The Experts below are selected from a list of 165 Experts worldwide ranked by ideXlab platform

Yehuda Adler - One of the best experts on this subject based on the ideXlab platform.

  • Diagnosis and management of Pericardial diseases
    Nature Reviews Cardiology, 2009
    Co-Authors: Massimo Imazio, Antonio Brucato, Rita Trinchero, Yehuda Adler
    Abstract:

    The clinical diagnosis of pericarditis is confirmed when at least two of four clinical criteria are present—typical chest pain, Pericardial Friction Rub, widespread ST-segment elevation, and Pericardial effusion Tests for pericarditis include electrocardiography, echocardiography, chest radiography and measurement of markers of inflammation (C-reactive protein, erythrocyte sedimentation rate) and myocardial lesions (troponin); etiology searches and hospitalization are restricted to high-risk patients High-risk features for pericarditis (predictive of nonviral, nonidiopathic etiologies and complications) include fever >38 °C, a subacute course, large Pericardial effusion or cardiac tamponade, and failure of aspirin or NSAIDs Pericardiocentesis is indicated for cardiac tamponade, high suspicion of tuberculous, purulent or neoplastic pericarditis and can also be considered for large or symptomatic effusions refractory to medical treatment Pericardial biopsy is indicated in patients with persistent, worsening illness without a definite diagnosis despite medical therapy (diagnostic) and with relapsing tamponade or large effusions with severe symptoms (therapeutic) Pericardiectomy is essentially recommended for persistent constriction; patients with newly diagnosed constriction who are hemodynamically stable can be given a trial of anti-inflammatory therapy for 2–3 months before pericardiectomy Randomized trial data on Pericardial diseases are scarce, but a number of new studies are moving the management of these conditions from empirically-based to evidence-based medicine. Massimo Imazio and colleagues show how the emerging data and the first guidelines for Pericardial disease can be used to tailor management to the individual patient. The management of Pericardial diseases is largely empirical because of the relative lack of randomized trials that involve patients with these conditions. A first attempt to bring together and organize current knowledge resulted in the publication of the first guidelines on the management of Pericardial diseases. Nevertheless, a number of observational studies and the first randomized trials are moving the management of Pericardial diseases towards evidence-based medicine, particularly for pericarditis. Emerging data indicate that management can be tailored to the individual patient and, although the optimal duration of treatment is not clearly established, some recommendations can be formulated to guide management and follow-up.

Toshiji Iwasaka - One of the best experts on this subject based on the ideXlab platform.

Raed A Aqel - One of the best experts on this subject based on the ideXlab platform.

  • regional pericarditis a review of the Pericardial manifestations of acute myocardial infarction
    Clinical Cardiology, 2009
    Co-Authors: Todd A Dorfman, Raed A Aqel
    Abstract:

    Regional pericarditis has been described in several settings, but occurs most frequently after transmural myocardial infarction. While the diagnosis remains elusive, it must be considered in all patients with recurrent chest pain following acute myocardial infarction (AMI). Pericarditis classically presents with positional chest pain, a Pericardial Friction Rub, diffuse ST-segment elevation, and PR depression, but regional ECG changes associated with infarction-associated pericarditis sometimes exist. Given the magnitude and frequency of AMI, it is imperative to be aware of the myriad of Pericardial manifestations of myocardial injury. An illustrative case and a comprehensive review of the literature will be provided.

Massimo Imazio - One of the best experts on this subject based on the ideXlab platform.

  • Diagnosis and management of Pericardial diseases
    Nature Reviews Cardiology, 2009
    Co-Authors: Massimo Imazio, Antonio Brucato, Rita Trinchero, Yehuda Adler
    Abstract:

    The clinical diagnosis of pericarditis is confirmed when at least two of four clinical criteria are present—typical chest pain, Pericardial Friction Rub, widespread ST-segment elevation, and Pericardial effusion Tests for pericarditis include electrocardiography, echocardiography, chest radiography and measurement of markers of inflammation (C-reactive protein, erythrocyte sedimentation rate) and myocardial lesions (troponin); etiology searches and hospitalization are restricted to high-risk patients High-risk features for pericarditis (predictive of nonviral, nonidiopathic etiologies and complications) include fever >38 °C, a subacute course, large Pericardial effusion or cardiac tamponade, and failure of aspirin or NSAIDs Pericardiocentesis is indicated for cardiac tamponade, high suspicion of tuberculous, purulent or neoplastic pericarditis and can also be considered for large or symptomatic effusions refractory to medical treatment Pericardial biopsy is indicated in patients with persistent, worsening illness without a definite diagnosis despite medical therapy (diagnostic) and with relapsing tamponade or large effusions with severe symptoms (therapeutic) Pericardiectomy is essentially recommended for persistent constriction; patients with newly diagnosed constriction who are hemodynamically stable can be given a trial of anti-inflammatory therapy for 2–3 months before pericardiectomy Randomized trial data on Pericardial diseases are scarce, but a number of new studies are moving the management of these conditions from empirically-based to evidence-based medicine. Massimo Imazio and colleagues show how the emerging data and the first guidelines for Pericardial disease can be used to tailor management to the individual patient. The management of Pericardial diseases is largely empirical because of the relative lack of randomized trials that involve patients with these conditions. A first attempt to bring together and organize current knowledge resulted in the publication of the first guidelines on the management of Pericardial diseases. Nevertheless, a number of observational studies and the first randomized trials are moving the management of Pericardial diseases towards evidence-based medicine, particularly for pericarditis. Emerging data indicate that management can be tailored to the individual patient and, although the optimal duration of treatment is not clearly established, some recommendations can be formulated to guide management and follow-up.

Athanasios J. Manolis - One of the best experts on this subject based on the ideXlab platform.

  • A Case of Acute Myocarditis Caused by Pandemic (H1N1) 2009 Influenza Virus
    Journal of the Formosan Medical Association, 2010
    Co-Authors: Antonios N. Pavlidis, Antreas Giannakopoulos, Peter G Danias, Athanasios J. Manolis
    Abstract:

    The new strain of swine-origin H1N1 influenza virus was initially described in April 2009, and the first cases of infection were reported in the Mexican state of Veracruz. As the disease spread rapidly to other countries, the World Health Organization declared the new strain of influenza virus as pandemic on June 11, 2009.1 Infection with this virus predominantly affects young patients in relatively good health, without documented underlying illnesses. Although the majority of them experience mild symptoms, severe complications associated with high mortality can occur. Acute myocarditis can cause substantial myocardial injury and lead to arrhythmia, atrioventricular block, cardiogenic shock and sudden cardiac death. The majority of myocarditis cases are of viral etiology and presentation can often mimic myocardial infarction, pulmonary embolism or acute heart failure. Although endomyocardial biopsy remains the gold standard, cardiac magnetic resonance imaging (CMRI) has recently been shown to be a powerful tool in the diagnosis of acute myocarditis. We present a rare case of acute myocarditis caused by H1N1 influenza virus in a young patient. An 18-year-old man of Greek origin was admitted with a 3-day history of fever, malaise, sore throat and dry cough, and a 5-hour history of central chest pain of sudden onset. The pain radiated to the left shoulder and was relieved when the patient leaned forward. The pain did not respond to sublingual glyceryl trinitrate. He was a smoker and had a history of spontaneous ventricular septal defect closure at the age of 3 years. On admission, his heart rate was 66 beats/min, oxygen saturation in room air was 98%, blood pressure was 115/75 mmHg, and axillary temperature was 37.1°C. Heart auscultation revealed normal heart sounds, a Pericardial Friction Rub and no murmurs. Electrocardiography showed sinus rhythm, with incomplete right bundle branch block, ST segment elevation with biphasic T-waves in leads V3 and V4, and ST segment depression with biphasic T-waves in leads I, II and aVL. Chest radiography was normal. Echocardiography depicted normal left ventricular ejection fraction, with no regional wall motion abnormalities or Pericardial effusion. White blood cell count was 12.5×109/L, C-reactive protein was 17.1 mg/L, and erythrocyte sedimentation rate was 17 mm/hr.