Exudative pericarditis is an inflammation of the outer membranes of the heart, characterized by the formation of a large amount of fluid between them and the deterioration of the heart. Patients with pericardial effusion complain of chest tightness and pain in the heart.
In patients with pericarditis, as the effusion accumulates, shortness of breath appears, when the esophagus is compressed, difficulty swallowing (dysphagia) occurs, and when the phrenic nerve is compressed, hiccups. In almost all cases of exudative pericarditis, there is a fever, the nature of which depends on the underlying disease.
The patient’s appearance is characteristic of exudative pericarditis: the face is puffy, pale cyanotic in color. Veins of the neck in a patient with exudative pericarditis, swollen due to difficulty in the outflow of blood to the heart through the superior vena cava.
In case of compression of the latter, swelling of the face, neck, front surface of the chest (Stokes collar) is expressed. Sometimes in patients with exudative pericarditis, swelling of the cervical veins can be noted only during inspiration. With abundant effusion in the pericardial cavity, patients with pericarditis take a characteristic position:
- sitting on the bed;
- bending forward and putting his hands on a pillow lying on his knees;
- in this position, they feel less difficulty breathing and heaviness in the heart.
When examining the area of the heart in a patient with exudative pericarditis, smoothing of the intercostal spaces can be detected. The apical impulse is not determined, but if it is palpated, then inside from the left border of dullness, sometimes it moves upward.
With percussion of the patient’s heart with exudative pericarditis, a significant increase in cardiac dullness in all directions is determined, with relative and absolute dullness almost merging. The form of dullness is reminiscent of a trapezoid or triangle, the cardio-hepatic angle from a straight line becomes dull.
With a large effusion, the border of dullness in a patient with exudative pericarditis rises to the second intercostal space and, spreading to the left, can reduce the zone of tympanitis of Traube space. Heart sounds with exudative pericarditis are significantly weakened due to the presence of fluid. The pulse is rapid, small, often paradoxical. Blood pressure with exudative pericarditis is normal or low.
Venous pressure is increased. Palpation of the patient’s abdomen with exudative pericarditis results in a significant increase in the liver as a result of stagnation of blood in it. X-ray examination of the patient with exudative pericarditis, reveals an increase in the shadow of the heart across and up; the waist of the heart is absent, the pulsation is sharply weakened, which is especially clearly detected on the X-ray diffraction pattern.
With exudative pericarditis, on the ECG, a low voltage of all the teeth can be noted, as well as changes in the S – T interval and the T wave in all standard leads. Initially, the S – T interval is located above the isoelectric line, and then below it. The T wave is initially smoothed, then becomes negative in all leads.
Changes on the ECG resemble those of a myocardial infarction, but differ from them in that they are detected identically in all leads, that is, concordantly, and there are no changes from the Q wave.
- Features of the disease
- Varieties of exudative pericarditis
- Causes of pericardial effusion
- The clinical picture and symptoms
- Causes of pericarditis in children
- Acute exudative pericarditis
- Chronic exudative pericarditis
- Differential diagnostics
- Additional analyzes
- Treatment by folk methods
Features of the disease
The inflammatory process in the heart with exudative pericarditis captures the heart bag, an increase in which leads to compression of the heart. Severe circulatory disorders lead to a deterioration in the quality of life, and in extreme cases – the death of the patient.
The stages depend on the duration of the disease:
- up to 6 weeks – acute stage;
- from 6 weeks to six months – subacute;
- over six months – a chronic form.
Violation of metabolic processes in the heart leads to the accumulation of fluid in a volume of up to 1-2 liters (normal – 20-30 ml), significantly compressing the nerve endings and adjacent organs. Exudative pericarditis is more dangerous than dry pericarditis, which in some cases can be cured spontaneously, but more favorable than constrictive pericarditis, which forms dense adhesions with mineralization of tissues and prevents healthy heart contraction.
Unlike hemorrhagic and serous-hemorrhagic types, it does not lead to an increase in the number of red blood cells. The diagnosis of exudative pericarditis increases with the diagnosis of cardiac diseases.
Sad data: among the total number of openings, about 5-6% indicates the presence of problems with the pericardium. The detection of these pathologies is lower, which indicates a low proportion of citizens in the presence of the first signs of the disease.
Varieties of exudative pericarditis
Different types of pericardial effusion disease are distinguished, which differ in symptoms, duration of treatment and, in general, clinical picture. We will talk about this later.
The composition of the effusion is divided into the following types of disease:
- serous pericarditis – appears at an early stage of the disease and is characterized by an exudate consisting of water and albumin;
- serous-fibrinous inflammation of the pericardium implies the presence of a large number of fibrinous fibers;
- hemorrhagic inflammation of the pericardium is associated with a malignant lesion or tuberculosis, characterized by a blood content in the exudate;
- purulent pericardium containing a large number of leukocytes and elements of necrotic tissue fibers;
- putrefactive pericardial disease manifests itself after anaerobic microorganisms enter the liquid;
- pericardial cholesterol has a high cholesterol level.
The clinical picture involves the division of exudative disease into the following forms:
- Acute exudative cardiac pericarditis – characterized by a treatment duration of not more than six weeks:
- Fibrinous or dry.
- Exudative or exudative.
- With tamponade.
- No tamponade.
- Subacute exudative pericarditis – lasts from six weeks to six months.
- Chronic inflammation of the pericardium lasts more than six months:
- With impaired functioning of the heart of a functional nature.
- With lime deposits.
- With fusion extrapericardial nature.
Causes of pericardial effusion
Normally, there is a fluid between the leaves of the pericardium, which lubricates and reduces their mutual friction, thus contributing to the smooth and painless work of the heart. When more than 50 ml of fluid accumulates in the pericardial cavity, the normal functioning of the heart is disrupted and hydropericardium develops.
The physiological volumes of pericardial fluid are 30 ml. This condition can trigger a number of reasons of different origin:
- viral diseases (flu, cytomegalovirus, chickenpox, parainfluenza);
- the presence in the body of malignant tumors (tumors of the lungs, chest);
- with radiation damage during radiation;
- injuries in the chest, bruises of the heart and neighboring organs;
- connective tissue disease (systemic lupus erythematosus, rheumatoid arthritis, periarteritis nodosa, scleroderma, dermatomyositis);
- complication of myocardial infarction as Dressler’s syndrome.
The accumulation of fluid in the pericardium takes place against the background of the influence of other pathologies – the ailment itself rarely develops. The development of the disease occurs due to the ingestion of specific viral pathogens and the appearance of infectious diseases. Typhoid fever, smallpox, tuberculosis, tularemia, pneumonia are diseases that negatively affect the pericardium.
Heart surgery similarly increases the risk of disease, other negative factors – a breakthrough in lung abscess, infectious endocarditis, and immunosuppressive therapy.
Radiation injury occurs under the influence of external radiation, and the degree of damage depends on the distance of the focus of radiation. All the reasons can be selected into groups:
Any cancer processes with metastases to the adjacent organs (mammary glands, lungs) provoke cardiac impairment. The process can be caused by injuries of the chest area, extensive myocardial infarction and chronic autoimmune and allergic processes (protective malfunctions – the body begins to damage its own tissues).
Medical studies do not confirm the direct relationship between the course of pregnancy and the development of effusion in the pericardium, however, in the later stages of women, moderate asymptomatic hydropericardium is possible.
It does not cause compression of the heart and passes after childbirth. In children, symptoms appear after acute – streptococcal and meningococcal – inflammatory diseases.
The clinical picture and symptoms
Signs of this heart disease depend on the rate of fluid accumulation (effusion), the severity of compression of the organ and the severity of the ongoing inflammation of the pericardium. Initially, aching pain in the chest area and general weakness are manifested. When the fluid in the pericardium becomes larger, the heart begins to compress, its normal functioning is disrupted.
This causes shortness of breath, a characteristic cough. The face and neck can swell, other signs of heart failure occur. If the fluid in the heart accumulates slowly, the patient’s body tries to adapt to this process. Therefore, a significant amount of effusion, even one liter, may not cause significant severity and pronounced symptoms.
A person sometimes does not even understand what is happening to him, explaining everything by overwork. When the inflammatory process in the heart with the accumulation of fluid proceeds quickly, literally in a couple of hours, the patient’s condition worsens strongly and sharply.
We must not forget about the general symptoms characteristic of the inflammatory process in the pericardium. For example, the infectious form of heart disease is accompanied by chills, fever, including intoxication. The chronic form of tuberculous exudative pericarditis suggests excessive sweating, loss of appetite and, accordingly, the patient’s body weight.
With excessive accumulation of fluid in the pericardium, the patient is recommended to take a sitting position. This is a necessary measure, which will facilitate his well-being. At the same time, experts advise the patient to rest his hands on his knees or the pillow that lies on them.
Crucial is the rate of fluid formation in the pericardial cavity, its amount is a secondary factor. With the slow formation of exudate, relative adaptation occurs, and even its significant volumes (more than 1000 ml) may not cause special complaints and worsening of the patient’s condition.
If there is a rapid accumulation of effusion, it is possible to develop an extremely difficult situation in a few hours. Patient complaints:
- Chest pain, aggravated by swallowing.
- Cough, hoarseness, hiccups (their cause is squeezing an array of fluid in the respiratory tract, diaphragm and nerve trunks).
- Shortness of breath, which with effusion pericarditis sharply intensifies in a supine position, up to suffocation. To reduce it, patients take a characteristic sitting position with the arms resting on the knees or a pillow laid on them.
When examining a patient, the following symptoms are revealed:
- Pallor with a bluish tint on the skin of the face and upper half of the body. At the same time, there is swelling of these areas, swollen veins of the neck.
- A cardiac impulse may not be detected.
- Deafness of heart sounds during auscultation.
- Tachycardia, the appearance of paradoxical pulsation (weakening of the pulse on inspiration) is possible.
- The increase in the boundaries of the liver.
- Radiographically visible expanded heart shadow and the straightening of its arcs, which forms a characteristic picture of a “triangular heart.” With fluoroscopy, a decrease in heart pulsation is noted.
The rapid formation of effusion between the pericardial leaves, even with a small amount (up to 300 ml), can cause the development of a life-threatening condition – tamponade of the heart. There is compression of the heart by the accumulated fluid with a pronounced violation of its motor function (decrease in cardiac output) up to acute heart failure and death.
Signs of cardiac tamponade are a sharp increase in the severity of all symptoms of pericarditis (edema, which can take the character of ascites, shortness of breath), to which a violation of consciousness (excitement or depression, fear of death) is attached. In the future, in the absence of emergency care, loss of consciousness, collapse and death are possible.
Causes of pericarditis in children
The most common cause of this disease in childhood is infections. Among them, the leading position is occupied by influenza viruses, entero- and adenoviruses, as well as infection with staphylococci and streptococci. Less common etiological factors are:
- tuberculosis pathogens,
- cholera and syphilis,
- fungal lesions.
The microorganism can penetrate both from the blood or lymph, and from the lungs, pleura, and heart muscle. Pericarditis of non-infectious origin develops with such pathologies:
- an allergic reaction to serum,
- autoimmune diseases
- blood diseases
- chest injuries due to trauma or surgery,
- renal insufficiency.
In addition, there is pericarditis, which cannot be associated with any known cause. It is called idiopathic.
Acute exudative pericarditis
Often it is the next phase in the development of dry pericarditis, and sometimes it occurs as an independent disease. Characterized by a constant pronounced shortness of breath, independent of physical activity. The patient takes a forced sitting position, leaning forward, resting on his hands. Sometimes it becomes easier for the patient to stand on his knees, clinging to the pillow.
In other cases, the patient is in a forced position lying on his right side with his knees raised to his stomach. After some time, the pain subsides, which is associated with the accumulation of fluid, pushing the inflamed pericardial sheets. Exudation in the pericardial cavity can compress veins flowing into the right atrium.
When the superior vena cava is compressed, the swollen veins of the neck are visible, especially those that increase when inhaled, the swelling and blueness (cyanosis) of the neck and face. If the inferior vena cava is squeezed, an increase and soreness of the liver appear, the abdomen rapidly increases (ascites increases), and swelling on the legs is less likely.
As a result of compression of the surrounding organs, a dry cough, swallowing disorders, hiccups, and vomiting can occur. Patients with an asthenic physique can sometimes see a bulge of the chest in the region of the heart or epigastrium (under the xiphoid process of the sternum). On examination, weakening of the apical impulse is determined.
With percussion, an increase in the zone of cardiac dullness is determined, and it has a different configuration in the position of the patient lying and standing. This is due to the redistribution of fluid under the action of gravity. During auscultation (listening), heart sounds are deaf, sometimes there is a slight noise of pericardial friction. Often there are violations of the heart rhythm. The pulse is frequent, blood pressure is reduced.
In severe cases, fluid compresses the heart, interfering with its work. The rapid accumulation of effusion leads to the development of such a formidable complication as cardiac tamponade. It is accompanied by pronounced shortness of breath up to 40-60 respiratory movements per minute, a sense of fear of death. The neck and face are swollen, cyanotic. The patient is covered with cold sweat.
Marked swelling of the cervical veins, ascites, swelling of the legs, pain in the right hypochondrium as a result of enlarged liver. Blood pressure drops sharply, collapse occurs, the patient loses consciousness. Without treatment, cardiac tamponade is fatal.
The “inflammatory” changes in the blood test are characteristic: an increase in the erythrocyte sedimentation rate, leukocytosis with a shift to the left. In many cases, a puncture of the pericardial cavity and a fluid analysis are performed to clarify the cause of pericarditis. An ECG and chest x-ray are performed. On the ECG, the decrease in the voltage of the teeth is determined.
Radiography significantly changes the shadow of the heart. The main method for diagnosing exudative pericarditis is echocardiography, that is, an ultrasound scan of the heart. Exudative pericarditis can be said with the accumulation of more than 80 ml of fluid in the pericardial cavity. In some cases, a puncture of the pericardial cavity and a study of the pericardial effusion are performed.
Chronic exudative pericarditis
Its symptoms are similar to those in acute exudative pericarditis, but they develop more slowly. Therefore, the general condition of the patient remains unchanged longer. Adhesive pericarditis is characterized by the adhesion of inflamed pericardial sheets to each other. In this case, the leaves of the pericardium remain elastic and extensible. Therefore, the disease proceeds without pronounced local symptoms.
The patient is mainly disturbed by weakness, sweating, shortness of breath, slight fever. There may be changes in the blood test, indicating an inflammatory process. Often undiagnosed adhesive pericarditis in a few years is transformed into constrictive.
Constrictive pericarditis is manifested by compression of the heart. Thickened stubborn pericardial sheets, as well as a constant significant effusion in its cavity, can disturb the mobility of the heart muscle. Sometimes parts of the heart are squeezed by scarred pericardial leaves and adhesions between them.
The patient complains of shortness of breath, pain in the heart, especially when throwing the head back. He is concerned about pain in the right hypochondrium, weakness, rapid heartbeat, interruptions in the work of the heart. Unlike acute exudative pericarditis, the symptoms are persistent, slowly progressing in nature.
On examination, you can notice the forced position of the patient half-sitting. Blue hands, feet (acrocyanosis), cyanosis and swelling of the face, swelling of the cervical veins, expansion of the saphenous vein network of the abdomen, chest, and extremities are noted. Sometimes a protrusion in the region of the heart is determined. Ascites appears (fluid accumulation in the abdominal cavity with an increase in the abdomen). Swelling of the lower extremities is uncharacteristic. They appear only in the late stages of the disease.
When examining the heart, it can be noted that the apical impulse is not determined. The tones are dull, additional tones (clicks) are possible. The pulse is frequent, blood pressure is often reduced. An enlarged dense liver is determined.
On the ECG, a decrease in the voltage of the teeth, a violation of the heart rhythm is noted. When radiography of the chest organs, the heart is most often not enlarged or even reduced in size, calcification of the pericardium is possible. With echocardiography, pericardial fusion is visible. Increased central venous pressure.
When a patient turns to a cardiologist for help, the doctor analyzes the data obtained during the examination of the patient, taking into account his complaints and the medical history, makes a preliminary diagnosis characterizing his state of health.
But for making a final diagnosis, insufficient data are obtained, which must be confirmed instrumentally:
- electrocardiography (ECG). Change in voltage of the ventricular complex.
- Chest x-ray.
- Pericardial puncture with aspiration of fluid and its further laboratory examination.
- Pericardial biopsy.
Exudative pericarditis differentiates with the following nosological units:
- acute myocardial infarction,
- vasogenic pains
- mitral valve prolapse,
- dry pleurisy.
In acute myocardial infarction, the pain syndrome is caused by the accumulation of metabolic products in the heart muscle (myocardium). Pain syndrome in myocardial infarction is accompanied by a number of clinical and laboratory signs that manifest themselves as a violation of central hemodynamics, cardiac arrhythmias, conduction processes in the myocardium, stagnation phenomena in the small circle (pulmonary) blood circulation, changes in ECG indices characteristic of myocardial infarction.
Biochemical analysis for myocardial infarction indicates the activity of cardiac isoenzymes. With dry pleurisy, the fact of the presence of pain and its characteristics associated with breathing, coughing, body position, pleural friction noise during auscultation examination is of great importance, in addition to the above, it should be noted that with dry pleurisy there are no changes on the electrocardiogram film .
The difference between aortic aneurysm and exudative pericarditis is that its cause is a genetic disease – Marfan syndrome or atherosclerotic lesion of its inner membrane. In some cases, chronic pericardial effusion may form.
Symptomatically, an aortic aneurysm manifests itself as follows:
- pain in the upper chest, without any irradiation,
- hoarse voice,
- shortness of breath,
- cough caused by compression of the mediastinum.
Aortic aneurysm is diagnosed with an X-ray examination of the chest cavity, echocardiography, and aortography. With a stratified aortic aneurysm, pains appear suddenly in the chest, tend to irradiate along the aorta.
At the same time, patients are in serious condition, often pulsation on the large artery disappears. During auscultation, aortic valve insufficiency is heard. Diagnostic measures for stratified aortic aneurysm will be:
- transesophageal ultrasound;
- computed tomography of the chest cavity.
In addition, if exudative pericarditis is diagnosed, then pericardiocentesis should be performed (a procedure that has a medical diagnostic character, in which a special needle is punctured with a pericardial sac in order to collect fluid for analysis).
After that, exudate is sown in order to identify a specific type of pathogen of this disease, it is important to determine the analysis of its sensitivity to antibacterial drugs. If it turns out Staphylococcus aureus, then usually prescribe the drug “Vancomycin” with a dosage of one gram intravenously, with an interval every twelve hours, the therapeutic course is from 14 to 21 days.
Sometimes a fungal infection can cause pericardial effusion. The treatment in this case is carried out with Amphotericin. ” The initial dose is 1 mg, it is in a glucose solution with a percentage equal to 5 percent and in the volume of fifty milliliters, administered parenterally (through a vein), dripped for 30 minutes.
If the patient tolerates this drug well, then the dosage regimen is changed according to the following scheme: 02 mg/kg for one hour. In the future, the dose is gradually increased to one and a half or one microgram/day. three or four hours before the onset of a positive effect. A side effect in Amphotericin, which is worth paying attention to, is nephrotoxic, and therefore kidney function monitoring is necessary.
If exudative pericarditis arose as a result of taking medications, then the treatment tactics will be aimed at stopping further use of these drugs and additionally prescribing non-steroidal anti-inflammatory drugs in combination with corticosteroids, which together lead to a quick recovery, especially if they were assigned from the first days of the onset of the disease.
Exudative pericarditis involves treatment in a hospital. The patient is prescribed massive drug therapy. Be sure to include such drugs:
- Glucocorticosteroids, especially if the disease is advanced. In large doses, they are required if anti-shock treatment is needed.
- NSAIDs. The presence or absence of any cardiac problems affects the choice of an anti-inflammatory agent. So, in the presence of ischemia, Aspirin, Diclofenac is used, in other cases – Ibuprofen, Indomethacin.
- Antibiotics if there is an infection.
- Analgesics. Often with the most powerful effect (including narcotic), since pain is very strong.
No folk remedies or other methods of therapy can help cure such a serious pathology. And if they completely replace medications, this will significantly worsen the prognosis of recovery. Be sure to prescribe funds for the treatment of the root cause of the pathological condition, for example, anti-tuberculosis, cytostatic, antibacterial and other drugs.
If the condition is acute, be sure to monitor the heart rate. Sometimes breathing mixtures are also selected to supply the body with oxygen. Surgery may be required to extract the effusion when it continues to accumulate in the heart cavity several weeks after the lack of therapy results.
In such cases, it is evacuated by biopsy. It is also required for the purulent form of pericarditis or tamponade. In a different situation, when the primary, conservative treatment does not give results, pericardectomy is prescribed. It will take a dissection of the chest to remove the abnormal tissue undergoing the inflammatory process.
Complications from such an operation occur only in 10% of cases. Disposal of attacks of pericardial effusion and its treatment is carried out under the supervision of doctors in a hospital. Monitoring includes fixing the dynamics of changes in heart rate, blood pressure, CVP.
The patient observes bed rest and takes a course of medications, which include:
- diuretic drugs;
Physiotherapeutic procedures are not indicated for this disease due to the risk of increased proliferative processes. In the presence of an infectious process, antibiotic therapy is prescribed (antibiotics of the cephalosporin group), including amoxylav or vancomycin. Inefficiency of treatment leads to a change in tactics – antibiotics of the aminoglycoside group are prescribed.
For tuberculosis patients, streptomycin is prescribed with the introduction of therapeutic substances through a catheter (in difficult situations). Fungal lesions require the use of flucytosine and amphotericin in the form of a dropper or intravenous. Mild forms of inflammation are treated with diuretics (furosemide), but the action of diuretics is difficult in the presence of diseases of the urinary system.
After removing the inflammation, non-hormonal drugs – ibuprofen and aspirin are prescribed. The dosage of all funds is determined by the amount of exudate. Respiratory problems will require enrichment of the body with oxygen by taking breathing mixtures (special mixtures of nitrogen and oxygen). Large accumulations of fluid – more than 200-300 ml – will require puncture and removal of effusion.
Evacuation of the fluid is performed by a 2-3 cm puncture with a needle under local anesthesia (novocaine) in certain areas of the sternum. After a puncture, the fluid exits by gravity or is aspirated with a syringe, then the collected fluid is sent for laboratory testing.
Purulent fluid is subject to rehabilitation – the cavity of the bag is washed with an antiseptic solution, and in advanced cases, a permanent catheter can be installed to remove the fluid. Untreated exudative pericarditis becomes chronic (fluid accumulation lasts more than 6 months), corrected exclusively by surgical intervention.
Surgery involves excision of part of the heart sac in areas without nerves and blood vessels. To date, there is no definite and only correct and etiotropic treatment of exudative pericarditis.
Most often in practical medicine, hormone therapy is used:
If there is a suspicion of pericardial effusion, it is always important to verify the actual presence of fluid in the pericardial cavity and exclude cardiomegaly. For this, the usual clinical – rheitheiological examination is supplemented with electrocardiography, radioisotopy or, better, ultrasound scanning of the heart, and then a diagnostic puncture of the pericardium is performed.
The classic puncture site is the angle between the left costal arch and the xiphoid process. Upon receipt from the pericardial cavity of a liquid similar to milk or sour cream and but with a composition corresponding to the chylus, the diagnosis of the chylopericardium becomes reliable.
In the differential and ignostic terms, it should be borne in mind hyoic and cholesterol pericarditis. With cholesterol pericarditis, which sometimes occurs with tuberculosis, cancer, hypertension, arthritis, mitral valve stenosis, atrial septal defect, the fluid has a golden yellow color and contains cholesterol crystals.
Diagnostic puncture is continued as therapeutic and they try to remove the entire chylus from the pericardium. At the same time, there may not be a correspondence between the amount of the chylus in the pericardium, on the one hand, and the patient’s condition and the size of the heart shadow on radiographs, on the other. Sometimes with an asymptomatic course of the disease, 1000-1600 ml of chylus is aspirated from the pericardium.
After aspiration of the chylus, air, oxygen or carbon dioxide (50-300 cm3) can be introduced into the pericardial cavity for diagnostic purposes and then X-rayed. Such pyemopericardiography allows one to more accurately establish the true size of the heart and the degree of thickening of the pericardium, to isolate and better contour the shadow of a heart tumor or pericardium.
After pneumopericardiography, sometimes a splash noise is heard, which disappears as the gas resolves.
Treatment by folk methods
Such treatment methods are recommended only in conjunction with traditional ones, and only after consulting a cardiologist.
- Take 5 tbsp. needles of coniferous trees, pour 0,5 liters of boiling water, hold for a little over low heat. Soak in a closed and wrapped container for another night. Pass through a sieve and consume 100 ml four times a day.
- The same amount of valerian, lemon balm, yarrow and anise fruit mix. Take 1 tbsp. mixture, pour 200 ml of boiling water, stand for half an hour under the l >
Most (about 40%) of people who have undergone pericarditis in the future suffer cardiac tamponade. By this pathological condition is meant the compression of the heart by the accumulated fluid. This can worsen its work so much that tamponade can cause myocardial arrest.
Somewhat less, about 30% of cases of complications are various types of tachycardia and arrhythmias. Especially severe forms of the disease develop in the presence of inflammatory processes in the myocardium.
A complication is a change in the shape of the heart, as well as the appearance of other types of pericarditis. When a heart is squeezed with a large amount of effusion in the pericardium, a life threat occurs due to tamponade of the heart. The surge of blood drops sharply and stagnation in the entire venous network increases.
Characteristic signs of this complication:
- painful shortness of breath;
- fear of death;
- swelling of the face and neck,
- bloated veins on the neck;
- bluish tint of the skin of the nose, lips and ears;
- fluid accumulation in the abdominal cavity;
- weak pulse, low pressure, cold sweat.
In such a situation, an urgent puncture (puncture) of the pericardium is indicated. If it is not done on time, the patient dies. Cardiac tamponade can be at the very beginning of pericarditis with a rupture of the muscle layer of the heart or aorta, surgery, tuberculosis, end-stage renal failure, or a tumor process.
The most common complication of exudative pericarditis is cardiac tamponade, observed in 40% of cases. The fluid accumulated between the leaves of the pericardium presses on the heart, preventing it from contracting normally. In approximately 30% of cases, pericarditis causes supraventricular tachycardia or paroxysmal atrial fibrillation, but this requires that the inflammation spread to the myocardium.
A special case of complication is a change in the type of pericarditis in a chronic or constrictive form. Upon transition to a chronic form, exudative-adhesive pericarditis develops, in which the symptoms of the disease do not completely disappear, but become less acute.
Between the external (parietal) and internal (visceral) sheets of the cardiac shirt, massive adhesions or separate adhesions form. In the most severe case, the pericardial cavity can completely overgrow with commissures, which leads to a constant decrease in cardiac output. In this case, only surgical treatment is possible.
Prospects for therapeutic measures and the patient’s condition. Patients who have undergone surgery or treatment are recommended to limit physical and mental stress, reduce salt intake, and carry out flu vaccination every year. Among the rehabilitation measures, spa treatment, frequent rest and diet are equally distinguished.
Surgical intervention is a danger: mortality during pericardectomy varies from 5 to 12% and depends on the presence of unrecognized myocardial fibrosis before surgery.
Exudative forms without complications demonstrate the positive dynamics of treatment and the patient’s return to normal life. In 30% of cases, with the spread of inflammation to the atrial myocardium, arrhythmia and tachycardia are formed. The general prognosis is moderately unfavorable, especially with a delay in therapeutic treatment.
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