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The presentation and course of inflammatory pericarditis depend on its cause, but all syndromes are often (not always) associated with chest pain, which is usually pleuritic and postural (relieved by sitting) The pain is substernal but may radiate to the neck, shoulders, back, or epigastrium Dyspnea may also be present and the patient is often febrile A pericardial friction rub is characteristic, with or without evidence of fluid accumulation or constriction (see below) The presentation of tuberculous pericarditis tends to be subacute, but nonspecific symptoms (fever, night sweats, fatigue) may be present for days to months Pericardial involvement develops in 1 8% of patients with pulmonary tuberculosis Symptoms and signs of bacterial pericarditis are similar to those of other types of inflammatory pericarditides, but patients appear toxic and are often critically ill Uremic pericarditis can present with or without symptoms; fever is absent Often neoplastic pericarditis is painless, and the presenting symptoms relate to hemodynamic compromise or the primary disease Postmyocardial infarction or postcardiotomy pericarditis (Dressler s syndrome) usually presents as a recurrence of pain with pleural-pericardial features A rub is often audible, and repolarization changes on the ECG may be confused with ischemia Large effusions are uncommon, and spontaneous resolution usually occurs in a few days Dressler s syndrome occurs weeks to several months after myocardial infarction or open heart surgery, may be recurrent, and probably represents an autoimmune syndrome Patients present with typical pain, fever, malaise, and leukocytosis Occasionally, the syndrome will occur within days of surgery Rarely, other symptoms of an autoimmune disorder, such as joint pain and fever, may occur Tamponade is rare with Dressler s syndrome after myocardial infarction but not when it occurs postoperatively The clinical onset of radiation pericarditis is usually within the first year but may be delayed for many years

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Acute (< 2 weeks) inflammation of the pericardium may be infectious in origin or may be due to systemic diseases (autoimmune syndromes, uremia), neoplasm, radiation, drug toxicity, hemopericardium, postcardiac surgery, or contiguous inflammatory processes in the myocardium or lung In many of these conditions, the pathologic process involves both the pericardium and the myocardium Viral infections (especially infections with coxsackieviruses and echoviruses but also influenza, Epstein Barr, varicella, hepatitis, mumps, and HIV viruses) are the most common cause of acute pericarditis and probably are responsible for many cases classified as idiopathic Males usually under age 50 years are most commonly affected The differential diagnosis is primarily with myocardial infarction Tuberculous pericarditis has become rare in developed countries but remains common in other areas It results from direct lymphatic or hematogenous spread; clinical pulmonary involvement may be absent or minor, although associated pleural effusions are common Bacterial pericarditis has become rare and usually results from direct extension from pulmonary infections Pneumococci can cause a primary pericardial infection Borrelia burgdorferi, the organism responsible for Lyme disease, can also cause myopericarditis Uremic pericarditis is a common complication of renal failure The pathogenesis is uncertain; it occurs both with untreated uremia and in otherwise stable dialysis patients Spread of adjacent lung cancer as well as invasion by breast cancer, renal cell carcinoma, Hodgkin s disease, and lymphomas are the most common neoplastic processes involving the pericardium and have become the most frequent causes of pericardial tamponade in many countries Pericarditis may occur 2 5 days after infarction due to an inflammatory reaction to transmural myocardial necrosis (postmyocardial infarction or postcardiotomy pericarditis (Dressler s syndrome) Radia-

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In Crystal you can use barcode fonts or generate images. By experience, I'd not recommend you to use fonts never because they simply will not ...

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How to add QR Code in Crystal Report - CodeProject
In Crystal you can use barcode fonts or generate images. By experience, I'd not recommend you to use fonts never because they simply will not ...

The diagnosis of viral pericarditis is usually clinical, and leukocytosis is often present Rising viral titers in paired sera may be obtained for confirmation Cardiac enzymes may be slightly elevated, reflecting a myocarditic component The echocardiogram is often normal or reveals only a trivial amount of fluid during the acute inflammatory process The diagnosis of tuberculous pericarditis can be inferred if acidfast bacilli are found elsewhere The tuberculous pericardial effusions are usually small or moderate but may be large

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The yield of organisms by pericardiocentesis is low; pericardial biopsy has a higher yield but may also be negative, and pericardiectomy may be required If bacterial pericarditis is suspected on clinical grounds, diagnostic pericardiocentesis may be of value In uremic patients not on dialysis, the incidence of pericarditis correlates roughly with the level of blood urea nitrogen (BUN) and creatinine The pericardium is characteristically shaggy in uremic pericarditis, and the effusion is hemorrhagic and exudative The diagnosis of neoplastic pericarditis can occasionally be made by cytologic examination of the effusion or by pericardial biopsy, but it may be difficult to establish clinically if the patient has received mediastinal radiation within the previous year Neoplastic pericardial effusions develop over a long period of time and may become quite huge (> 2 L) The sedimentation rate is high in postmyocardial infarction or postcardiotomy pericarditis Large pericardial effusions and accompanying pleural effusions are frequent Myxedema pericardial effusions due to hypothyroidism usually are characterized by the presence of cholesterol crystals

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