Pericarditis – inflammation of the pericardial sac (the outer membrane of the heart, the pericardium) is more often infectious, rheumatic, or post-infarction. Manifested by weakness, constant pain behind the sternum, aggravated by inhalation, cough (dry pericarditis). May occur with sweating fluid between the leaves of the pericardium (pericardial effusion) and accompanied by severe shortness of breath. Exudative pericarditis is dangerous by suppuration and the development of cardiac tamponade (compression of the heart and blood vessels by the accumulated fluid) and may require emergency surgical intervention.
Pericarditis can manifest itself as a symptom of a disease (systemic, infectious or cardiac), is a complication of various pathologies of internal organs or injuries. Sometimes in the clinical picture of the disease, it is pericarditis that becomes of paramount importance, while other manifestations of the disease go by the wayside. Pericarditis is not always diagnosed during the patient’s life, in about 3-6% of cases, signs of previously transferred pericarditis are determined only by autopsy. Pericarditis is observed at any age, but is more common among adults and the elderly, and the incidence of pericarditis in women is higher than in men.
- Pericarditis treatment
- 1. Mode
- Therapy of acute pericarditis
- Treatment of secondary pericarditis
- Causes of Pericarditis
- Acute pericarditis
- Chronic pericarditis
- Pericarditis – Symptoms
- Dry pericarditis
- Pericardial effusion
- Diagnosis of pericarditis
- Prevention of pericarditis
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.
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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.
Therapy of acute pericarditis
The method of treatment of pericarditis is chosen by the doctor depending on the clinical and morphological form and cause of the disease. A patient with acute pericarditis is shown bed rest before the activity subsides. In the case of chronic pericarditis, the regimen is determined by the patient’s condition (restriction of physical activity, diet: high-grade, fractional, with limited salt intake).
In acute fibrinous (dry) pericarditis, mainly symptomatic treatment is prescribed: non-steroidal anti-inflammatory drugs (acetylsalicylic acid, indomethacin, ibuprofen, etc.), analgesics to relieve severe pain, drugs that normalize metabolic processes in the heart muscle, potassium preparations.
Treatment of acute exudative pericarditis without signs of compression of the heart, basically, is similar to that with dry pericarditis. At the same time, regular strict monitoring of the main hemodynamic parameters (blood pressure, CVP, heart rate, cardiac and stroke indices, etc.), the volume of effusion, and signs of the development of acute cardiac tamponade are required.
If exudative pericarditis has developed against a background of bacterial infection, or in cases of purulent pericarditis, antibiotics are used (parenterally and locally – through a catheter after drainage of the pericardial cavity). Antibiotics are prescribed taking into account the sensitivity of the identified pathogen. With the tuberculosis genesis of pericarditis, 2–3 anti-TB drugs are used for 6–8 months. Drainage is also used to introduce cytostatic agents into the pericardial cavity in case of tumor damage to the pericardium; for aspiration of blood and the introduction of fibrinolytic drugs for hemopericardium.
Treatment of secondary pericarditis
The use of glucocorticoids (prednisone) contributes to a more rapid and complete absorption of effusion, especially with allergic pericarditis and developing connective tissue diseases against the background. is included in the treatment of the underlying disease (systemic lupus erythematosus, acute rheumatic fever, juvenile rheumatoid arthritis).
With a rapid increase in the accumulation of exudate (threatened cardiac tamponade), pericardial puncture (pericardiocentesis) is performed to remove the effusion. Pericardial puncture is also used for prolonged resorption of the effusion (during treatment for more than 2 weeks) to identify its nature and nature (tumor, tuberculosis, fungal, etc.).
Patients with constrictive pericarditis in case of chronic venous stasis and cardiac compression perform pericardial surgery: resection of cicatricial sections of the pericardium and adhesions (subtotal pericardectomy).
The therapeutic effect exerted in the course of basic therapy is reduced to the treatment of symptomatic manifestations of pericarditis. The main goal is the removal of seizures and other external signs of pathology, while treatment of the causes of the development of the inflammatory process is not carried out. The course of basic therapy with medical means (drugs) and substances is a classic way of treatment. When implementing it, use:
- acetylsalicylic acid;
- non-selective inhibitors: diclofenac, ibuprofen, indomethacin and derivatives of the active substances of these drugs;
- selective inhibitors: lornoxicam (in tablet form and in the form of injections), meloxicam and celecoxib, as well as derivatives of the active substances of these drugs;
- analgesics (painkillers): tramadol, pantazocine and morphine, derivatives of the active substances of these drugs.
A medical course of basic therapy is usually used in the treatment of idiopathic (occurring on their own) forms of the disease, as well as in cases where the cause of the pathology has not been established.
All patients suffering from pericarditis and undergoing drug therapy in the form of tablets need protection of the gastrointestinal tract. Acute manifestations of the pathology are treated using colchicine, which is also an effective prophylactic for the development of a relapse of the disease. This drug is well tolerated by the human body and to the least extent demonstrates its side effects.
Most often, acetylsalicylic acid, aspirin, is used in the course of basic drug therapy. This drug, acting on platelets, lowers clotting and increases pericardial effusion. Such drugs as ibuprofen (indomethacin and diclofenac) are recommended for use after meals: they contain enzymes that affect the inflammatory process, and can provoke gastritis or the development of stomach ulcers.
All selective inhibitors used for treatment in the form of tablets have the least effect on the gastric mucosa and are recommended for patients suffering from peptic ulcer disease and other digestive organs pathologies.
Analgesics are used to relieve the pain experienced by the patient. Pain medications that are used to treat pericarditis can be addictive, so their appointment and administration are strictly controlled by a medical specialist. The dose of the drug and the method of its introduction into the body is selected by the doctor, taking into account the characteristics of the development of the disease and the condition of the patient’s body.
In the absence of cardiac tamponade and moderate effusion, the patient is recommended to take the drug Furosemide, which helps to naturally remove fluid from the patient’s body, as well as the absorption of effusion from the pericardium. The course of treatment with this drug, as a rule, does not exceed a week, after which the dose is reduced and minimized.
Glucocorticosteroid drugs are hormonal drugs that have an anti-inflammatory effect. In most cases, prednisolone, as well as its derivatives, decortin, prednol, and metipred, are used to relieve inflammation. The systematic use of corticosteroid drugs should be strictly limited to patients with connective tissue pathologies, as well as the autoreactive or uremic nature of pericarditis. Moreover, the administration of glucocorticosteroid drugs directly to the pericardial region is highly effective.
Therapy of pericarditis, developing as a result of an infectious lesion, is carried out only in the conditions of inpatient treatment and observation of the patient. With this form of the disease, almost all drugs are administered intravenously into the patient’s body, which requires certain skills for medical personnel, this method of systematic administration of drugs and substances is not recommended in outpatient settings.
Vancomycin, amoxiclav and benzylpenicillin are used to treat the infectious form. These drugs belong to the group of antibiotics, the action of which may cause an allergic reaction. Also, as a result of the use of such drugs, side effects can be observed. Other antimicrobial drugs are often used, the choice of which depends on the characteristics of the development of pathology.
For the treatment of pericarditis, the cause of which was a fungal infection of the patient’s body, flucytosine and amphotericin are most often used. These drugs are administered intravenously, and the course of their use is designed for several weeks. The dosage is determined by a specialist and depends on the stage of development of the pathology and the general condition of the patient’s body. The fungal form of pericarditis sometimes disappears on its own, without the use of medications.
Pericarditis caused by tuberculous lesions of the patient’s body is treated with drugs selected depending on the form, stage of development and characteristics of the underlying disease. The patient, as a rule, is placed in specialized medical institutions, and the duration of the therapeutic effect may take several months. For the treatment of the tuberculous form of pathology, rifampicin, isoniazid and pyrazinamide are used.
Therapy of viral pericarditis presents certain difficulties and is realized only in the conditions of in-patient observation of a patient. During treatment, the focus is on the course of basic therapy with medications, this avoids the development of complications. There are no specific recommendations for taking medications. The course and characteristics of treatment are determined depending on the causative agent of the disease and its susceptibility to the active substance of the drug.
Causes of Pericarditis
Pericardial inflammation can be infectious and non-infectious (aseptic). The most common causes of pericarditis are rheumatism and tuberculosis. With rheumatism, pericarditis is usually accompanied by damage to other layers of the heart: endocardium and myocardium. Pericarditis of rheumatic and in most cases of tuberculous etiology is a manifestation of an infectious-allergic process. Sometimes tuberculous lesion of the pericardium occurs when the infection migrates through the lymphatic ducts from the foci in the lungs and lymph nodes.
The risk of developing pericarditis increases in the following conditions:
- infections – viral (influenza, measles) and bacterial (tuberculosis, scarlet fever, tonsillitis), sepsis, fungal or parasitic lesions. Sometimes the inflammatory process goes from organs adjacent to the heart to the pericardium with pneumonia, pleurisy, endocarditis (lymphogenous or hematogenous)
- allergic diseases (serum sickness, drug allergy)
- systemic diseases of the connective tissue (systemic lupus erythematosus, rheumatism, rheumatoid arthritis, etc.)
- heart disease (as a complication of myocardial infarction, endocarditis and myocarditis)
- heart damage due to injuries (wound, strong blow to the heart), operations
- metabolic disorders (toxic effect on the pericardium with uremia, gout), radiation damage
- pericardial malformations (cysts, diverticulums)
- general edema and hemodynamic disturbances (lead to the accumulation of liquid contents in the pericardial space)
Proven is the fact that pericarditis is very common. They are found in almost six percent of all autopsies.
Symptoms and treatment of pericarditis depend on the reasons why it arose.
Disease groups by origin:
Gogin classification of causes:
- bacterial, caused by microorganisms such as legionella, staphylococci, salmonella, streptococci, meningococci, pneumococci;
- rheumatic fever due to streptococcal infection;
- viral, including in combination with infection with influenza, HIV, hepatitis, Coxsackie, mumps, rubella, chickenpox;
- specific for a number of infectious diseases, for example: typhoid, cholera, brucellosis;
- non-infectious, caused by an allergy to drugs, as a response to conditions associated with a distorted immune response of the body, trauma, systemic diseases, hemodialysis, metabolic disorders, for example, uremia, oncology;
- idiopathic, with unknown etiology.
Pericarditis is divided into acute, which are resolved 6 weeks from the debut:
- Catarrhal – associated with the onset of inflammation of the mucous membranes;
- dry (fibrinous) – an inflammatory effusion appears, adhesions form between the layers of the pericardium, preventing the body from working effectively;
- effusion (exudative) without tamponade of the heart or with it. An accumulation of fluid forms in the structures of the organ, which changes its hemodynamics. There is a separation of the leaves of the pericardium. If there is blood in it, a hemorrhagic type of disease occurs.
Subacute pericarditis, the outcome of which occurs in the period from 6 weeks to six months:
- exudative – there is an accumulation of fluid in the pericardium;
- adhesive – the membranes of the heart undergo an adhesive process;
- constrictive without or with cardiac tamponade – as a result, the ventricles do not change their size, but the atria increase. In some cases, scar tissue deforms the entire pericardium, calcium deposits may be present that draw the organ into the so-called “carapace”.
Pericarditis can take the form of chronic inflammation, lasting more than six months from the start. It is characterized by all the same stages as described above.
The main complaint of patients in the acute period is intense pain behind the sternum, extending to the left shoulder blade, arm or neck. Suffering is somewhat reduced when taking NSAIDs or in a sitting position of a person with an inclination forward, amplification is noted lying on your back. In some cases, the temperature increases, shortness of breath, palpitations occur, and pressure decreases.
Conducted and echocardiography is shown. It helps to determine:
- organ boundaries;
- degree of increase in pericardium;
- change in the right structures;
- exudative volume;
- the presence of effusion.
When radiographs pay attention to the shadows of the heart. In some cases, an MRI, CT scan is prescribed.
Important assessment of noise during auscultation. They can be different depending on the stage of the pathology:
- ternary. The first is formed by cardiac contraction, the second by systole, the third by rapid relaxation in diastole.
When diagnosed, laboratory blood counts also change. The following are noted:
- expressed ESR;
- the presence of C-reactive protein;
- an increase in troponin with viral and causeless pericarditis;
- the presence of positive blood culture with infectious inflammation of the heart.
With inflammation of the cavity, urine tests for creatinine and urea are mandatory. Their presence indicates the development of uremic acute pericarditis.
Pericarditis is called a chameleon because of the variability of its symptoms, due to which it is often mistaken for other diseases. When diagnosing pay attention to ECG data, the characteristic noise of friction, pain.
Differentiation of dry pericarditis should be carried out with such conditions:
- a heart attack with complaints of pain in the heart, epistenocarditis pericarditis;
- changes in the lungs when coughing, shortness of breath;
- chest injuries with retrosternal pain radiating to different parts of the body;
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Exudative diagnosis requires differentiation with:
The conditions for the treatment of pericarditis are physiological rest, diet, conscientious use of tablets. With a viral, idiopathic nature, the main goal is to minimize inflammation, relieve pain. With other causes of the formation, drug treatment of the pathogen and previous condition pericarditis.
Outpatient treatment protocol:
Inpatient treatment is necessary in such cases:
- large-scale pericardial effusion;
- pericardial injury;
- low effectiveness of NSAIDs;
NSAIDs (often aspirin, less often ibuprofen) are indicated in large doses immediately after hospitalization and are used until the temperature normalizes. With effusion, beta-blockers and other agents that change heart rate are not prescribed.
Surgical intervention is a treatment technique in cases of cardiac tamponade, purulent or neoplastic pericarditis, as well as with a large effusion. The pericardium is drained, a catheter is inserted into its structure.
Patients with a history of pericarditis should be registered, they are shown periodic sanatorium-resort treatment.
As with any heart disease, prevention is very important in this case. You should not even take lightly routine operations such as tooth extraction or pathologies such as SARS. Any of them can cause a heart complication.
If you experience suspicious symptoms, especially in the presence of chronic conditions, combined with fever, you should seek medical help.
Of heart diseases, hearing infarctions, ischemic disease, deposition of cholesterol plaques in blood vessels and other chronic diseases that develop in humans over the years are heard.
Inflammatory processes are characteristic of this organ to a lesser extent, because the chest is absolutely sterile, the penetration of infection into any part of the heart is a force majeure circumstance. However, there are inflammatory pathogens, and they can occur urgently.
That is why it is recommended to know the symptoms of pericarditis – inflammation of the pericardial sac.
The heart has very good protection. The chest and ribs protect against accidental injuries and injuries; the organ itself is located very deep in the sternum.
Nature provides for the protection of the heart muscle with the help of external connective tissue, called a heart bag or in Latin Pericardium.
This is the “bag”, very dense and reliable, which protects the heart from displacement and damage, prevents overload during operation.
The “bag” in which the heart is placed is double. It consists directly of the pericardium – the inner “capacity” and the outer layer, called the visceral leaf. Between them, a serous fluid is produced, which lubricates the layers so that the connective tissue does not wear out prematurely and is not damaged by a constant contraction of the heart muscles.
Inflammation begins with the formation of even more serous fluid, which often includes pus. Symptoms of pericarditis are manifested brightly, may be similar to other heart diseases – including heart attack.
This condition can be acute or chronic, the latter is more common. The disease involves active therapy.
There are primary and secondary forms of the disease. Primary means that the disease developed independently, without any prerequisites. Secondaries are more common, they suggest that a source of infection or autoimmune problems existed earlier, and then the lesion spread to the pericardium.
The main danger associated with pericarditis is the accumulation of effusion – serous fluid, which normally should be no more than 10-30 ml. If the fluid continues to accumulate, this interferes with the outflow of blood, resulting in the most dangerous complication – cardiac tamponade.
Risk factors for this complication:
- acute course of the disease;
- rapid accumulation of effusion;
- extensive spread of effusion without localization in one place.
An increase in the amount of fluid to 100-150 ml between the leaves of the pericardium in 70-80% of cases causes this serious complication. If the tamponade captures a large area of the heart sac, a shock state occurs, ending in death without treatment.
There are primary and secondary pericarditis (as a complication of diseases of the myocardium, lungs and other internal organs). Pericarditis can be limited (at the base of the heart), partial, or capture the entire serous membrane (general spilled).
Acute and chronic pericarditis are distinguished depending on the clinical features.
Acute pericarditis develops quickly, lasts no more than 6 months and includes:
1. Dry or fibrinous – the result of increased blood supply to the serous membrane of the heart with sweating in the pericardial cavity of fibrin; liquid exudate is present in small quantities.
2. Exudative or exudative – the allocation and accumulation of liquid or semi-liquid exudate in the cavity between the parietal and visceral pericardial sheets. Exudate exudate can be of a different nature:
- serous-fibrinous (a mixture of liquid and plastic exudate, in small quantities can completely dissolve)
- hemorrhagic (bloody exudate) with tuberculous and scurvy inflammation of the pericardium.
- with cardiac tamponade – accumulation of excess fluid in the pericardial cavity can cause an increase in pressure in the pericardial fissure and impaired normal functioning of the heart
- no tamponade
The formed elements of the blood (leukocytes, lymphocytes, erythrocytes, etc.) in different amounts are necessarily present in the exudate in each case of pericarditis.
Chronic pericarditis develops slowly, more than 6 months and are divided into:
1. Exudative or exudative.
2. Adhesive (adhesive) – represents the residual effects of pericarditis of various etiologies. With the transition of the inflammatory process from the exudative stage to the productive in the pericardial cavity, granulation and then scar tissue forms, the pericardial sheets stick together to form adhesions between themselves, or with adjacent tissues (diaphragm, pleura, sternum):
- asymptomatic (without persistent circulatory disorders)
- with functional disorders of the heart
- with deposition in the altered pericardium of calcium salts (“armored” heart “)
- with extracardial fusion (pericardial and pleurocardial)
- constrictive – with the germination of pericardial leaves by fibrous tissue and their calcification. As a result of pericardial compaction, there is a limited filling of the heart chambers with blood during diastole and venous stasis develops.
- with dissemination along the pericardium of inflammatory granulomas (pearl mussel), for example, with tuberculous pericarditis
Non-inflammatory pericarditis is also found:
- Hydropericardium is an accumulation of serous fluid in the pericardial cavity in diseases that are complicated by chronic heart failure.
- Hemopericardium – accumulation of blood in the pericardial space as a result of rupture of aneurysm, wound of the heart.
- Chylopericardium is an accumulation of chylous lymph in the pericardial cavity.
- Pneumopericardium – the presence of gases or air in the pericardial cavity when injuring the chest and pericardium.
- Exudation with myxedema, uremia, gout.
In the pericardium, various neoplasms can occur:
- Primary tumors: benign – fibromas, teratomas, angiomas and malignant – sarcomas, mesotheliomas.
- Secondary – damage to the pericardium as a result of the spread of metastases of a malignant tumor from other organs (lungs, breast, esophagus, etc.).
- Paraneoplastic syndrome is a pericardial lesion that occurs when a malignant tumor affects the body as a whole.
Cysts (pericardial, coelomic) are a rare pathology of the pericardium. Their wall is represented by fibrous tissue and, like the pericardium, is lined with mesothelium. Pericardial cysts can be congenital and acquired (a consequence of pericarditis). Pericardial cysts are constant in volume and progressive.
Pericarditis – Symptoms
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).
- 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).
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 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.
Exudative (effusion) pericarditis develops as a result of dry pericarditis or on its own 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. The appearance of the patients is characterized by a swollen face, neck, front surface of the chest, swelling of the veins of the neck (“Stokes collar”), and pale skin with cyanosis. On examination, smoothing of the intercostal spaces is noted.
Complications of pericarditis are:
- Cardiac tamponade – compression of the heart;
- Myocarditis, endocarditis;
- Heart failure;
- Myocardial infarction;
- Thrombosis and thromboembolic complications;
In the case of exudative pericarditis, the development of acute cardiac tamponade is possible, in the case of constrictive pericarditis, the occurrence of circulatory failure: exudate compression of the hollow and hepatic veins, the right atrium, which complicates ventricular diastole; development of false cirrhosis of the liver.
Pericarditis causes inflammatory and degenerative changes in the adjacent layers of the myocardium (myopericarditis). Due to the development of scar tissue, myocardial fusion with nearby organs, the chest and the spine (mediastino-pericarditis) is observed.
Diagnosis of pericarditis
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);
- 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.
It is very important to diagnose pericardial inflammation in a timely manner, since it can pose a threat to the patient’s life. Such cases include compressive pericarditis, pericardial effusion with acute cardiac tamponade, purulent and tumor pericarditis. It is necessary to differentiate the diagnosis with other diseases, mainly with acute myocardial infarction and acute myocarditis, to identify the cause of pericarditis. Diagnosis of pericarditis includes collecting an anamnesis, examining a patient (listening to and tapping the heart), and conducting laboratory tests.
- Analyzes. General, immunological and biochemical (total protein, protein fractions, sialic acids, creatine kinase, fibrinogen, seromucoid, CRP, urea, LE cells) blood tests are performed to clarify the cause and nature of pericarditis.
- Electrocardiography ECG is of great importance in the diagnosis of acute dry pericarditis, the initial stage of exudative pericarditis and adhesive pericarditis (when compressing the cavities of the heart). In the case of exudative and chronic inflammation of the pericardium, a decrease in the electrical activity of the myocardium is observed. FKG (phonocardiography) notes systolic and diastolic murmurs that are not associated with the functional heart cycle, and periodically occurring high-frequency fluctuations.
- Radiation diagnostics. X-ray of the lungs is informative for the diagnosis of exudative pericarditis (there is an increase in size and a change in the silhouette of the heart: a spherical shadow is characteristic of an acute process, triangular for a chronic one). With the accumulation of up to 250 ml of exudate in the pericardial cavity, the size of the heart shadow does not change. A weakened pulsation of the contour of the shadow of the heart is noted. The shadow of the heart is poorly distinguishable behind the shadow of the pericardial sac filled with exudate. With constrictive pericarditis, fuzzy contours of the heart are visible due to pleuropericardial adhesions. A large number of adhesions can cause a “motionless” heart, which does not change the shape and position during breathing and changing body position. With a “shell” heart, calcareous deposits in the pericardium are noted. CT of the chest, MRI and MSCT of the heart diagnoses thickening and calcification of the pericardium.
- Echocardiography. Echocardiography is the main method for the diagnosis of pericarditis, which reveals the presence of even a small amount of liquid exudate (
15 ml) in the pericardial cavity, a change in heart movements, the presence of adhesions, thickening of the leaves of the pericardium.
CT OGK. Exudative pericarditis. A significant amount of fluid in the pericardial cavity.
Prevention of pericarditis
The prognosis in most cases is favorable, with the right treatment started in a timely manner, the patients’ working ability is restored almost completely. In the case of purulent pericarditis in the absence of urgent medical measures, the disease can be life threatening. Adhesive (adhesive) pericarditis leaves persistent changes, because surgery is not effective enough.
Only secondary prophylaxis of pericarditis is possible, which consists of clinical supervision by a cardiologist, rheumatologist, regular monitoring of electrocardiography and echocardiography, rehabilitation of foci of chronic infection, a healthy lifestyle, moderate physical activity.
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