Pericarditis – symptoms, types, causes and treatment of pericarditis

The causes of pericarditis are divided into infectious and aseptic. Frequently encountered include rheumatism and tuberculosis. With rheumatism, not only the pericardium is affected.

Pericarditis caused by these diseases is infectious or allergic.

With tuberculosis, the infection penetrates the pericardium by means of lymph from the lungs.

Also, fluid in the pericardium accumulates when:

  • with the penetration of microbes, viruses, fungi;
  • heart attack;
  • elevated cholesterol, hormonal disruptions;
  • all kinds of injuries in the heart;
  • tumors and neoplasms of a different nature, located directly on or near the heart.

Factors contributing to an increased risk of the disease include:

  • infections of various etiologies (viral and bacterial). Quite often, the inflammatory process penetrates from organs adjacent to the heart;
  • various allergic reactions;
  • lupus erythematosus, rheumatism, rheumatoid arthritis;
  • heart disease;
  • various injuries and injuries in the region of the heart;
  • malignant neoplasms;
  • changes in metabolic processes;
  • pathological structure of the pericardium;
  • general edema and hemodynamic changes.

The most common pericarditis caused by Escherichia coli, meningococci, streptococci, pneumococci and staphylococci. Pericarditis caused by other representatives of microflora is much less common, but they are also noted in the statistics. For example, tuberculosis contributes to the occurrence of pericarditis in 6 cases out of 100.

There are metabolic causes of pericarditis. These are thyrotoxicosis, Dressler syndrome, myxedema, gout, chronic renal failure. Rheumatism can lead to pericarditis, although in recent years cases of rheumatic pericarditis have been very rare. But the inflammation of the visceral leaf caused by collagenosis or systemic lupus erythematosus, began to be diagnosed more often. Often, pericarditis occurs as a result of drug allergies. It occurs as a result of an allergic lesion of the pericardial sac.

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Constrictive tuberculous pericarditis

Pericarditis of tuberculous etiology is rare in developed countries, but often in developing countries. There has been an increase in the number of cases in sub-Saharan Africa along with the HIV and AIDS epidemic. The disease can manifest itself in three forms: constrictive pericarditis, effusion-constrictive pericarditis and effusion pericarditis.

Clinical manifestations. Clinical manifestations are very diverse – from asymptomatic to severe, due to constrictive changes. With a superficial examination and echocardiography, the disease can be missed. Rarely, a concomitant pulmonary tuberculosis process is found. Pericardial calcifications are found in less than 5% of cases.

Treatment. Initial treatment tactics in patients with uncalcified tuberculosis constrictive pericarditis include the appointment of anti-TB therapy. Since the process is fibrous-caseous in nature, the disappearance of constriction during treatment is observed in 15-20% of all cases for 3-4 months. In the absence of improvement from the ongoing anti-tuberculosis therapy for 6 weeks or the insufficient effectiveness of the treatment carried out for several months, pericardectomy is indicated. With calcifying pericarditis, the tactics are the opposite: early pericardectomy is performed with the appointment of anti-TB drugs.

Features A mixed form, often found in tuberculous etiology of pericarditis. Due to the accumulation of exudate and compression of the visceral pericardium, pericardial pressure increases. On the echocardiography, a mushy effusion with fluid clotting is noted.

Treatment is carried out according to standard four-component regimens with anti-TB drugs. The role of adjuvant glucocorticoid therapy is unclear. Mortality is about 10% and on average 30% of patients need to perform pericardectomy within 2 years of observation.

Pathophysiology. In more than 95% of cases, the effusion is hemorrhagic in nature, sometimes it can even resemble venous blood. The absence of damage to the lung parenchyma in the presence of an increase in lymph nodes in the area of ​​the root of the lung in most patients indicates a direct spread of infection from the lymph nodes to the pericardium.

The clinical picture. Systemic manifestations are variable. Typical pericardial pain is rare, ECG changes characteristic of pericarditis are not detected. Signs of a pulmonary tuberculosis process are detected only in 30% of cases. Echocardiography indicates fluid accumulation in the pericardium with the presence of typical formations of low echogenicity, thickening of the visceral sheet of the pericardium with fibrinous plaque.

Diagnostics. The final diagnosis of tuberculous etiology of pericarditis is based on the detection of mycobacteria in the pericardial fluid or in a histological examination of the biopsy. The presence of exudate in the pericardial cavity should be detected during pericardiocentesis. The fluid should be sent for microscopic examination to determine acid-resistant bacilli and perform inoculation.

The sensitivity of the culture method increases when the culture is sown on a special Kirchner medium immediately after taking the sample from the patient’s bed. A pericardial biopsy and drainage of its cavity facilitate histological examination. These manipulations can be performed under local anesthesia from under the xiphoid process of the sternum.

The diagnosis of probable tuberculous pericarditis is made when revealing tuberculosis of extracardiac localization together with pericarditis of unknown origin. Palpation of the supraclavicular fossa often allows you to detect enlarged lymph nodes, which are necessarily subject to a biopsy. Acid-resistant bacilli are found in sputum in only 10% of cases.

Tuberculin skin tests have low diagnostic value in both endemic and non-endemic areas. The question still remains open, which study is more informative – enzyme-linked immunosorbent assay (ELISPOT) with the determination of T cells specific for M. tuberculosis antigen, or a skin test with tuberculin.

A number of samples have been developed for the rapid determination of mycobacteria in the pericardial fluid. PCR allows you to quickly detect the DNA (deoxyribonucleic acid) of M. tuberculosis even in 1 μl of pericardial fluid (sensitivity 75%, specificity 100%). An increase in the level of adenosine deaminase more than 40 U / L is highly informative and has a sensitivity of 83% and a specificity of 78%. A high level of γ-interferon also serves as a marker of tuberculous pericarditis. Sensitivity is 92%, specificity is 100%.

Treatment of tuberculous pericarditis is carried out according to the standard four-component scheme with antituberculosis drugs for 6 months. Mortality is about 8%. About 15% of patients over the next two years require repeated pericardiocentesis, about 10% – pericardectomy. Adding glucocorticoid therapy to the standard treatment regimen has a positive effect on the course of the disease, but its role in improving survival rates is poorly understood and controversial, especially with concomitant HIV infection.

Predisposing factors. These include: immunosuppression (for example, immunosuppressive therapy in the treatment of lymphomas, HIV or AIDS); history of pericardial effusion; heart surgery; chest trauma; in children – pharyngitis; pneumonia; otitis media, endocarditis; arthritis.

Provoking factors: heart surgery, aspiration of the contents from the pericardial cavity, endocarditis spreading through the aortic root to the pericardial cavity, hematogenous spread of infection from distant septic foci, such as osteomyelitis or pneumonia.

Pathogens in adults – Staphylococcus aureus, gram-negative bacilli, anaerobes; in children – Haemophilus, Staphylococcus aureus and N. meningitides.

The clinical picture. In adults, manifestations are rare. It begins as an acute infectious disease with a fulminant course, which, if untreated, is fatal. The main reason for this unfavorable prognosis is the lack of alertness regarding this diagnosis in debilitated patients with a systemic infectious process.

Diagnostics. Pericardiocentesis reveals pus in the pericardial cavity, high leukocyte count, low glucose, gram-positive bacteria in punctate, positive results of inoculation of pericardial fluid and blood.

Treatment. Complete drainage of the pericardial cavity from access from under the xiphoid process and systemic antibiotic therapy. Even with adequate treatment, mortality reaches 40%.

It is difficult to distinguish between cases of constrictive pericarditis and restrictive cardiomyopathy. However, to understand this situation is vital, since pericardectomy is one of the most effective operations in the treatment of this type of pericarditis. There are a number of points that help to conduct differential diagnosis:

  1. Clinically: the presence of noise of mitral or tricuspid insufficiency indicates an extremely low likelihood of constrictive pericarditis.
  2. ECG: a deviation of the electrical axis to the left is more evidence of myocardial damage.
  3. Radiography of pericardial capcificates is characteristic of constrictive pericarditis.
  4. Echocardiography: detection of concentric left ventricular myocardial hypertrophy interspersed with “shiny granules” indicates amyloidosis. Left ventricular hypertrophy can occur with hemochromatosis. EMF is characterized by obliteration of the wall of the left ventricle. With constrictive pericarditis, PV is not changed, while with myocardial pathology a decrease in this indicator is noted. When conducting a Doppler study with constrictive pericarditis, the early peak longitudinal expansion velocity (peak Ev) is higher than 8,0 cm / s. The sensitivity of the method is 89%, specificity is 100%.
  5. CT and MRI: these research methods are informative when the thickness of the pericardium exceeds 3 mm.
  6. Cardiac catheterization: if the end-diastolic pressure in the right and left ventricles differs by more than 6 mm Hg, we can talk about the presence of restrictive cardiomyopathy.
  7. Endocardial and myocardial biopsy: helps in the diagnosis of heart amyloidosis and hemochromatosis. Severe fibrosis indicates the presence of restrictive cardiomyopathy.

If all of the above research methods are not informative, it is justified to perform diagnostic thoracotomy.

Classification

1) According to the forms of flow, they are divided into:

  • Acute – lasts no more than 6 weeks. It develops with bacterial, viral, traumatic or drug (toxic) pericarditis. It happens fibrinous, exudative or purulent (which is rare). There are cases of spontaneous cure;
  • Subacute – the duration of the disease ranged from 6 weeks to six months with the full recovery of the patient. It has various forms, except purulent;
  • Chronic – the duration of the disease for more than six months. Often found in autoimmune lesions and after resorption of purulent exudate. Structural changes occur in the tissues of the heart;
  • Recurrent – characterized by periodic remissions and exacerbations. Divided by:
    • Intermittent – remission and exacerbations occur on their own, regardless of treatment.
    • Continuous – exacerbations occur one after another. In order for remission to occur, anti-inflammatory therapy must be performed.

2) For development reasons:

  • Infectious:
    • Bacterial – is one of the dangerous, but easily treatable, if you determine the exact cause. It is difficult and long. It makes up to 15% of all pericarditis. The causative agents are streptococci, chlamydia, borrelia, rickettsia, etc. It happens serous, serous-fibrinous, hemorrhagic and purulent;
    • Tuberculosis – provoked by Mycobacterium tuberculosis, which is often spread in lung diseases and AIDS. Symptoms develop gradually, although there are exceptions;
    • Viral – the penetration of viruses on the serous membrane. They are transferred with blood flow, as a rule, from other diseased organs with HIV, rubella, hepatitis, chickenpox, mumps, etc. The proportion of all viral pericarditis is up to 45%. It happens serous, serous-fibrinous, hemorrhagic. Self-healing is possible;
    • Fungal – it is rare enough, provoked by candida, aspergillosis, coccidioidosis, etc. It usually develops on the background of the activation of harmful fungi that live in the body of every person;
    • Parasitic – is rare, mainly among residents of tropical countries. The causative agents are toxoplasma, echinococcus, etc .;
    • Protozoal.
  • Non-infectious:
    • Autoimmune – begins with exudative inflammation, which gradually turns into fibrous and ends with constrictive pericarditis;
    • Malignant;
    • Metabolic;
    • Post-infarction – it is early (develops immediately after a heart attack) and delayed (Dressler’s syndrome; develops several hours after a heart attack);
    • Traumatic (post-traumatic) – occurs after situations traumatic for the heart: stroke, damage or fractures of the chest, affecting the organ. Often acute, in the absence of treatment flows into a chronic form;
    • Idiopathic – the reasons cannot be established. This includes patients who become ill due to a rare virus or due to a genetic predisposition;
    • Radiation – is rare and only due to the fault of doctors, when the duration, dose and amount of ionizing radiation was exceeded;
    • Medicinal (toxic);
    • Tumor

3) By the method of penetration:

  • Hematogenous – through the blood;
  • Lymphatic – through lymph;
  • Direct contact – with chest injuries, when the heart is open.
  • Dry (fibrinous) – the symptoms are often imperceptible or mild. It is characterized by a thickening of the leaves, which can remain for life;
  • Exudative (effusion) – accumulation of fluid in the heart bag. It can be as a result of dry pericarditis, and develop to inflammation (with tuberculosis, tumor, allergic or toxic damage);
  • Adhesive – goes through the stages of development of dry and effusion pericarditis, is characterized by the formation of adhesions;
  • Constrictive is the most severe stage of pericarditis, in which adhesions are already formed that disrupt the functioning of the heart. The tissue of the heart becomes inextensible, inelastic. Calcium begins to be deposited, due to which tissue mineralization occurs. Connective tissue grows. All this happens as a result of tuberculosis, tumor damage, autoimmune inflammation, the spread of pus in the pericardium.
  • Purulent – is one of the severe forms of the disease, which can lead to death. The temperature rises sharply, a frequent heartbeat begins. If emergency assistance is not provided, the patient may die. It often develops with bacterial pericarditis.
  • Hemorrhagic (cardiac tamponade) – accumulation of blood (red blood cells), violation of the vessels and walls of the heart. It develops with post-infarction, tumor pericarditis or with bleeding disorders.
  • Serous-fibrinous and serous – water or water with fibrin.
  • Putrid – the presence of anaerobic bacteria in a liquid.

Signs and symptoms of pericarditis

In the acute form, pain is noted in the chest space or in the left side of the chest. But there are cases when the patient characterizes the pain as dull and aching.

With this course of the disease, the pain often radiates to the neck or back. Quite often, the pain syndrome becomes stronger when coughing, taking a deep breath and in a horizontal position.

These symptoms are similar to myocardial infarction, which is difficult to diagnose.

For the chronic form, prolonged inflammation is characteristic, due to which the pericardial bag is filled with fluid.

  • shortness of breath when leaning back;
  • cardiopalmus ;
  • increased body temperature for a long time;
  • fatigue, fatigue;
  • cough;
  • swelling of the abdomen and legs;
  • increased sweating at night;
  • weight loss.

The manifestation of the disease depends on the form and intensity of the inflammatory process. For example, with a dry form, signs of pericarditis are expressed in the form of pain in the heart and pericardial noise detected by listening. In this case, the pain is similar to that of dry pleurisy or angina pectoris, as a result of which the treatment of the disease often begins with some delay due to the complexity of the diagnosis.

With inflammation of the pericardium, a characteristic feature of pain is that it increases with coughing, a deep sigh, and horizontal position of the body.

In the exudative form of the disease, which is accompanied by the release of fluid into the pericardial sac, symptoms of pericarditis include difficulty in breathing, compression of the esophagus, a feeling of tightness in the heart and shortness of breath. Most of the patients are in fever, they have swelling of veins on the neck and swelling of the face.

On the ECG with pericarditis, the following signs can be detected:

  • the absence of a pathological Q wave;
  • unidirectional (concordant) displacement of the ST segment above the isoelectric line in many ECG leads;
  • the appearance of sinus tachycardia;
  • a change in the polarity and shape of the T wave in many leads;
  • decrease in the total voltage of the ECG (in the case of exudate in the pericardial cavity);
  • various disorders of conduction and rhythm.

Manifestations of exudative pericarditis depend on the rate of fluid accumulation, the degree of compression of the heart and the severity of the inflammatory process in the pericardium. Initially, the main complaints are severity and aching pain in the chest. As fluid accumulates in the pericardial cavity, due to mechanical compression of adjacent organs, shortness of breath, dysphagia, barking cough, hoarseness of the voice occur. Swelling of the face and neck, swelling of the cervical veins on inspiration, and the gradual development of symptoms of heart failure are characteristic. The noise of pericardial friction is not characteristic, but can be heard with moderate effusion in a certain position of the patient’s body.

There are general manifestations associated with the cause of the development of exudative pericarditis: with infectious genesis – chills, fever, intoxication; in chronic tuberculosis, sweating, lack of appetite, weight loss, hepatomegaly are added. With purulent exudative pericarditis, infectious foci in nearby organs, a septic process are possible. Epistenocardial pericardial effusion occurs within 4 days after myocardial infarction and is manifested by shortness of breath, orthopnea, swelling of the cervical veins. Rheumatic pericarditis usually develops with severe pancreatitis; uremic – is accompanied by a clinical picture of chronic renal failure.

In the case of tumor origin, pericarditis is accompanied by profuse effusion, chest pain, atrial arrhythmias, and the development of cardiac tamponade. With a large volume of effusion, patients are forced to take a sitting position, which facilitates their condition.

Manifestations of pericarditis depend on its form, stage of the inflammatory process, the nature of the exudate and the rate of its accumulation in the pericardial cavity, the severity of the adhesive process. In acute inflammation of the pericardium, fibrinous (dry) pericarditis is usually noted, the manifestations of which change in the process of exudate isolation and accumulation.

It develops as a result of dry pericarditis or independently with rapidly developing allergic, tuberculous or tumor pericarditis.

There are complaints of pain in the heart, a feeling of tightness in the chest. With the accumulation of exudate, there is a violation of blood circulation through the hollow, hepatic and portal veins, shortness of breath develops, the esophagus is compressed (the passage of food is disturbed – dysphagia), the phrenic nerve (hiccups appear). Almost all patients have a fever.

Dry pericarditis

It manifests itself as pain in the region of the heart and the noise of pericardial friction. Pain in the chest – dull and pressing, sometimes extending to the left shoulder blade, neck, both shoulders. Mild pain often occurs, but there are severe and painful, resembling an attack of angina pectoris. Unlike heart pain with angina pectoris, pericarditis is characterized by its gradual increase, duration from several hours to several days, lack of reaction when taking nitroglycerin, temporary subsidence from taking narcotic analgesics.

Patients can simultaneously feel shortness of breath, palpitations, general malaise, dry cough, chills, which brings the symptoms of the disease closer to manifestations of dry pleurisy. A characteristic sign of pain with pericarditis is its intensification with deep breathing, swallowing, coughing, a change in body position (decrease in a sitting position and strengthening in a supine position), surface breathing and frequent.

Pericardial friction noise is detected by listening to the patient’s heart and lungs. Dry pericarditis can end in a cure in 2-3 weeks or go into exudative or adhesive.

Diagnosed within 6 weeks to 6 months from the onset of the disease. In this case, chest pain, weakness, fever, shortness of breath are mild. Symptoms of the disease depend on the severity of morphological changes in the pericardial leaves. Adhesive pericarditis is characterized by the appearance of adhesions between the layers of the pericardium, as well as the formation of adhesions between the heart and the walls of the chest cavity, as well as with adjacent organs (Fig. 1, d).

Constrictive pericarditis occurs when the outer and inner leaves of the pericardium are fused over a large extent (Fig. 1, e). A dense carapace forms, covering the heart, making it difficult to fill with blood. As a result, heart failure occurs with stagnation of blood in the region of a large circle of blood circulation. With a significant severity of the process, constrictive pericarditis can also be complicated by tamponade due to compression of the heart with rigid pericardium.

Chronic pericarditis is diagnosed if the disease lasts more than 6 months. In most cases, this form occurs in a number of autoimmune diseases or after resorption of purulent contents in a heart bag. There is no longer an acute inflammatory process at this stage, but the formation of adhesions or carapace can be observed.

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Symptoms are mainly due to compression of the heart – stagnation of blood in the lungs and liver, swelling of the cervical veins. Given the long course of the disease, such manifestations as gradual weight loss, chronic fatigue are possible.

The onset of pericarditis usually passes with minimal clinical manifestations, or even without them, which largely depends on the form, rate of progression and the cause of the disease.

  • Pain in the region of the heart (often radiating to the hands, epigastric region or trapezius muscle), which is acute or paroxysmal, sometimes painful in nature, resembling attacks of angina pectoris or anginal status in myocardial infarction, which indicate a “dry” stage of pericarditis, which is due to fibrous overlays on the visceral and parietal sheets, which begin to rub together;
  • Pain in the region of the heart intensifies when the patient is lying down, taking a deep breath, swallowing or coughing, but at the same time they may weaken in a sitting position and shallow breathing;
  • A slight increase in body temperature, slight chills;
  • General malaise and heaviness in the muscles;
  • The pain syndrome is not relieved by Nitroglycerin;
  • The noise of friction between the leaves of the pericardium when listening to the work of the heart;
  • Among the non-specific symptoms can be distinguished – shortness of breath, dry cough, palpitations, skin rash.

Important! Pain may be absent or mild in cancer, uremia and tuberculosis.

  • With exudative pericarditis of an infectious nature, there are observed – fever, chills, nausea, blanching of the skin, a rash is possible;
  • The body temperature is normal, elevated or high, depending on the cause of pericarditis (in case of viral – elevated, bacterial – high, allergic and rheumatic – usually normal);
  • General malaise, weakness, increased fatigue;
  • Uncomfortable, and there may be pain in the region of the heart, especially when trying to deep breathe;
  • The following symptoms may also appear, depending on the tissues and organs involved in the inflammatory process – shortness of breath (when pressing the pericardium on the lungs), “barking” cough (pressure on the trachea), hoarseness of the voice (contact with the recurrent laryngeal nerve), swallowing reflex disorder ( dysphalgia – in contact with the esophagus).
  • Tachycardia;
  • Low blood pressure;
  • The patient experiences discomfort in the supine position, so he tries to sit more;
  • Among the non-specific symptoms can be distinguished – swelling of the skin in the region of the heart, dilated veins in the neck (one of the main signs of heart failure).

Diagnostics

Screening for suspected pericarditis begins with listening to the chest through a stethoscope (auscultation). The patient should lie on his back or lean back with support on his elbows. In this way, one can hear the characteristic sound that the inflamed tissue makes. This noise, reminiscent of the rustling of fabric or paper, is called pericardial friction.

Among the diagnostic procedures that can be carried out as part of a differential diagnosis with other diseases of the heart and lungs:

  • An electrocardiogram (ECG) is a measurement of the electrical impulses of the heart. The characteristic signs of ECG with pericarditis will help to distinguish it from myocardial infarction.
  • Chest x-ray to determine the size and shape of the heart. When the volume of fluid in the pericardium is more than 250 ml, the image of the heart in the image is enlarged.
  • Ultrasound gives a real-time image of the heart and its structures.
  • Computed tomography may be needed if you need to get a detailed image of the heart, for example, to exclude pulmonary thrombosis or aortic dissection. With the help of CT, the degree of thickening of the pericardium is also determined for the diagnosis of constrictive pericarditis.
  • Magnetic resonance imaging is a layered image of an organ obtained using a magnetic field and radio waves. Allows you to see thickening, inflammation and other changes in the pericardium.

Blood tests usually include: general analysis, determination of ESR (an indicator of the inflammatory process), urea nitrogen and creatinine to assess kidney function, AST (aspartate aminotransferase) for liver function analysis, lactate dehydrogenase as a cardiac marker.

The differential diagnosis is carried out with myocardial infarction.

Timely diagnosis of pericarditis plays an extremely important role, since inflammation of the pericardium is a serious threat to the life of the patient. These cases are related: tumor and purulent pericarditis, pericardial effusion with acute cardiac tamponade and compressive pericarditis.

Diagnosis of pericarditis includes: conducting laboratory tests, examining the patient (tapping and listening to the heart) and collecting an anamnesis. To clarify the nature and causes of pericarditis, biochemical, immunological and general blood tests are performed.

In the diagnosis of acute dry pericarditis, adhesive pericarditis and the initial stage of exudative pericarditis, ECG is of great importance. In the case of chronic and exudative inflammation of the pericardium, as a rule, a decrease in the electrical activity of the heart muscle is observed.

The main diagnostic method for pericarditis, which reveals the presence of even a small amount of fluid exudate in the pericardial cavity, as well as to determine the thickening of the leaves of the pericardium, the presence of adhesions, and changes in heart movements, is echocardiography.

Diagnosis of pericarditis includes:

  • Anamnesis, visual examination of the patient, listening to the heart and its percussion;
  • General blood analysis;
  • Blood chemistry;
  • Immunological blood test;
  • PCR reaction;
  • Electrocardiography (ECG);
  • Echocardiography (echocardiography);
  • Roentgenography (x-ray);
  • Magnetic resonance therapy (MRI);
  • Computed tomography (CT);
  • Ultrasound examination (ultrasound);
  • Angiography;
  • Multispiral computed tomography (MSCT), or coronarography;
  • Also, in the case of an exudate form of the disease, a puncture and pericardial biopsy can be taken.

The first thing the doctor does when the pericardial bag has undergone inflammation is listening to the patient, while the patient should be in a horizontal position or lean back with support on the elbows.

In this type of research, the specialist hears a characteristic noise similar to the rustling of leaves or paper.

In addition, the following studies are carried out to diagnose this disease:

  • ECG;
  • Radiography helps determine the size and shape of the heart. If the fluid is more than 250 ml, then in the picture the heart is enlarged;
  • Ultrasound diagnosis allows you to determine the amount of fluid volume and violation of the structure of the pericardium;
  • computed tomography allows you to differentiate pericarditis from other diseases;
  • Magnetic resonance imaging;
  • blood tests.

In patients with exudative pericarditis, a slight bulging of the anterior chest wall and slight swelling in the precadial region, weakening or disappearance of the apical impulse, expansion of the boundaries of relative and absolute cardiac dullness, blunting of the percussion tone at the angle of the left shoulder blade are noted. The development of cardiac tamponade is indicated by an increase in CVP, a drop in blood pressure, tachycardia with transient arrhythmia, and a paradoxical pulse. Diagnosis of exudative pericarditis and its differentiation from other heart diseases (acute myocardial infarction, acute myocarditis) is helped by examination data, chest X-ray, ECG and echocardiography, multispiral CT, pericardial puncture.

    On the x-ray with a significant amount of flu >

CT OGK. Exudative pericarditis. A significant amount of fluid in the pericardial cavity.

Complications and consequences of pericarditis

Depending on the form of the disease, the consequences of pericarditis can be very different, from recovery, ending with relapses and transition to exudative pericardium. For example, the consequences of acute pericarditis are expressed as pericardial fusion, in which the pericardium fuses not only with the mediastinal organs, but also with organs in the heart. There is a proliferation and calcification of connective tissue, which can spread to the heart muscle and neighboring organs (diaphragm, lungs, pleura).

In general, pericarditis is considered to be a disease with a favorable outcome, since timely qualified care leads to complete recovery in most patients. In rare cases, with a severe course of the disease, some complications of pericarditis can be observed. Sometimes they become the reason for getting a disability group.

The main complications that occur with pericarditis are:

  1. Heart tamponade. This is a pathological condition, which is characterized by a rapid accumulation of fluid in the pericardial cavity with a serious violation of the heart. This complication is the most dangerous consequence of pericarditis. Such a quick filling of a heart bag with blood is usually observed after an injury, with pericardial tumors or a rupture of the muscle membrane of the heart. A rapid increase in pressure in the pericardial cavity leads to severe compression of the heart. Without urgent puncture and elimination of the cause of tamponade, the patient simply dies of heart failure.
  2. Thickening and clumping of pericardial leaves. Usually a consequence of fibrinous inflammation. A dense plaque from fibrin does not resolve over time, so some symptoms of pericarditis may remain for a long time after the inflammatory process has subsided. First of all, this is the pericardial friction noise that will be heard in most of these patients for the rest of their lives. In addition, moderate pain behind the sternum may be observed after heavy physical exertion. In this case, the heart somewhat increases in volume, which compensates for the high oxygen consumption by the muscles. Because of this, the thickened leaves of the pericardium are even more closely adjacent to each other. Most often, specific treatment for this complication is not required.
  3. Violation of the conduction of the heart. May be observed for a long time after pericarditis. They are manifested by periodic bouts of arrhythmia (especially with exercise). The cause of such disorders is damage to the muscle membrane of the heart. The fact is that the cells in the myocardium evenly conduct an electrical impulse, causing the heart to contract. In inflammatory lesions, the electrical conductivity of tissues changes, due to which the impulse spreads unevenly. There is no specific surgical treatment for such complications. The patient is forced to take antiarrhythmic drugs as necessary and be observed by a cardiologist. If episodes of arrhythmia occur very often, this can affect a person’s ability to work and cause a disability group.
  4. The formation of fistulas. It is possible only with purulent pericarditis and is a rare complication of pericarditis. Pyogenic microorganisms can destroy body tissues. Because of this, holes sometimes form in the wall of the pericardium. Through them, the message of two natural cavities of the body occurs – the heart bag on one side and the pleural cavity or esophagus on the other. With this complication, a number of characteristic symptoms are observed, the first of which is severe pain. The defect in the leaf of the pericardium does not disappear after the cure of the purulent process. This may predispose to pericarditis in the future and disrupt the functioning of the heart. This complication requires surgical treatment, which consists in closing the pericardial cavity.

Pericarditis often entails serious complications if treatment has been delayed.

With the exudative form of this disease, acute tamponade may appear.

With constructive, circulatory failure often occurs, fluid compresses the vena cava and hepatic veins, the atrium, which causes ventricular diastole insufficiency, and false cirrhosis of the liver may develop.

Myocardial accretion may also occur with nearby organs, the chest, due to the appearance of scar tissue.

Complications of pericarditis are:

  • Cardiac tamponade – compression of the heart;
  • Myocarditis, endocarditis;
  • Heart failure;
  • Myocardial infarction;
  • Strokes
  • Thrombosis and thromboembolic complications;
  • Death.

Uremic pericarditis

Pathophysiology. Uremia is accompanied by fibrinous and often hemorrhagic inflammation, which can lead to cardiac tamponade or compression.

Treatment. Symptomatic pericarditis that occurred before dialysis begins responds to peritoneal dialysis or hemodialysis. It is necessary to conduct hemodialysis without the use of heparin in order to prevent the development of hemopericardium. Many patients who develop uremic pericarditis during hemodialysis (dialysis-induced pericarditis) respond to an intensification of the dialysis regimen.

Pericarditis treatment

How to treat pericarditis? Treatment, treatment tactics and the choice of drugs for pericardial disease directly depend on the form, type and cause of the disease. For example, with viral pericarditis, antiviral drugs are used, bacterial – antibiotics, fungal – antimycotic drugs, and their cross-application will not help, i.e. antibiotics for viruses will not help, but they can complicate the course of the disease and cause a number of side effects.

Therefore, the treatment of pericarditis with drugs begins only after a thorough diagnosis, and the use of drugs at your discretion is highly not recommended! Of course, if the Lord Himself tells you what to drink, then yes, and so, be extremely vigilant!

1. Mode 2. Drug treatment (conservative treatment); 3. Diet 4. Surgical treatment; 5. Prevention of complications of the disease.

1. Mode

All patients with suspected pericarditis are subject to mandatory hospitalization.

Bed rest is recommended, the patient should be limited from physical activity.

Mandatory monitoring of the level of arterial and venous pressure, heart rate (heart rate).

Also, for timely diagnosis of the appearance of pericardial effusion, repeated echocardiographic studies are indicated.

Important! Before using drugs, be sure to consult your doctor!

Important! Before using folk remedies against pericarditis, be sure to consult your doctor!

Needles. 5 tbsp. spoons of coniferous needles from pine, spruce, fir or juniper pour 500 ml of boiling water, put the product on a slow fire and boil for 10 minutes. Then set aside the infusion agent for 8 hours, wrapping it, strain and take 100 ml 4-5 times a day.

Birch Earrings. Fill a 2/3 liter jar with large earrings of birch, fill them with vodka to the top of the jar, close the capron lid and put it on for two weeks for insisting. You need to take the drug 20 drops, 3 times a day, 30 minutes before eating.

Tactics and methods of treatment completely depend on the type of pericarditis and the root causes of its appearance.

For the treatment of pericarditis, both conservative therapy and surgical intervention are used.

Very often, surgery is the only way to overcome the armored heart.

Treatment of pericarditis with the use of medications involves the reduction of edema and relief of inflammation. And also to eliminate the root causes of the disease.

The following medications are used to treat inflamed pericardium:

  • drugs aimed at eliminating pain, for example, Ibuprofen;
  • colchicine is used in the acute form of the disease to prevent recurrence of the disease, while attacks it is used in the chronic form of the disease;
  • anti-inflammatory drugs;
  • antibiotics and antifungal agents to eliminate infections that contributed to the development of pericarditis;
  • funds aimed at eliminating arrhythmias.

The patient is advised to avoid any kind of physical activity for 3 months.

If the doctor suspects the presence of cardiac tamponade during diagnosis, the patient is subject to hospitalization, where a more accurate diagnosis will be made.

If the diagnosis is correct, then surgical treatment is required.

  • Pericardiocentesis is the puncture of the pericardium with a needle or catheter in order to extract the collected fluid. This procedure helps to improve the patient’s condition. In addition, it allows you to determine the type of pericarditis, and in the case of an infectious one, you can identify the pathogen.

Drainage can stand up to several days, which gives a good therapeutic effect. In 99% of cases, tamponade regresses.

  • The formation of an opening between the pericardium and the pleural cavity is used if fluid constantly accumulates in the pericardium.

The exudate from the pericardium goes there, thus reducing the pressure in the pericardium.

The complete removal of the pericardium can also be carried out. This type of surgical intervention is performed with constant relapses of the disease, as well as with complicated forms.

Treatment of pericarditis with folk remedies is possible, but only as additional treatment methods.

With this disease, the use of any means without a doctor’s prescription is dangerous to health.

For the treatment of folk remedies of pericarditis, you will need:

  • 5 tbsp. tablespoons of chopped young needles of any coniferous tree (spruce, pine), which should be poured half a liter of boiling water. The infusion is brought to a boil and cooked on low heat for 10 minutes. Then it must be insisted for 6-8 hours and filtered. Take half a glass 4-5 times a day.

This infusion has antimicrobial, diuretic properties, as well as an anti-inflammatory effect.

  • It is necessary to make a collection of motherwort grass, marshmallow cinnamon, hawthorn flowers (3 parts each) and chamomile flowers in an amount of 1 part. From the resulting mixture, take 1 tbsp. spoon and pour it with 1 cup boiling water. Insist 8 hours, then strain. Apply half a glass orally 3 times a day 60 minutes after eating.

Treatment of exudative pericarditis is carried out in a hospital, management of patients is determined by the volume and etiology of the pathology, the severity of hemodynamic disorders. In an acute process in the pericardium, monitoring of blood pressure, heart rate, and CVP is necessary.

  • Pharmacotherapy. To relieve pain, fever and faster absorption of effusion with exudative pericarditis, NSAIDs (ibuprofen, indomethacin), glucocorticosteroids (prednisone) are prescribed. Active treatment of the underlying disease is carried out using antibacterial, anti-tuberculosis, cytostatic drugs, hemodialysis, etc.
  • Pericardial puncture. It is indicated for the evacuation of a large accumulation of liquid that does not absorb within 2-3 weeks; with cardiac tamponade and purulent pericarditis. If, after repeated punctures and drainage, the pericardial effusion continues to accumulate rapidly, a pericardectomy is performed.

Depending on the form of the disease, treatment of pericarditis can be surgical and conservative. For most patients, drug treatment is usually sufficient and surgery is not required. Surgical intervention is necessary for patients with stenotic pericarditis. Surgical treatment of pericarditis includes pericardiectomy, which involves the removal of part of the pericardium.

This operation is prescribed in cases where the patient has the following symptoms: a decrease in blood pressure, a significant deterioration in blood circulation and attacks of shortness of breath. In 90% of cases, pericardiectomy leads to success. It allows you to free the patient’s heart from a squeezing capsule, and after 3-4 months the normal functioning of the heart muscle is restored. However, in 10% of cases, the operation results in death.

Pericarditis therapy is selected for each patient individually, depending on the form of the inflammatory process and the cause of the disease. In acute pericarditis, the patient must strictly observe bed rest until the inflammatory process subsides – this will protect him from adverse effects and reduce the risk of complications.

In chronic inflammation of the pericardial sac, the need for bed rest is determined by the general condition of the patient, as a rule, during the period of exacerbation he is shown a diet with salt restriction, decreased physical activity, and if necessary, bed rest.

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When diagnosing dry acute pericarditis, symptomatic treatment is prescribed, including:

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If the cause of the development of pericarditis is a bacterial infection or puncture of exudate revealed the presence of pus, then a course of antibiotic therapy is definitely prescribed. Medicines are administered parenterally (in the form of injections) and directly into the cavity of the pericardial sac after preliminary drainage of the pericardium.

With pericarditis against tuberculosis, several anti-TB drugs are added to the methods of treatment described above, while the minimum course of therapy with them is 6 months. When diagnosing hemopericardium, fibrinolytic drugs are introduced into the cavity of the pericardial sac.

Constrictive tuberculous pericarditis

To some extent, the etiology of pericarditis also determines the pathogenesis of the disease, which generally corresponds to the pathogenesis of inflammation, which develops as an allergic or infectious one. The immediate causes of pericarditis, first of all, are presented in the form of factors that primarily damage the serous membrane of the heart.

Infectious causes of pericarditis include:

Among other causes of the disease, mechanical (cause alteration of the pericardium without the participation of infectious agents and allergies) and toxic (for example, toxemia with uremia) are distinguished.

This systematization of the etiology of pericarditis will make it possible to understand the causes of individual cases of the disease, since, firstly, the negative effect of one of the factors on the pericardium can be controversial, and secondly, the effect of these factors can be mixed (for example, infection trauma).

The most studied mechanisms of pathogenesis of pericarditis include the following:

  • introduction of infectious pathogens into the pericardial cavity through the blood and lymph vessels;
  • inflammatory aseptic reaction to toxic substances;
  • germination of tumor tissue from neighboring organs and contact inflammation;
  • the development of hyperergic inflammation as a result of an immune response to exogenous antigens of tissue and bacterial origin.

The course of pericarditis is chronic and acute. At the very beginning of the disease, chronic pericarditis can be of a primary chronic nature, but can also transform from an acute course. In the pathogenesis of pericarditis (especially acute tuberculosis or benign), the allergic component is of no small importance.

The risk of developing pericarditis increases with the following conditions:

  • allergic diseases (drug allergy, serum sickness);
  • heart disease (for example, a complication of myocardial infarction, myocarditis, endocarditis);
  • damage to the heart during injuries (a strong blow to the region of the heart, wound);
  • pericardial malformations (diverticula, cysts);
  • systemic diseases of the connective tissue (systemic lupus erythematosus, rheumatism, rheumatoid arthritis);
  • metabolic disorders (toxic effect on the pericardium with gout, uremia);
  • hemodynamic disturbances and general edema (lead to the accumulation of liquid contents in the pericardial space).

There is an etiological (pericarditis caused by the action of an infectious agent on the body, aseptic pericarditis and idiopathic pericarditis) classification of pericarditis and clinical and morphological (acute forms and chronic forms).

Exudative or effusion pericarditis is an inflammatory disease of the pericardium, accompanied by an increase in the amount of fluid (up to 200-300 milliliters or more) in the cavity of the heart bag. In some cases, effusion pericarditis can develop after dry pericarditis, in others – already in the early stages of ongoing inflammation. When effusion begins to glow in the pericardial sac, exudative pericarditis develops into a primary disease.

Acute exudative pericarditis is a significant aggravating factor in a key disease, coming to the fore in the clinical picture. Treatment of exudative pericarditis, taking into account its etiology, is carried out in a hospital. The tactics of treatment depend on the volume of fluid in the pericardial cavity. If there is a small amount of fluid, there is no need for therapy.

Fibrinous pericarditis – also known as acute pericarditis, is an infectious or non-infectious inflammation of the leaves of the heart shirt, which is characterized by the deposition of exudate on them. Acute pericarditis is the most common form of inflammation of the heart shirt. Since fibrin is one of the fractions of exudate, fibrinous pericarditis is formally also exudative, but in terms of clinical manifestation and course it differs from effusion and is considered separately.

The main symptoms of acute pericarditis are expressed in the form of chest pain, which can be associated with irritation of the sensitive receptors of the left phrenic nerve, located on a limited area of ​​the parietal pericardium between the fifth and sixth intercostal spaces. This form of the disease is characterized by increased pain during swallowing, on inspiration, as well as with sudden movements. In half of the patients, the pain syndrome is mild or absent.

With the help of a micropreparation with fibrous pericarditis, as a rule, a thickening of the epicardium is revealed, which is partially necrotic. It determines the overlays, which consist of intact polymorphonuclear leukocytes and fibrin strands (Fig. 2). From the myocardium, dystrophic changes in cardiomyocytes and intermuscular edema are noted. The vessels of the heart are full-blooded, dilated.

Constrictive pericarditis (lat. Contsrictio – compression) is a serious complication of pericardial disease, which is quite rare. Constrictive or compressive pericarditis is characterized by fusion and thickening of the leaves of the pericardium (in 52% of cases, their calcification), which lead to the restriction of diastolic filling of the heart chambers, as well as to their compression.

This form of the disease develops due to the formation of a scar capsule with adhesive pericarditis. When the capsule covers the ventricles of the heart and begins to impede their diastolic distension, cardiac output decreases so much that neither high venous pressure in the ventricles nor tachycardia can compensate for its insufficiency. The cause of most constrictive or compressive pericarditis is considered tuberculosis.

The long-term prognosis in the case of the failure of pericardectomy, as well as in some unoperated cases, is generally unfavorable. With the help of surgical treatment, it is possible to provide an additional 10-15 years of life without losing its good quality.

Adhesive pericarditis – also known as adhesive pericarditis, is the result of various forms of pericardial inflammation. In some cases, the transition of the exudative stage of inflammation to the productive one is accompanied by the appearance of adhesions between the parietal leaf of the pericardium and neighboring tissues (liver capsule, pleura, sternum, diaphragm, etc.

), as well as the formation of adhesions between the leaves of the pericardium. Auscultation often reveals a short and sharp systolic tone during systole, located on the phonocardiogram in the mesosystole, or at the beginning of the systole. As a rule, adhesive pericarditis proceeds without hemodynamic disturbances and clinical manifestations.

Traumatic pericarditis is a purulent-putrefactive inflammation of the heart bag, which develops as a result of damage to its foreign body. Mostly, this form of pericarditis is found in cattle, less commonly in sheep and goats. Among the main symptoms of the disease are noted: pain in the heart, remitting type fever, tachycardia, decreased productivity and appetite, tension and enlarged jugular veins, swelling of the lower neck, progressive exhaustion. Treatment consists in removing foreign bodies and prescribing symptomatic therapy.

Dry pericarditis

Dry pericarditis is an inflammation of the pericardium, characterized by the deposition of fibrin strands between its visceral and parietal leaves. The key features of this form of pericarditis are: fever, pain behind the sternum, shortness of breath, weakness, pericardial rub, myalgia. Diagnosis of dry pericarditis is based on ECG, radiography and echocardiography, MRI, CT, laboratory tests and auscultation data.

Purulent pericarditis

Purulent pericarditis is an infectious inflammation of the serous membrane of the heart, which is accompanied by the formation of a purulent effusion in the pericardium. This form of pericarditis occurs with severe symptoms of hemodynamic disturbances (pain in the heart, heart attacks, cyanosis, shortness of breath) and signs of intoxication (heavy sweats, chills, lack of appetite, fever).

The diagnosis of purulent pericarditis is established according to the data of pericardial puncture, echocardiography and X-ray examination. Treatment includes pericardectomy or drainage of the pericardial cavity, as well as antibiotic therapy. In the absence of special treatment, the disease can be fatal due to intoxication and cardiac tamponade. Patients who have had purulent pericarditis have to be monitored by a cardiac surgeon and a cardiologist.

General recommendations for pericarditis regarding the regimen of patients and their diet suggest compliance with certain rules. First of all, patients need to eat a complete and easily digestible food containing a sufficient amount of vitamins and protein. You should cut foods rich in easily fermenting carbohydrates and fiber, as well as salt.

Etiology. As a rule, a secondary lesion occurs with a malignant tumor of the bronchi, mammary gland, and kidneys. Primary pericardial tumors are rare and are usually represented by mesothelioma, the development of which is associated with previous contact with asbestos.

Diagnostics. Metastases can lead to the development of hemorrhagic effusion in the pericardial cavity or cause pronounced compression of the heart with large tumors. Malignant cells are detected in 85% of cases with aspiration of pericardial fluid. To verify the diagnosis, the definition of tumor markers is used – carcinoembryonic antigen, a-fetoprotein and carbohydrate antigens (for example, CA-25).

1. Mode

Treatment of pericarditis with folk remedies

Folk remedies can be used for dry pericarditis of bacterial or viral origin. With exudative or constrictive type, traditional medicine can not cope. Therefore, before starting traditional therapy, it is necessary to consult a doctor to find out the type of disease and the possibility of combining it with medications.

To alleviate the condition, as painkillers and antimicrobials, you can use:

  1. Hazelnut infusion. It is necessary to take 15 walnuts and pour them with 500 ml of alcohol. The mixture is insisted for two weeks and take one teaspoon of the product in a glass of water in the morning and evening after eating.
  2. Infusion of coniferous needles. It is necessary to take 5 tablespoons of young needles of spruce, fir, pine or juniper and pour 500 ml of water. Boil for 10 minutes and leave for 6-8 hours. Then strain the infusion and take 100 ml 3 times a day.
  3. Tincture of cornflower. You need to take one tablespoon of the flowers of the plant and pour 100 ml of alcohol. Insist for two weeks and take 15-20 drops 3 times a day before meals.
  4. Birch infusion. To prepare the remedy, you will need a liter jar filled with two-thirds of the birch earrings. Then all this needs to be filled with alcohol or vodka to cover the plant. The mixture is infused for 10-14 days, after which the medicinal infusion is ready for use. It is taken 30 minutes before a meal, 1 teaspoon 3 times a day.

All of these recipes help reduce chest pain and eliminate shortness of breath.

Exudative-constrictive tuberculous pericarditis

Clinical manifestations. In advanced cases of untreated myxedema, an exudation with a high protein content often occurs. In patients with chronic, asymptomatic effusion pericarditis, accompanied by bradycardia, low voltage of the QRS complexes, a history of radiation exposure to the thyroid gland and its dysfunction, it is necessary to exclude myxedema. Cardiac tamponade is uncharacteristic.

Treatment. The appointment of thyroid hormone replacement therapy leads to the resolution of effusion pericarditis.

Prognosis and prevention

The main complication of acute exudative pericarditis is cardiac tamponade; in 30% of cases, when inflammation spreads to the atrial myocardium, paroxysmal atrial fibrillation or supraventricular tachycardia can occur. The transition of exudative pericarditis to chronic and constrictive is possible. If cardiac tamponade develops, there is a high risk of death. The prognosis of pericardial effusion depends on the cause of the pericardial lesion and the timeliness of treatment; in the absence of cardiac tamponade, it is relatively favorable.

Prevention of exudative pericarditis is the prevention and early etiopathogenetic treatment of those diseases that may lead to its development. In this regard, the issue of prevention of exudative pericarditis is relevant not only for cardiology, but also for rheumatology, pulmonology and phthisiology, oncology, allergology.

There are no special measures to prevent pericarditis because there are many causes of this disease.

The most important thing a person can do is to consult a specialist when the first symptoms appear.

Timely diagnosis and treatment contributes to a quick recovery and helps to avoid serious complications.

  • Timely access to a doctor for pain in the heart, infectious diseases;
  • A balanced diet with the use of foods enriched with vitamins and minerals, as well as the rejection of junk food;
  • Prevention of hypovitaminosis;
  • Prevention of acute respiratory infections of acute respiratory infections;
  • Avoiding hypothermia of the body;
  • Stress avoidance;
  • The use of drugs only after consultation with a doctor, especially of an antibacterial nature.

Preventive measures of pericarditis are composed of several main points:

  • timely treat diseases that may cause subsequent pericarditis (heart attack, rheumatism, tuberculosis, pneumonia, flu, cancer, rheumatoid arthritis);
  • people who are registered with a cardiologist and rheumatologist periodically undergo examinations;
  • lead a healthy lifestyle, follow a diet;
  • try to avoid chest injuries.

Persons who have undergone pericarditis in the future should be regularly observed by a cardiologist, since relapse is possible with this disease.

Summing up, it should be noted that pericarditis is a pathological condition that threatens human life and health. Therefore, if any of the above symptoms are detected, you need to contact a specialist for help. Timely diagnosis and treatment of the disease increases the likelihood of avoiding unpleasant consequences.

Forecast

The prognosis of this disease depends entirely on the severity of the disease. So, with a mild form of a shell-like heart, treatment may not be required or it will only be medication.

Complex forms of pericarditis are not only difficult to treat, but can also threaten the patient’s life.

With timely treatment, the prognosis is quite good. The recovery period takes from 2 weeks to 3 months. Relapse occurs in 15 – 30% of cases. When complications such as heart failure, hyperthermia, and a large amount of fluid accumulate, the prognosis worsens.

The worst prognosis occurs with constrictive pericarditis. Removal of the pericardium with this diagnosis is successful only in 60% of cases.

In order to prevent undesirable consequences and complications of pericarditis, it is necessary to seek the help of a cardiologist in time. With pericarditis, it is very important not to self-medicate, which can only aggravate the situation.

The prognosis of pericarditis is based on its clinical picture, which depends on the phase of the inflammatory process, the degree of sensitization of the tissues of the serous heart membrane, the general reactivity of the body and the nature of the inflammatory process.

The highest percentage of deaths occurs with the development of purulent, hemorrhagic and putrefactive pericarditis. Fears for the patient’s life often arise with constrictive pericarditis, with progressive heart failure. But modern methods of surgical treatment allow in many cases to save the lives of patients even with very severe forms of the disease.

Radial pericarditis

Clinical manifestations of pericarditis can occur during treatment, in the early period after undergoing radiation therapy. But most often, the disease develops a year after radiation exposure. In 50% of cases, cardiac tamponade develops, which requires drainage.

Treatment. Due to the pronounced compression, more than 20% of patients require pericardectomy. Operational mortality is high (21%). Postoperative 5-year survival is very low (1%), mainly due to developing myocardial fibrosis and a marked thickening of the visceral pericardial leaf.

Postcardiotomy syndrome

The clinical picture. The syndrome occurs in approximately 30% of surgical interventions on the heart. It most often develops in patients who received aminocaproic acid during surgery. After a latent period of 2-3 weeks, fever, pericarditis, pleurisy, pneumonitis with a clear tendency to relapse occur.

Treatment. NSAIDs, analgesics such as aspirin, colchicine. Glucocorticoids (both ingestion and intrapericardial administration) quickly cause a decrease in clinical symptoms. Their use should be limited in severe patients, since relapse may develop with the discontinuation of these drugs. Prescribing anticoagulants should be avoided, as there is a risk of developing hemopericardium.

Postinfarction Pericarditis

  1. An early form that develops during the first week in at least 20% of patients with transmural myocardial infarction. As a result of the close location of the necrosis zone to the pericardium, the latter is involved in the inflammatory process.
  2. Late form of pericarditis (autoimmune reaction of a delayed type, Dressler’s syndrome). It develops in terms from two weeks to several months after MI. With the course of this form is very similar to postcardiotomy syndrome.

Treatment. Ibuprofen is believed to improve coronary blood flow and is the most preferred drug. The use of aspirin in a dose of up to 650 mg every 4 hours for 5-6 days is indicated. With relapses of pericarditis, glucocorticoid preparations may be necessary, but their prescribing should be avoided if possible, since they slow down the recovery of the myocardium. The use of anticoagulants should be avoided, as they increase the risk of developing hemopericardium.

Acute rheumatic fever

It accounts for a significant portion of pericarditis worldwide. Almost always, the disease is accompanied by severe pancreatitis and valve damage. The effusion with rheumatic pericarditis is transparent, light straw in color, sterile. Heart tamponade rarely develops, and the accumulated exudate undergoes rapid reabsorption in response to the use of salicylates and glucocorticoid therapy.

Fungal pericarditis

Diagnostics. The clinical picture may resemble that of pericarditis of tuberculous etiology. Therefore, for differential diagnosis, it is necessary to perform staining and culture of the aspirated fluid from the pericardial cavity, as well as a biopsy.

Treatment. For therapy, fluconazole, ketoconazole, ytr-conazole, amphotericin B or amphoteric and a B-lipid complex are used. NSAIDs are used as a symptomatic treatment. Sulfanilamides are the most preferred drugs for detecting Nocardia. The identification of actinomycosis requires the appointment of a combination of three antibiotics, including penicillins.

Amoebic pericarditis

Clinical manifestations. There are two forms of the disease:

  1. Hepatic form: an abscess is located next to the pericardium, there is no rupture of the abscess; clinically – pericardial friction noise, effusion in the pericardial cavity does not contain pus; ECG and X-ray – signs of pericarditis.
  2. Heart form: a liver abscess breaks into the pericardial cavity with the development of purulent pericarditis as a result. Perhaps an acute course with the development of shock and death in a short period of time or a gradual increase in symptoms of cardiac tamponade. Diagnosis is complicated. If the patient reveals purulent pericarditis, signs of heart failure, liver pain on palpation in the epigastric region, the amoeba origin of pericarditis must be suspected. Detection of a fixed and high-standing left dome of the diaphragm during CT or fluoroscopy can also indicate this disease. The final diagnosis is based on performing pericardiocentesis (the resulting liquid is brownish, pus may resemble anchovy sauce) and serological reactions to antibodies against amoeba (immunofluorescence reaction, enzyme-linked immunosorbent assay or gel diffusion method).

Treatment. With the hepatic form, pericardial inflammation is successfully stopped with the resolution of a liver abscess. With a heart form, drainage of the pericardial cavity and the appointment of metronidazole are necessary. A rare complication is the development of constrictive pericarditis.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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