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In 2009, Knowles won the inaugural Snooker Super 6s tournament at the Crucible Theatre in Sheffield. |
Knowles began the 2011/12 season by entering PTC1. |
= = = Dixie Carter = = = |
Dixie Virginia Carter (May 25, 1939 – April 10, 2010) was an American film, television and stage actress and singer. She starred as Julia Sugarbaker on the sitcom "Designing Women" (1986–93), and as Randi King on the drama series "Family Law" (1999–2002). She was nominated for the 2007 Primetime Emmy Award for Outstanding Guest Actress in a Comedy Series for her role as Gloria Hodge on "Desperate Housewives" (2006–07). |
Carter made her professional stage debut in a Memphis production of the musical "Carousel" in 1960, and made her Broadway debut in the 1974 musical "Sextet". After appearing for two years as District Attorney Brandy Henderson on the CBS soap "The Edge of Night" (1974–76), she starred in the 1976 Broadway musical "Pal Joey". Her other television roles included the sitcoms "On Our Own" (1977–78), "Filthy Rich" (1982–83) and "Diff'rent Strokes" (1984–85). She returned to Broadway to play Maria Callas in the play "Master Class" in 1997, and to play Mrs. Meers in the musical "Thoroughly Modern Millie" in 2004. |
Dixie Virginia Carter was born May 25, 1939, to Esther Virginia (née Hillsman; December 15, 1909 – May 1, 1988) and Halbert Leroy Carter (December 3, 1910 – February 25, 2007) in McLemoresville, Tennessee. Carter spent many of her early years in Memphis. She attended the University of Memphis and Rhodes College. |
In college, she was a member of the Delta Delta Delta sorority. In 1959, Carter competed in the Miss Tennessee pageant, where she placed first runner-up to Mickie Weyland. Carter won the Miss Volunteer beauty pageant at the University of Tennessee the same year. |
In 1960, Carter made her professional stage debut in a Memphis production of "Carousel", co-starring George Hearn, who she would go on to marry 17 years later. She moved to New York City in 1963 and got a part in a production of Shakespeare's "The Winter's Tale". |
In 1967, she began an eight-year hiatus from acting, to focus on raising her two daughters; she returned to acting in 1974, when she filled in for actress Nancy Pinkerton as Dorian Cramer on "One Life to Live" while Pinkerton was on maternity leave. She subsequently was cast in the role of Assistant D.A. Olivia Brandeis "Brandy" Henderson on the soap opera "The Edge of Night" from 1974 to 1976. Carter took the role though some advised her that doing a daytime soap might negatively affect her career. However, she was first noticed in this role, and after leaving "Edge of Night" in 1976, she relocated from New York to Los Angeles and pursued prime-time television roles. In 1976, she won the "Theater World" Award for "Jesse and the Bandit Queen". |
She appeared in series such as "Out of the Blue" (as Aunt Marion), "On Our Own" (as April Baxter), "Diff'rent Strokes" (as the first Maggie McKinney Drummond, Phillip Drummond's second wife), "The Greatest American Hero" (playing a KGB spy), and as the stuck-up and conniving Carlotta Beck on "Filthy Rich" (1982). |
Carter's appearance in "Filthy Rich" paved the way for her most notable role, that of sharp-tongued liberal interior decorator Julia Sugarbaker in the 1986–93 television program "Designing Women", set in Atlanta. "Filthy Rich" was created by Linda Bloodworth Thomason, who also created "Designing Women". (In the beginning, without knowing the content of the show, Bloodworth-Thomason's only idea was to create a show starring Carter, and fellow cast mates Delta Burke, Annie Potts, and Jean Smart. "Filthy Rich" also featured fellow "Designing Women" cast member Delta Burke in its cast.) After much persuasion from creators Linda Bloodworth-Thomason and her husband Harry Thomason, Hal Holbrook, Carter's real-life husband, had a recurring role as attorney Reese Watson. Carter's daughters Ginna and Mary Dixie Carter also had guest-star roles as Julia Sugarbaker's nieces Jennifer and Camilla in the episode "The Naked Truth" in 1989. |
In 1997, Carter starred as Maria Callas in Terrence McNally's play "Master Class". She played the role from January to June. The role previously had been played by Zoe Caldwell and Patti LuPone. |
Noted for portraying strong-minded Southern women, Carter provided the voice of Necile in Mike Young Productions' cartoon feature "The Life and Adventures of Santa Claus". She was also in the voice cast of "My Neighbors the Yamadas", the English-language dub of Studio Ghibli's 1999 anime movie of the same. |
From 1999 to 2002, she portrayed Randi King on the legal drama "Family Law". From 1999 to 2000, she was a cast member on the short-lived sitcom "Ladies Man," appearing as a regular on both "Ladies Man" and "Family Law". In 2004, she made a guest appearance on "", playing a defense attorney named Denise Brockmorton in the episode called "Home", in which she defended the paranoid mother of two children (Diane Venora) who had manipulated her older son to kill the younger son after breaking her home rules. |
Carter starred in several Broadway musicals and plays. She appeared on- and off-Broadway as well, playing the role of Melba Snyder in the 1976 revival of "Pal Joey" and Maria Callas in "Master Class". |
In 2006–07, Carter found a resurgence of fame with a new generation of fans portraying Gloria Hodge, Bree Van de Kamp's disturbed (and scheming) mother-in-law on "Desperate Housewives". Creator Marc Cherry started in Hollywood as Carter's assistant on the set of "Designing Women". Her first and only Emmy Awards nomination was for the 59th Primetime Emmy Awards under the category of Outstanding Guest Actress in a Comedy Series for her role as Gloria Hodge. |
Carter gave an interview in 2006 for the feature-length documentary "That Guy: The Legacy of Dub Taylor", which received support from Taylor's family and many of Dub's previous coworkers, including Bill Cosby, Peter Fonda, Don Collier, Cheryl Rogers-Barnett, and many others. The project was scheduled to have its world premiere at Taylor's childhood hometown of Augusta, Georgia on April 14, 2007. |
Her final film was "That Evening Sun", which she filmed with her husband Hal Holbrook in East Tennessee in Summer 2008. The film, produced by Dogwood Entertainment (a subsidiary of DoubleJay Creative), is based on a short story by William Gay. "That Evening Sun" premiered at South By Southwest, where it competed for the narrative feature grand jury prize. |
In 1967, Carter married businessman Arthur Carter (no relation). Following the birth of her daughters, Carter left acting for eight years to raise her children with Arthur's three children, Jon, Whendy, and Ellen Carter. |
She divorced Arthur Carter in 1977, and married theatre and TV actor George Hearn the same year. Two years later, she divorced Hearn. She was married for the third time on May 27, 1984, to fellow actor Hal Holbrook (14 years her senior). She and Holbrook divided their time between their homes in Beverly Hills, California, and McLemoresville, Tennessee. |
In 1996, Carter published a memoir titled "Trying to Get to Heaven", in which she talked frankly about her life with Hal Holbrook, "Designing Women", and her plastic surgery during the show's run. She acknowledged, along with other celebrities, having used human growth hormone for its antiaging properties. |
Carter was a registered Republican, who described her political views as libertarian. She was interviewed by Bill O'Reilly along with Pat Boone at the 2000 Republican National Convention. Although her "Designing Women" character Julia Sugarbaker was known for her liberal political views and subsequent monologues, Carter disagreed with many of her character's left-of-center commentaries and made a deal with the producers that for every speech she had to make with which she disagreed, Julia would get to sing a song in a future episode. Carter once jokingly described herself as "the only Republican in show business". In her lifetime, Carter was also a strong supporter of the gay community. |
Carter died on April 10, 2010, in Houston, Texas. Her death was announced by her husband, who stated the cause as complications from endometrial cancer which was diagnosed earlier in 2010. Dixie Carter was interred in McLemoresville, Tennessee. |
The Dixie Carter Performing Arts and Academic Enrichment Center (informally called "The Dixie") in Huntingdon, Tennessee, is named in honor of Carter. |
A public service announcement made by Carter in 2003 describing and offering outreach to sufferers of spasmodic torticollis/cervical dystonia began appearing in New York and New Jersey, and then across the United States in 2010. |
= = = Enemy of the State (film) = = = |
Enemy of the State is a 1998 American action-thriller film directed by Tony Scott, produced by Jerry Bruckheimer and written by David Marconi. The film stars Will Smith and Gene Hackman, with Jon Voight, Lisa Bonet, Gabriel Byrne, Dan Butler, Loren Dean, Jake Busey, Barry Pepper, and Regina King in supporting roles. The film tells the story of a group of NSA agents conspiring to kill a Congressman and the cover up that ensues after a tape of the murder is discovered. |
The film was released on November 20, 1998 in the U.S. and worldwide. "Enemy of the State" garnered generally positive reviews from film critics and audiences, with many praising the writing and direction as well as the chemistry between Smith and Hackman. Given the events of 9/11, the Patriot Act, and Edward Snowden's revelations about the NSA's PRISM surveillance program, the film has become noteworthy for being ahead of its time regarding issues of National Security and privacy. |
NSA official Thomas Bryan Reynolds meets with U.S. Congressman Phil Hammersley (R-NY) in a public park to discuss support for a new piece of counterterrorism legislation the U.S. Congress is pushing that dramatically expands the surveillance powers of intelligence agencies over individuals and groups. Hammersley remains committed to blocking its passage, since he believes it would almost totally destroy the privacy of U.S. citizens. Reynolds, determined to have the bill pass so as to gain a long-delayed and anticipated promotion within the NSA, has his team murder Hammersley, spread heart pills over his car, place his body in the car and push it in a lake to simulate the cause of death as a heart attack. In the aftermath, they discover that wildlife researcher Daniel Zavitz had a camera aimed in the woods at their location. Zavitz inspects the footage and, realizing he has captured the congressman's murder, calls a journalist he knows. The call is monitored by Reynolds's team who attempt to break into Zavitz's apartment to retrieve the tape. Realizing he is in danger, Zavitz transfers the video to a disc before fleeing the apartment ahead of Reynolds's men. |
Zavitz bumps into an old college friend, labor lawyer Robert Clayton Dean, and slips the disc into his shopping bag without his knowledge. Shortly after, Zavitz is killed when he collides with a fire truck on a stolen bicycle; Reynolds' men later kill the journalist he'd called. When Reynolds and his team discover that Dean might have the video and after failing to convince him (under the guise of police officers) to allow them to search his shopping purchases, they, believing that Dean and Zavitz were in collusion together, raid his house and plant surveillance devices. They then disseminate false evidence to implicate Dean of working with the family of mafia kingpin Paulie Pintero and having an affair with ex-girlfriend Rachel Banks. The subterfuge destroys Dean's life: he is dismissed from his job, his bank accounts are frozen, and his wife Carla throws him out of the house. |
Dean believes Pintero is behind the smear campaign as revenge for a prior case, with help from Brill, a secretive contact of Banks. Dean sets up a meet with Brill, to which the NSA sends an impostor, but the real Brill rescues Dean. Brill explains that his pursuers are NSA agents and rids him of tracking devices hidden in his clothing. With Dean and Brill in hiding, the NSA agents kill Banks and frame Dean for the murder. |
Dean obtains the disc and Brill identifies Reynolds in the recovered video, but the disc is destroyed during an escape from an NSA raid. Brill, whose real name is Edward Lyle, tells Dean of his past as a communications expert; he was stationed in Iran during the Iranian Revolution; his partner, Rachel's father, was killed, but Lyle made it out and has been in hiding since. Lyle tries to urge Dean to run away, but Dean is determined to clear his name. |
Dean and Lyle trail another supporter of the surveillance bill, U.S. Congressman Sam Albert (R-NH), videotaping him having an affair with his aide. Dean and Lyle "hide" one of the NSA's bugs in Albert's room so Albert will find it and have the NSA start an investigation into Albert's tapping. Lyle also deposits money into Reynolds's bank account to make it appear that he is taking bribes, putting pressure on Reynolds. |
Lyle contacts Reynolds to set up a meeting to exchange the video and get Reynolds to incriminate himself. Reynolds' men instead ambush the meeting and hold Lyle and Dean at gunpoint, demanding the tape. Dean tells them that the Hammersley murder footage is in the hands of Pintero, understanding Pintero's restaurant is under FBI surveillance. Dean, Reynolds, and the NSA team enter Pintero's restaurant. With the use of ambiguous language, Dean convinces Pintero that Reynolds is after the incriminating video Dean blackmailed him with and the encounter turns into a massive gunfight that kills the mobsters, Reynolds, and several members of his NSA team. During this ordeal, Lyle uses subterfuge and acting to goad FBI surveillance that Pintero is kidnapping cops, prompting a raid. Lyle escapes while the FBI rescues Dean and uncovers the entire conspiracy. |
The U.S. Congress is forced to abandon the bill to avoid a national scandal, although they cover up the NSA's involvement to preserve the agency's reputation. Dean is cleared of all the charges and is reunited with his wife. Lyle leaves Dean a "goodbye" message via his TV as he is watching, showing himself relaxing in a tropical location. |
The story is set in both Washington, D.C., and Baltimore, and most of the filming was done in Baltimore. Location shooting began on a ferry in Fell's Point. In mid-January, the company moved to Los Angeles to complete production in April 1998. Writers Aaron Sorkin, Henry Bean and Tony Gilroy each performed an uncredited rewrite of the script. |
Mel Gibson and Tom Cruise were considered for the part that went to Will Smith, who took the role largely because he wanted to work with Gene Hackman, and had previously enjoyed working with producer Jerry Bruckheimer on "Bad Boys". George Clooney was also considered for a role in the film. Sean Connery was considered for the role that went to Hackman. The film is notable for having cast several soon-to-be stars in smaller supporting roles, which casting director Victoria Thomas credited to people's interest in working with Gene Hackman. |
The film's crew included a technical surveillance counter-measures consultant who also had a minor role as a spy shop merchant. Hackman had previously acted in a similar thriller about spying and surveillance, "The Conversation" (1974). The photo in Edward Lyle's NSA file is of Hackman in "The Conversation." |
"Enemy of the State" received 71% positive reviews on the film-critics aggregator Rotten Tomatoes, with 84 critics surveyed. The site's consensus is; "An entertaining, topical thriller that finds director Tony Scott on solid form and Will Smith confirming his action headliner status." Metacritic displayed a normalized ranking of 67 out of 100 on the basis of 22 critics. Kenneth Turan of the "Los Angeles Times" expressed enjoyment in the movie, noting how its "pizazz [overcame] occasional lapses in moment-to-moment plausibility;" Janet Maslin of "The New York Times" approved of the film's action-packed sequences, but cited how it was similar in manner to the rest of the members of "Simpson's and Bruckheimer's school of empty but sensation-packed filming." In a combination of the two's views, Edvins Beitiks of the "San Francisco Examiner" praised many of the movie's development aspects, but criticized the overall concept that drove the film from the beginning—the efficiency of government intelligence—as unrealistic. |
Kim Newman considered "Enemy of the State" a "continuation of "The Conversation"", the 1974 psychological thriller that starred Hackman as a paranoid, isolated surveillance expert. |
The film opened at #2, behind "The Rugrats Movie", grossing $20,038,573 over its first weekend in 2,393 theatres and averaging about $8,374 per venue.The film made an additional $95.9 million in gross rentals. |
An episode of PBS' "Nova" titled "Spy Factory" reports that the film's portrayal of the NSA's capabilities are fiction: although the agency can intercept transmissions, connecting the dots is difficult. However, in 2001, then-NSA director Gen. Michael Hayden, who was appointed to the position during the release of the film, told CNN's Kyra Phillips that "I made the judgment that we couldn't survive with the popular impression of this agency being formed by the last Will Smith movie." James Risen wrote in his 2006 book "" that Hayden "was appalled" by the film's depiction of the NSA, and sought to counter it with a PR campaign on behalf of the agency. |
In June 2013 the NSA's PRISM and Boundless Informant programs for domestic and international surveillance were uncovered by "The Guardian" and "The Washington Post" as the result of information provided by whistleblower Edward Snowden. This information revealed capabilities such as collection of Internet browsing, email and telephone data of not only many Americans, but citizens of other nations as well. "The Guardian"'s John Patterson argued that Hollywood depictions of NSA surveillance, including "Enemy of the State" and "Echelon Conspiracy", had "softened" up the American public to "the notion that our spending habits, our location, our every movement and conversation, are visible to others whose motives we cannot know." |
= = = Roland A. Wank = = = |
Roland A. Wank (1898–1970) was a Hungarian modernist architect, best known for his work for the Tennessee Valley Authority in the United States. |
Wank was educated at the Royal Joseph Technical University in Budapest. He worked as an architect in Austria until 1924 when he emigrated to the United States. |
Wank was recruited by the Tennessee Valley Authority (TVA) in 1933 as that organization's first chief architect. His first work for them was to design Norris, a settlement for TVA workers. He went on to redesign the Norris Dam itself, taking the existing engineering proposal and simplifying its overall appearance, removing ornament, and pulling the structural masses into a more coherent and dramatic spatial composition. Wank also opened the powerhouse to public view, with a reception room staffed with information officers. Although the original engineers were not pleased, the TVA Board was, and Wank went on to give a distinctively modern look to subsequent TVA projects like the Fontana Dam, the Chickamauga Dam, and the Hiwassee Dam. |
At the Fontana Dam, Wank collaborated with well-known industrial architect Albert Kahn on the design of "A-6" prefabricated house types in the workers' town of Fontana, North Carolina, meant to house 5000 workers. Fontana Village is now a resort. Wank also went on to collaborate with Fellheimer & Wagner as the design architects for the Cincinnati Union Terminal building, many corporate buildings in New York and New Jersey, structures for the New Jersey Turnpike and a branch department store (1951) in Montclair, New Jersey for Newark-based Hahne & Company. |
= = = São Borja, Rio Grande do Sul = = = |
São Borja is a city in the Brazilian state of Rio Grande do Sul. São Borja is the oldest municipality in the Brazilian state of Rio Grande do Sul and was founded in 1682 by the Jesuits as the first of the Seven Points of the Missions, and named São Francisco de Borja, in honor of Saint Francis Borgia. It is situated on the Western Frontier of Rio Grande do Sul on the border with Argentina which is defined by the Uruguai river. |
São Borja is known as the Land of the Presidents as it is the birthplace of two Brazilian Presidents: Getúlio Vargas (1882–1954) and João Goulart (1919–1976). |
The city is linked to the Argentinian city of Santo Tomé through the Integration Bridge. |
The city is served by São Borja Airport. |
= = = Southern College of Optometry = = = |
Southern College of Optometry is a private college of optometry in Memphis, Tennessee. |
Southern College of Optometry is a private, non-profit institution founded in 1932, and it is one of only 23 schools of optometry in the United States. J.J. Horton, MD, an ophthalmologist, established SCO in 1932. The class of 1934 was SCO's first graduation class. Since then, SCO has educated more than 6,000 optometrists from all 50 states and several foreign countries. A new clinical facility was opened in 1953 at its current location, which was later expanded to include a campus of new administrative offices, classrooms and a library. |
In 1970, SCO moved into its current structure, which houses multimedia classrooms, laboratories, faculty/administrative offices, the library, a student center, a computer learning resource center and an out-patient clinic known as the Eye Institute. The Eye Center at SCO opened in 2002. The free-standing eye and vision center now serves up to 60,000 patients a year and is one of the largest facilities of its kind in the United States. There are 70 fully equipped examination rooms, 14 individual spaces for advanced technology-based testing, a retinal laser center, a digital angiography center, a full service optical, and on-site ophthalmology services. |
In 2013, the college finished construction on a multimillion expansion program which included new state-of-the-art classrooms, study spaces, and new labs. Lewis N. Reich, OD, PhD, was named as SCO's seventh President in January 2016 and formally installed in the office in May 2016. |
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The Eye Center cares for more than 60,000 patients annually, offering diagnosis, treatment of eye diseases and management of chronic eye health and visual disorders. The Eye Center provides a full range of service, including comprehensive eye examinations for patients of all ages. It is one of the largest facilities of its kind in the United States. There are 70 fully equipped examination rooms, 14 individual spaces for advanced technology-based testing, a retinal laser center, a digital angiography center, a full service optical, and on-site ophthalmology services. |
Similar to a teaching hospital, The Eye Center is a primary health care facility providing services for patients, mostly from Memphis/Shelby County, West Tennessee, Arkansas & Mississippi. The Eye Center is under the direction of Dr. James E. Venable, vice president for clinical programs, and Dr. Christopher Lievens, chief of staff. |
As a teaching facility, The Eye Center is divided into service areas. These service areas cover a wide range of vision needs for our patients, including: |
• Adult Primary Care Service, for patients older than 12 |
• Pediatric Primary Care Service, for patients 12 and under |
• Cornea and Contact Lens Service, for patients of all ages |
• Advanced Care Ocular Disease Service, for treatment of eye disease |
• Vision Therapy and Rehabilitation Service, for patients of all ages |
• The Technology Center, featuring the latest technology for vision testing and measurement |
• The Eye Center Optical, offering designer and practical eyewear for the whole family |
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In 2005, Dr. Jerry Hayes and his wife, Cris, funded the establishment of the Hayes Center for Practice Excellence at SCO. With matching funds committed by SCO’s Board of Trustees, an endowment was created to support the Hayes Center in its mission to serve the optometric profession as the premier resource for practice management education. One of the first of its kind, the center focuses on teaching independent optometrists how to manage the business side of their practice, strategic planning, budgeting, overhead control and increasing profitability. |
The Hayes Center is under the direction of Lisa Wade, OD, who was named Director of the Hayes Center for Practice Excellence in 2015 |
SCO students represent a large cross-section of U.S. demographics and regions, and alumni live and practice in all 50 states and abroad. Notable individuals include: |
The winners of the Varilux Optometry Student Bowl in 2003, 2004, and 2005 were all students from SCO. |
= = = Pericarditis = = = |
Pericarditis is inflammation of the pericardium (the fibrous sac surrounding the heart). Symptoms typically include sudden onset of sharp chest pain. The pain may also be felt in the shoulders, neck, or back. It is typically better sitting up and worse when lying down or breathing deeply. Other symptoms may include fever, weakness, palpitations, and shortness of breath. Occasionally onset of symptoms is gradual. |
The cause of pericarditis is believed to be most often due to a viral infection. Other causes include bacterial infections such as tuberculosis, uremic pericarditis, following a heart attack, cancer, autoimmune disorders, and chest trauma. The cause often remains unknown. Diagnosis is based on the chest pain, a pericardial rub, specific electrocardiogram (ECG) changes, and fluid around the heart. Other conditions that may produce similar symptoms include a heart attack. |
Treatment in most cases is with NSAIDs and possibly colchicine. Steroids may be used if those are not appropriate. Typically symptoms improve in a few days to weeks but can occasionally last months. Complications can include cardiac tamponade, myocarditis, and constrictive pericarditis. It is a less common cause of chest pain. About 3 per 10,000 people are affected per year. Those most commonly affected are males between the ages of 20 and 50. Up to 30% of those affected have more than one episode. |
Substernal or left precordial pleuritic chest pain with radiation to the trapezius ridge (the bottom portion of scapula on the back) is the characteristic pain of pericarditis. The pain is usually relieved by sitting up or bending forward, and worsened by lying down (both recumbent and supine positions) or by inspiration (taking a breath in). The pain may resemble that of angina but differs in that pericarditis pain changes with body position, where heart attack pain is generally constant and pressure-like. Other symptoms of pericarditis may include dry cough, fever, fatigue, and anxiety. |
Due to its similarity to the pain of myocardial infarction (heart attack), pericarditis can be misdiagnosed as a heart attack. Acute myocardial infarction can also cause pericarditis, but the presenting symptoms often differ enough to warrant diagnosis. The following table organizes the clinical presentation of pericarditis differential to myocardial infarction: |
The classic sign of pericarditis is a friction rub heard with a stethoscope on the cardiovascular examination, usually on the lower left sternal border. Other physical signs include a person in distress, positional chest pain, diaphoresis (excessive sweating); possibility of heart failure in form of pericardial tamponade causing pulsus paradoxus, and the Beck's triad of low blood pressure (due to decreased cardiac output), distant (muffled) heart sounds, and distension of the jugular vein (JVD). |
Pericarditis can progress to pericardial effusion and eventually cardiac tamponade. This can be seen in people who are experiencing the classic signs of pericarditis but then show signs of relief, and progress to show signs of cardiac tamponade which include decreased alertness and lethargy, pulsus paradoxus (decrease of at least 10 mmHg of the systolic blood pressure upon inspiration), low blood pressure (due to decreased cardiac index), (jugular vein distention from right sided heart failure and fluid overload), distant heart sounds on auscultation, and equilibration of all the diastolic blood pressures on cardiac catheterization due to the constriction of the pericardium by the fluid. |
In such cases of cardiac tamponade, EKG or Holter monitor will then depict electrical alternans indicating wobbling of the heart in the fluid filled pericardium, and the capillary refill might decrease, as well as severe vascular collapse and altered mental status due to hypoperfusion of body organs by a heart that can not pump out blood effectively. |
The diagnosis of tamponade can be confirmed with trans-thoracic echocardiography (TTE), which should show a large pericardial effusion and diastolic collapse of the right ventricle and right atrium. Chest X-ray usually shows an enlarged cardiac silhouette ("water bottle" appearance) and clear lungs. Pulmonary congestion is typically not seen because equalization of diastolic pressures constrains the pulmonary capillary wedge pressure to the intra-pericardial pressure (and all other diastolic pressures). |
Pericarditis may be caused by viral, bacterial, or fungal infection. |
In the developed world, viruses are believed to be the cause of about 85% of cases. In the developing world tuberculosis is a common cause but it is rare in the developed world. Viral causes include coxsackievirus, herpesvirus, mumps virus, and HIV among others. |
Pneumococcus or tuberculous pericarditis are the most common bacterial forms. Anaerobic bacteria can also be a rare cause. Fungal pericarditis is usually due to histoplasmosis, or in immunocompromised hosts Aspergillus, Candida, and Coccidioides. The most common cause of pericarditis worldwide is infectious pericarditis with tuberculosis. |
Laboratory values can show increased urea (BUN), or increased blood creatinine in cases of uremic pericarditis. Generally however, laboratory values are normal, but if there is a concurrent myocardial infarction (heart attack) or great stress to the heart, laboratory values may show increased cardiac markers like Troponin (I, T), CK-MB, Myoglobin, and LDH1 (lactase dehydrogenase isotype 1). |
The preferred initial diagnostic testing is the ECG, which may demonstrate a 12-lead electrocardiogram with diffuse, non-specific, concave ("saddle-shaped"), ST-segment elevations in all leads except aVR and V1 and PR-segment depression possible in any lead "except aVR"; sinus tachycardia, and low-voltage QRS complexes can also be seen if there is subsymptomatic levels of pericardial effusion. The PR depression is often seen early in the process as the thin atria are affected more easily than the ventricles by the inflammatory process of the pericardium. |
Since the mid-19th Century, retrospective diagnosis of pericarditis has been made upon the finding of adhesions of the pericardium. |
When pericarditis is diagnosed clinically, the underlying cause is often never known; it may be discovered in only 16–22 percent of people with acute pericarditis. |
Pericarditis can be classified according to the composition of the fluid that accumulates around the heart. |
Types of pericarditis include the following: |
Depending on the time of presentation and duration, pericarditis is divided into "acute" and "chronic" forms. Acute pericarditis is more common than chronic pericarditis, and can occur as a complication of infections, immunologic conditions, or even as a result of a heart attack (myocardial infarction), as Dressler's syndrome. Chronic pericarditis however is less common, a form of which is constrictive pericarditis. The following is the clinical classification of acute vs. chronic: |
The treatment in viral or idiopathic pericarditis is with aspirin, or non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen). Colchicine may be added to the above as it decreases the risk of further episodes of pericarditis. |
Severe cases may require one or more of the following: |
About 30% of people with viral pericarditis or pericarditis of an unknown cause have one or several recurrent episodes. |
= = = Pericardiocentesis = = = |
In medicine, pericardiocentesis (PCC) is a procedure where fluid is aspirated from the pericardium (the sac enveloping the heart). |
The patient undergoing pericardiocentesis is positioned supine with the head of the bed raised to a 30- to 60-degree angle. This places the heart in proximity to the chest wall for easier insertion of the needle into the pericardial sac. Anatomically, the procedure is carried out under the xiphoid process, up and leftwards. |
Subsets and Splits