Tuberculous pericarditis natural history, complications and prognosis: Difference between revisions

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Latest revision as of 19:53, 10 February 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]

Overview

Tuberculous pericarditis does not have the typical classic presentation of an acute pericarditis (sudden-onset chest pain and typical ECG changes). Instead, it most commonly presents with systemic signs and symptoms. If left untreated, tuberculous pericarditis can be complicated by constrictive pericarditis which can then ultimately lead to heart failure. Common complications of tuberculous pericarditis include acute pericarditis, constrictive pericarditis, cardiac tamponade, and heart failure. Antituberculosis therapy has dramatically improved the prognosis of tuberculous pericarditis and it is evident from the decrease in mortality rate with time.

Natural History, Complications, and Prognosis

Natural History

Tuberculous pericarditis does not have the typical classic presentation of an acute pericarditis (sudden-onset chest pain and typical ECG changes).
Instead, it most commonly presents with systemic signs and symptoms:^[1]
- Cough (94%)
- Dyspnea (88%)
- Chest pain (76%)
- Fever (70%)
- Night sweats (56%)
- Orthopnea (53%)
- Weight loss (48%)
If left untreated, tuberculous pericarditis can be complicated by constrictive pericarditis which can then ultimately lead to heart failure.^[2]

Complications

Common complications of tuberculous pericarditis include:^[3]^[4]

Prognosis

Antituberculosis therapy has dramatically improved the prognosis of tuberculous pericarditis.
It is evident from the decrease in mortality rate with time:
- 30 - 40% in North America (1953 - 1970) and 12% (1970 - 1986)^[5]
- 16% in Cape Town (1952 - 1957)^[6]
- 6.5% in Eastern Cape (1980 - 1984)
Most untreated patients (up to 90% at 1 year) die from tuberculous dissemination or heart failure, the average survival being 3 to 4 months.

References

↑ Fowler, Noble O. (1991). "Tuberculous Pericarditis". JAMA: The Journal of the American Medical Association. 266 (1): 99. doi:10.1001/jama.1991.03470010103039. ISSN 0098-7484.
↑ Chang SA (November 2017). "Tuberculous and Infectious Pericarditis". Cardiol Clin. 35 (4): 615–622. doi:10.1016/j.ccl.2017.07.013. PMID 29025551.
↑ Chang SA (November 2017). "Tuberculous and Infectious Pericarditis". Cardiol Clin. 35 (4): 615–622. doi:10.1016/j.ccl.2017.07.013. PMID 29025551.
↑ Fowler, Noble O. (1991). "Tuberculous Pericarditis". JAMA: The Journal of the American Medical Association. 266 (1): 99. doi:10.1001/jama.1991.03470010103039. ISSN 0098-7484.
↑ Quale JM, Lipschik GY, Heurich AE (June 1987). "Management of tuberculous pericarditis". Ann. Thorac. Surg. 43 (6): 653–5. doi:10.1016/s0003-4975(10)60243-3. PMID 3109338.
↑ SCHRIRE V (September 1959). "Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period". S. Afr. Med. J. 33: 810–7. PMID 14443596.

Template:WH Template:WS

[Fowler1991-1] Fowler, Noble O. (1991). "Tuberculous Pericarditis". JAMA: The Journal of the American Medical Association. 266 (1): 99. doi:10.1001/jama.1991.03470010103039. ISSN 0098-7484.

[pmid29025551-2] Chang SA (November 2017). "Tuberculous and Infectious Pericarditis". Cardiol Clin. 35 (4): 615–622. doi:10.1016/j.ccl.2017.07.013. PMID 29025551.

[pmid290255512-3] Chang SA (November 2017). "Tuberculous and Infectious Pericarditis". Cardiol Clin. 35 (4): 615–622. doi:10.1016/j.ccl.2017.07.013. PMID 29025551.

[Fowler19912-4] Fowler, Noble O. (1991). "Tuberculous Pericarditis". JAMA: The Journal of the American Medical Association. 266 (1): 99. doi:10.1001/jama.1991.03470010103039. ISSN 0098-7484.

[pmid3109338-5] Quale JM, Lipschik GY, Heurich AE (June 1987). "Management of tuberculous pericarditis". Ann. Thorac. Surg. 43 (6): 653–5. doi:10.1016/s0003-4975(10)60243-3. PMID 3109338.

[pmid14443596-6] SCHRIRE V (September 1959). "Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period". S. Afr. Med. J. 33: 810–7. PMID 14443596.

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@@ Line 2: / Line 2: @@
 {{Tuberculous pericarditis}}
-{{CMG}}; {{AE}}
+{{CMG}}; {{AE}}{{sab}}
 ==Overview==
-If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
+Tuberculous pericarditis does not have the typical classic presentation of an [[acute pericarditis]] (sudden-onset [[chest pain]] and typical [[The electrocardiogram|ECG]] changes). Instead, it most commonly presents with [[systemic]] [[Medical sign|signs]] and [[Symptom|symptoms]]. If left untreated, tuberculous pericarditis can be [[Complication|complicated]] by [[constrictive pericarditis]] which can then ultimately lead to [[heart failure]]. Common [[Complication (medicine)|complications]] of tuberculous pericarditis include [[acute pericarditis]], [[constrictive pericarditis]], [[cardiac tamponade]], and [[heart failure]]. Antituberculosis therapy has dramatically improved the [[prognosis]] of tuberculous pericarditis and it is evident from the decrease in [[mortality rate]] with time.
-OR
-Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
-OR
-Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
 ==Natural History, Complications, and Prognosis==
 ===Natural History===
-*Tuberculous pericarditis does not have the typical classic presentation of an acute pericarditis (sudden-onset chest pain and typical ECG changes).
+*Tuberculous pericarditis does not have the typical classic presentation of an [[acute pericarditis]] (sudden-onset [[chest pain]] and typical [[The electrocardiogram|ECG]] changes).
-*Instead, it most commonly presents with systemic signs and symptoms:<ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref>
+*Instead, it most commonly presents with [[systemic]] [[Medical sign|signs]] and [[Symptom|symptoms]]:<ref name="Fowler1991">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref>
-**Cough (94%)
+**[[Cough]] (94%)
-**Dyspnea (88%)
+**[[Dyspnea]] (88%)
-**Chest pain (76%)
+**[[Chest pain]] (76%)
-**Fever (70%)
+**[[Fever]] (70%)
-**Night sweats (56%)
+**[[Night sweats]] (56%)
-**Orthopnea (53%)
+**[[Orthopnea]] (53%)
-**Weight loss (48%)
+**[[Weight loss]] (48%)
+*If left untreated, tuberculous pericarditis can be [[Complication|complicated]] by [[constrictive pericarditis]] which can then ultimately lead to [[heart failure]].<ref name="pmid29025551">{{cite journal |vauthors=Chang SA |title=Tuberculous and Infectious Pericarditis |journal=Cardiol Clin |volume=35 |issue=4 |pages=615–622 |date=November 2017 |pmid=29025551 |doi=10.1016/j.ccl.2017.07.013 |url=}}</ref>
 ===Complications===
-*Common complications of [disease name] include:
+*Common [[Complication (medicine)|complications]] of tuberculous pericarditis include:<ref name="pmid290255512">{{cite journal |vauthors=Chang SA |title=Tuberculous and Infectious Pericarditis |journal=Cardiol Clin |volume=35 |issue=4 |pages=615–622 |date=November 2017 |pmid=29025551 |doi=10.1016/j.ccl.2017.07.013 |url=}}</ref><ref name="Fowler19912">{{cite journal|last1=Fowler|first1=Noble O.|title=Tuberculous Pericarditis|journal=JAMA: The Journal of the American Medical Association|volume=266|issue=1|year=1991|pages=99|issn=0098-7484|doi=10.1001/jama.1991.03470010103039}}</ref>
-**[Complication 1]
+**[[Acute pericarditis]]
-**[Complication 2]
+**[[Constrictive pericarditis]]
-**[Complication 3]
+**[[Cardiac tamponade]]
+**[[Heart failure]]
 ===Prognosis===
-*Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [--]%.
+*Antituberculosis therapy has dramatically improved the [[prognosis]] of tuberculous pericarditis.
-*Depending on the extent of the [tumor/disease progression] at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as poor/good/excellent.
+*It is evident from the decrease in [[mortality rate]] with time:
-*The presence of [characteristic of disease] is associated with a particularly [good/poor] prognosis among patients with [disease/malignancy].
+**30 - 40% in North America (1953 - 1970) and 12% (1970 - 1986)<ref name="pmid3109338">{{cite journal |vauthors=Quale JM, Lipschik GY, Heurich AE |title=Management of tuberculous pericarditis |journal=Ann. Thorac. Surg. |volume=43 |issue=6 |pages=653–5 |date=June 1987 |pmid=3109338 |doi=10.1016/s0003-4975(10)60243-3 |url=}}</ref>
-*[Subtype of disease/malignancy] is associated with the most favorable prognosis.
+**16% in Cape Town (1952 - 1957)<ref name="pmid14443596">{{cite journal |vauthors=SCHRIRE V |title=Experience with pericarditis at Groote Schuur Hospital, Cape Town: an analysis of one hundred and sixty cases studied over a six-year period |journal=S. Afr. Med. J. |volume=33 |issue= |pages=810–7 |date=September 1959 |pmid=14443596 |doi= |url=}}</ref>
-*The prognosis varies with the [characteristic] of tumor; [subtype of disease/malignancy] have the most favorable prognosis.
+**6.5% in Eastern Cape (1980 - 1984)
+**
+*Most untreated [[Patient|patients]] (up to 90% at 1 year) die from tuberculous dissemination or [[heart failure]], the average survival being 3 to 4 months.
 ==References==