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Pericarditi, Miocarditi e CMP infiammatorie: cosa cè di nuovo? Pericarditi Massimo Imazio, MD, FESC Dipartimento di Cardiologia Ospedale Maria Vittoria,

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Presentation on theme: "Pericarditi, Miocarditi e CMP infiammatorie: cosa cè di nuovo? Pericarditi Massimo Imazio, MD, FESC Dipartimento di Cardiologia Ospedale Maria Vittoria,"— Presentation transcript:

1 Pericarditi, Miocarditi e CMP infiammatorie: cosa cè di nuovo? Pericarditi Massimo Imazio, MD, FESC Dipartimento di Cardiologia Ospedale Maria Vittoria, Torino

2 Medico di Guardia Pericardite

3 Eziologia, Diagnosi

4 Imazio M, et al. Circulation. 2007;115:2739

5 Everything may cause pericarditis… Int J Clin Pract 2007; 61: 138 Imazio M et al. Future Cardiology 2007; 3: 623

6 Levy PY et al.Future MIcrobiol 2006; 1(2):229 Major infectious agents 1.Viral (most common: Echovirus and Coxsackievirus (usual), Influenza, EBV, CMV, Adenovirus, Varicella, Rubella, Mumps, HBV, HCV, HIV, Parvovirus B19 and Human Herpes Virus 6 (increasing reports); 2.Bacterial (most common: tuberculous (4-5%), Coxiella burnetii (5-7%?), other bacterial rare may include Pneumo-, Meningo-, Gonococcosis, Haemophilus, Staphylococci, Chlamydia, Mycoplasma, Legionella, Leptospira, Listeria) 3.Fungal (rare: Histoplasma more likely in immunocompetent patients, Aspergillosis, Blastomycosis, Candida more likely in immunosuppressed host) 4.Parasitary (very rare: Echinococcus, Toxoplasma) SYSTEMATIC BATTERY OF SEROLOGICAL TESTS

7 Acute pericarditis: etiology Imazio M, et al. Circulation. 2007;115:2739 Imazio M, Trinchero R. Future Cardiology 2007; 3: 623

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10 Triage in acute pericarditis Clinical and echo evaluation Is specific etiology highly suspected or prevalent? YES Specific etiology search and management NO Clinical poor prognostic predictors? YES HIGH RISK CASES Admission to hospital Etiology search Empiric trial with NSAID NO LOW RISK CASES Outpatient treatment with NSAID No Etiology search Response to NSAID? NO MODERATE TO HIGH RISK Admission to hospital Etiology search YES LOW RISK PERICARDITIS Outpatient follow-up No Etiology search

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15 Diagnostic criteria Imazio M, Trinchero R. J Cardiovasc Med 2007; 8: 404

16 Etiologic screening Specific etiology? Bacterial pericarditis (Tbc, purulent) Neoplastic pericarditis Pericarditis related to systemic disease

17 Specific etiology Tuberculous pericarditis Search for TBC (sputum, urine), X- ray, CT Pericardiocentesis Purulent pericarditis Pericardiocentesis Neoplastic pericarditis X-ray, mammography, CT Pericardiocentesis

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19 Am J Cardiol 2007; 99:

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23 Pathogenesis of recurrences Imazio M, Trinchero R. Future Cardiology 2007; 3: 623

24 Etiology of recurrent pericarditis

25 Terapia

26 ASA o FANS Aspirina2-4g/die Ibuprofene mg/die Indometacina75-150mg/die Nimesulide200mg/die Imazio M et al. J Cardiovasc Med 2007; 8: 748

27 Corticosteroidi come FR per le recidive Imazio M, et al. Circulation. 2007;115:2739 Imazio M, Trinchero R Rec Prog Med 2006; 98(5):265-70

28 Nature Cardiovasc Med 2008; in press PrednisoneEffetti collaterali gravi RecidiveRicoveri 1mg/Kg/die25% mg/Kg/die<10%++

29 Cleve Clin J Med 2007; 74: 385-6

30 COPE: COlchicine for acute PEricarditis NNT= 5 Corticosteroid therapy: Recurrences OR % CI 1.21 to 15.25; p=0.024 Drug withdrawal Imazio M et al. Circulation 2005; 112(13):

31 Colchicina e recidive Imazio M, Trinchero R Rec Prog Med 2006; 98(5):265-70

32 Colchicina e storia naturale della pericardite recidivante Brucato A et al. Clin Exp Rheumatol. 2006;24(1): Attack rate Rec/pt/ month

33 Colchicine: How does it work? Imazio M, Trinchero R. Future Cardiology 2007; 3: 623

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35 Colchicina e pericardite: Trials in corso Imazio M et al. JCM 2007; Dic; 8(12): Imazio M et al. JCM 2007; Oct;8(10):830-4 Imazio M et al. JCM 2007; Aug;8(8):613-7.

36 Clin Sci 2007; 113(11):443-8

37 JCM 2007; 8:

38 Prognosi

39 Am J Cardiol 2007; 100:1026

40 MD on duty MOST CASES ARE BENIGN, TRIAGE FOR DECISION-MAKING


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