| Popis: |
An analysis has been made of the clinical features in twenty-seven patients with acute serofibrinous pericarditis of undetermined etiology. It is important to distinguish this type from others having a more serious prognosis, particularly those associated with myocardial infarction, tuberculosis or rheumatic fever. Although the cause is not known, it seems possible that in many cases it is a virus; in some instances pericarditis may represent an immune reaction to bacterial invasion of the throat or sinuses. An infection of the upper respiratory passages or pneumonia of the primary atypical variety preceded pericarditis in twenty-three of the twenty-seven patients. The course was variable in severity and duration but the prognosis for recovery was always good. Shock or congestive failure was not observed. Cardiac enlargement apparently was due to a greater extent to dilatation than to effusion into the pericardial sac. Pleural effusion was present in fourteen cases. The occurrence of fever, a friction rub and an increase in the sedimentation rate of the erythrocytes on the first day of illness were aids in differentiating this type of pericarditis from that following cardiac infarction. Serial electrocardiograms were usually diagnostic. Transient cardiac irregularity due to premature contractions was recorded in three patients. It is noteworthy that prolongation of the P-R interval, frequently seen in acute rheumatic fever, was not observed. Recurrences, milder than the original attacks, occurred four times in three cases. Penicillin, streptomycin and sulfadiazine exerted no manifest beneficial effect on the pericarditis. Aureomycin, because of its antiviral action and in the light of recent favorable results observed in the treatment of primary atypical pneumonia, is worthy of trial. Follow-up examinations, made at intervals ranging from six months to sixteen years after the original illness, showed complete recovery without sequelae in every instance. It appears unlikely, therefore, that this disorder is the precursor of constrictive pericarditis. |
