, immune-inflammatory, metabolic, iatrogenic, and traumatic. Thus, the recognition of pericardial heart disease remains challenging. Treatment of pericardial disease is also problematic in that there is a paucity of randomized, placebo-controlled trials from which appropriate therapy may be selected and important clinical decisions assisted. This article reviews pericarditis and its sequelae, pericardial effusions, cardiac tamponade and constrictive pericarditis.

Topics: Cardiac Surgical Procedures; Cardiac Tamponade; Cardiovascular Agents; Evidence-Based Medicine; Humans; Pericardial Effusion; Pericardiectomy; Pericardiocentesis; Pericarditis; Pericarditis, Constrictive; Pericardium; Treatment Outcome

Benign acute pericarditis is a common disorder. Recurrence is probably the most troublesome complication, characterized by a return of pericardial pain after recovery from an episode of typical acute pericarditis. Treatment of recurrence is often difficult and the guidelines issued by scientific societies remain vague. A number of investigators published enthusiastic reports on the efficacy of colchicine as adjuvant treatment of recurrent pericarditis and other authors suggested that colchicine should also be used as part of the treatment regimen of acute pericarditis. Colchicine is effective and safe and may be proposed as treatment of choice, especially in the idiopathic form. Treatment with corticosteroids exacerbates and extends the course of recurrent pericarditis and attenuates the efficacy of colchicine.

Topics: Adrenal Cortex Hormones; Cardiovascular Agents; Colchicine; Drug Therapy, Combination; Humans; Male; Middle Aged; Pericarditis; Recurrence; Treatment Outcome

Several systemic and cardiac diseases cause an impairment of left ventricular filling or of the ability to maintain cardiac output, without an increase in end-diastolic pressure. Prevalence of diastolic dysfunction has been found to be higher than systolic dysfunction in most studies. Many physiological conditions (age, sex and body weight), and pathological processes, such as cardiac or systemic diseases, can increase the incidence of diastolic dysfunction. Early diagnosis of left ventricular diastolic impairment has been demonstrated to have important therapeutic implications. Several invasive or non-invasive methods to investigate diastolic properties of the left ventricle have been described; a large number of studies compared different parameters of diastolic function in order to find the most accurate: this is of particular prognostic relevance since diastolic dysfunction may remain asymptomatic for a long period before resulting in overt heart failure. The purpose of this article is to provide an extensive review of the contemporary literature regarding diastolic function assessment and its role in daily practice.

Topics: Acute Disease; Angiotensin-Converting Enzyme Inhibitors; Cardiac Output, Low; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Diabetes Complications; Diastole; Echocardiography; Humans; Hypertension; Myocardial Ischemia; Pericarditis; Renin-Angiotensin System; Ventricular Dysfunction, Left; Ventricular Function, Left

Topics: Cardiovascular Agents; Colchicine; Humans; Pericarditis; Prognosis; Secondary Prevention

Topics: Cardiovascular Agents; Diagnosis, Differential; Electrocardiography; Humans; Pericarditis; Prognosis

The aim of the present study was to evaluate the safety and efficacy of the combination of indomethacin and statin compared with indomethacin plus placebo in patients with a first episode of pericarditis. A total of 55 consecutive patients with acute pericarditis were randomized in a double-blind manner into two groups: group 1 (statin group) was treated with 150 mg of indomethacin plus 10 mg of rosuvastatin, and group 2 (placebo group) was treated with 150 mg of indomethacin plus placebo. Both groups received treatment up to the normalization of inflammation markers and for the following week. Clinical and laboratory assessments [white cell count, ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein), troponin I, creatine kinase and brain natriuretic peptide plasma levels], ECG and echocardiogram were performed at baseline and daily up to discharge. All of the patients were followed as outpatients for 3 months to evaluate any recurrence of pericarditis. The two groups were similar in age, sex and laboratory parameters [group 1 (the statin group), n=28 patients; gender, 18 male and ten female; and age, 29.5+/-5.7 years; group 2 (placebo group), n=27 patients; gender, 16 male/11 female; and age, 29.2+/-4.8 years]. The statin group, when compared with the placebo group, had a significantly faster reduction in CRP values (5.0+/-1.0 compared with 6.0+/-2.0 days respectively; P=0.022), ST segment normalization (3.5+/-1.0 compared with 4.5+/-1.0 days respectively; P=0.001), pericardial effusion (4.5+/-1.0 compared with 5.5+/-1.0 days respectively; P=0.001) and ESR (5.0+/-1 compared with 6.0+/-2 days respectively; P=0.022). Our results show that the combination of statin and indomethacin treatment in patients with acute pericarditis is feasible, with a significant reduction in inflammatory markers and a favourable trend in hospitalization time (5.5+/-2.0 compared with 6.5+/-2.0 days respectively; P=0.069). However, these preliminary findings require further studies in a larger sample of patients.

Topics: Acute Disease; Adult; Anti-Inflammatory Agents, Non-Steroidal; C-Reactive Protein; Cardiovascular Agents; Double-Blind Method; Drug Therapy, Combination; Electrocardiography; Female; Fluorobenzenes; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Indomethacin; Inflammation Mediators; Male; Pericarditis; Pyrimidines; Recurrence; Rosuvastatin Calcium; Sulfonamides; Treatment Outcome

Colchicine is one of the more ancient drugs of vegetal origin still in use in clinical practice. It has been used for centuries as drug to treat gout, but its anti-inflammatory effects made it efficacious also in different cardiovascular indications (e.g. pericarditis, acute and chronic coronary syndromes, atrial fibrillation), that are well beyond its original indication. The treatment and prevention of pericarditis is the only registered cardiovascular indication in Italy (allowing prescription in class A by the National Healthcare System), while other indications are off-label. When used at low doses (0.5 mg/day), the drug is safe and efficacious with limited side effects, mainly gastrointestinal. Gastrointestinal absorption is fast since the drug is a small lipophilic molecule that is eliminated by cells through P-glycoprotein. Colchicine is metabolized by cytochrome P450 in the liver and mainly excreted into the biliary tract. It is also excreted, essentially unmodified, by the kidneys. It is concentrated in white blood cells, especially neutrophils, that are without P-glycoprotein. In these cells, blocking tubulin polymerization, colchicine reduces their function, also interfering with endothelial adhesion and platelet interactions. Moreover, it is responsible for a non-specific inhibition of the inflammasome, thus reducing the generation of pro-inflammatory cytokines, such as interleukin-1. The aim of this paper is to provide concise replies to the most common clinical questions on the use of colchicine for cardiovascular indications.

Topics: Atrial Fibrillation; Cardiovascular Agents; Colchicine; Drug-Related Side Effects and Adverse Reactions; Humans; Pericarditis

Topics: Acute Coronary Syndrome; Adult; Cardiac Catheterization; Cardiovascular Agents; Cardiovascular Diseases; Combined Modality Therapy; Coronavirus Infections; COVID-19; Diabetes Mellitus, Type 2; Diagnosis, Differential; Extracorporeal Membrane Oxygenation; Female; Heart Failure; Heart Transplantation; Humans; Hyperlipidemias; Hypertension; Hypertrophy, Left Ventricular; Immunosuppressive Agents; Intra-Aortic Balloon Pumping; Kidney Transplantation; Male; Middle Aged; Pandemics; Pericarditis; Pneumonia, Viral; Postoperative Complications; Respiration, Artificial; Respiratory Distress Syndrome; Shock, Cardiogenic

Topics: Adult; Anti-Inflammatory Agents; Antineoplastic Combined Chemotherapy Protocols; Arsenic Trioxide; Cardiovascular Agents; Chest Pain; Drug Substitution; Echocardiography; Electrocardiography; Humans; Idarubicin; Leukemia, Promyelocytic, Acute; Male; Myocarditis; Pericarditis; Remission Induction; Tretinoin

A 53-year-old woman with myelodysplastic syndrome received a cord blood transplant because she had frequent episodes of febrile neutropenia. As a conditioning regimen for transplant, she received 12 Gy total body irradiation, intravenous cytosine arabinoside 3 g/m2 every 12 hours on days -5 and -4, and cyclophosphamide 60 mg/kg/day on days -3 and -2. She received tacrolimus and short-term methotrexate treatment as prophylaxis for graft-versus-host disease. Her cardiac function was normal before transplant. She developed acute heart failure with a mild pericardial effusion 11 days after transplant, but her failure improved with a diuretic, vasodilator, and inotropic agent. She complained of dyspnea, and chest auscultation revealed pericardial friction rubs on day 28. Massive pericardial effusion was detected by echocardiography and pericarditis was diagnosed. The pericardial space was drained by pericardiocentesis. The pericardial fluid was exudative, but no bacteria or fungi were cultured. On viral polymerase chain reaction examination, human herpesvirus-6 was detected at a level of 3 × 104 copies/mL in the pericardial effusion, but not in the peripheral blood. With conservative treatment alone, that did not include antiviral therapy, her symptoms disappeared on day 56. We conclude that human herpesvirus-6 reactivation may have been associated with her pericarditis.

Topics: Cardiovascular Agents; Cord Blood Stem Cell Transplantation; DNA, Viral; Female; Heart Failure; Herpesvirus 6, Human; Humans; Immunosuppressive Agents; Middle Aged; Myelodysplastic Syndromes; Pericardial Effusion; Pericardiocentesis; Pericarditis; Roseolovirus Infections; Tomography, X-Ray Computed; Treatment Outcome; Virus Activation

Cardiac disease in SSc can manifest in various ways and is associated with a poor prognosis. There is little evidence on how best to detect and manage cardiac disease in SSc. Our objective was to produce an expert consensus best practice pathway for the management of cardiac disease in SSc.. The UK Systemic Sclerosis Study Group set up several working groups to develop a number of consensus best practice pathways for the management of SSc-specific complications, including cardiac disease. A multidisciplinary task force was convened. The guidelines were partly informed by a comprehensive literature review.. A best practice pathway for cardiac disease (with a focus on primary cardiac disease) in SSc is presented, including approaches for early detection and standard pharmacological and device therapies. Due to the benefits, shared care and a multidisciplinary approach are recommended. A future research agenda has been formulated in response to the relative lack of understanding of the natural history of primary cardiac disease that was highlighted by the initiative.. The physician should be alert to the possibility of cardiac disease in SSc; it is best managed within a multidisciplinary team including both rheumatologists and cardiologists. This pathway provides a reference for all physicians managing patients with SSc.

Topics: Arrhythmias, Cardiac; Biomarkers; Cardiomyopathies; Cardiovascular Agents; Electrocardiography; Evidence-Based Medicine; Heart Failure; Humans; Magnetic Resonance Angiography; Medical History Taking; Monitoring, Ambulatory; Patient Care Team; Pericarditis; Physical Examination; Risk Factors; Scleroderma, Systemic

Topics: Adenoviridae Infections; Adult; Biopsy; Cardiovascular Agents; Combined Modality Therapy; Defibrillators; Disease Progression; Emergencies; Female; Fever; Heart-Assist Devices; Hemodynamics; Humans; Myocarditis; Myocardium; Parvoviridae Infections; Pericarditis; Shock, Cardiogenic; Spironolactone; Ventricular Dysfunction, Left

Methylphenidate is a potent central nervous system stimulant that exerts its effects by increasing synaptic levels of dopamine and norepinephrine. It has become key to treating attention deficit-hyperactivity disorder (ADHD) in children and adolescents. As the use of stimulant medications has ballooned in the past decade, so too has awareness of the cardiovascular complications of these drugs. Effects on heart rate and blood pressure as well as tachyarrhythmias have been well described. However, acute cardiomyopathy and pericarditis secondary to methylphenidate use has been rarely reported. We report the case of a 17-year-old male who developed chest pain, elevated cardiac biomarkers, and acute left ventricular dysfunction following a single dose of methylphenidate. The risk of cardiomyopathy in the setting of methylphenidate treatment should prompt further study on the safety of this drug, and lead to ways of identifying those at risk of developing these complications.

Topics: Acute Disease; Adolescent; Angina Pectoris; Attention Deficit Disorder with Hyperactivity; Cardiomyopathies; Cardiovascular Agents; Central Nervous System Stimulants; Drug Therapy, Combination; Electrocardiography; Humans; Male; Methylphenidate; Pericarditis; Ventricular Dysfunction, Left

Topics: Acute Disease; Aged; Cardiovascular Agents; Colchicine; Female; Humans; Pericarditis; Recurrence; Time Factors

Topics: Cardiac Surgical Procedures; Cardiovascular Agents; Cardiovascular Diseases; Coronary Disease; Echocardiography; Heart Failure; Humans; Hypertension; Kidney Failure, Chronic; Pericarditis; Renal Dialysis