Reasons for the diagnosis and therapy of exudative effusion pericarditis

Pericardial inflammation is accompanied by an accumulation of fluid (exudate) inside the heart sac. Normally, this fluid should be 15-50 ml, and with effusion pericarditis, 500 ml or more can accumulate.

The more effusion in the pericardial cavity, the stronger the heart is compressed and loses its working capacity, up to a complete stop of blood circulation. In the worst case scenario, the patient is more likely to die.

Symptoms of exudative pericarditis: shortness of breath, acrocyanosis, chest pain, tachycardia, swelling of the cervical veins, low blood pressure.

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Acute pericarditis

Acute pericarditis develops against the background of an infectious lesion, and it can also be a complication of such ailments as sepsis, tuberculosis, rheumatism, and others. The inflammatory process covers the outer and inner pericardial sheets. The initial stages of the disease usually pass without additional exudate (dry pericarditis), but subsequently lead to an exudative form.

Symptoms of acute pericarditis: fever, pain in the heart.

If acute pericarditis does not begin to be treated in a timely manner, the process may turn into a chronic form, which is characterized by thickening of the leaves of the pericardium and their further sticking together (“gluing”).

This form of the disease usually occurs as a complication of acute pericarditis, pericardial effusion. It often develops against a background of blood or kidney diseases, tuberculosis, rheumatism or injuries.

With constrictive pericarditis (it is also called squeezing, adhesive), two sheets of a heart bag stick together. This leads to disruption of the normal functioning of the heart. Sometimes in the thickened pericardium, calcium crystals begin to accumulate, liming occurs (a phenomenon known as the “armored heart”).

Symptoms of constrictive pericarditis: a disease for a long time can occur without pain. The patient has swollen veins in the neck, low blood pressure, signs of heart failure (swelling of the legs, ascites).

This form of pericarditis occurs with various injuries of the chest in the heart area (gunshot or stab wound, blunt trauma, etc.).

Symptoms of traumatic pericarditis: various pains in the heart, possibly shortness of breath.

Purulent pericarditis

Acute purulent pericarditis can be a complication of cardiac surgery, as well as traumatic pericarditis. But the most common causes are infections caused primarily by Staphylococcus aureus.

With a purulent form of the disease, purulent exudate quickly accumulates in the cavity of the heart bag.

Symptoms of purulent pericarditis: clear signs of intoxication, chills, fever, shortness of breath, pain in the heart.

This type of pericarditis usually develops against the background of an allergic or infectious process in the body and proceeds in a dry form. Its relapses often occur simultaneously with infectious diseases (ARVI, ARI). During remission does not manifest itself.

Symptoms of non-specific pericarditis: fever, pain in the heart, pericardial friction sounds are heard through a stethoscope.

This type of disease often occurs in children and adolescents (usually against a background of rheumatism). Fibrinous pericarditis (or dry pericarditis) is characterized by the fact that the fluid from the heart sac disappears completely. Without the necessary lubrication, the myocardium during contractions constantly touches the wall of the heart bag, which complicates cardiac work.

Symptoms of fibrinous pericarditis: severe pains stitching, aching or pressing in the area of ​​the heart.

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As we see, despite the variety of clinical forms, there are common symptoms of pericarditis: localization of pain in the heart, shortness of breath.

If these symptoms appear, consult a cardiologist immediately.

Pericarditis treatment

The treatment regimen for pericarditis is selected taking into account the cause of the disease and its clinical and morphological form.

In acute form, bed rest is indicated until the inflammatory process subsides. In the case of a chronic course, the daily regimen is determined by the well-being of the patient. Usually recommended:

  • follow a diet (fractional nutrition, salt restriction);
  • reduce physical activity.

In acute dry (fibrinous) form, symptomatic treatment is usually prescribed, which involves taking:

  • analgesics that relieve pain;
  • anti-inflammatory non-stero >

If an acute exudative form of pericarditis without symptoms of compression of the heart is diagnosed, monitoring of hemodynamic parameters, excluding the development of cardiac tamponade and determining the volume of effusion is mandatory.

Exudative pericarditis resulting from a bacterial infection, like purulent pericarditis, is treated with antibiotics (administered parenterally or via a catheter after drainage of the pericardial cavity). The choice of an antibacterial drug is carried out after determining the sensitivity of the pathogen to specific components.

Treatment of secondary pericarditis involves the use of glucocorticoids, for example, prednisolone. The result is a quick complete resorption of effusion. If the risk of developing cardiac tamponade is obvious (exudate accumulates at a high speed), pericardial puncture is performed.

In the treatment of patients with constrictive pericarditis, who are diagnosed with congestion and compression of the heart, a surgical operation is performed – a resection of scarred areas, adhesions.

The therapy is carried out in stationary conditions under the watchful supervision of specialists. The patient should observe bed rest and take the following drugs:

  • antibiotics;
  • hormonal agents;
  • diuretic drugs;
  • antihistamines

If the pathology is bacterial in nature, then the patient is most often prescribed drugs such as Vancomycin and Amoxiclav. If the therapy was ineffective, then the doctor changes the tactics of treatment, prescribing drugs of other groups.

If pericarditis is of tuberculosis origin, then the patient is prescribed Streptomycin, which is introduced into the body through a catheter. Fungal ailments are treated using Amphotericin or Flucytosine.

With significant fluid accumulations, the patient is punctured, after which the effusion in the pericardial cavity is removed. To do this, under local anesthesia, a two-three-centimeter puncture is performed. The needle is removed and the fluid flows by gravity, after which it is examined in the laboratory.

In the presence of purulent accumulations, the heart bag is washed with an antiseptic, after which a catheter is installed to completely drain the fluid. If the disease becomes chronic, the operation involves excision of the affected tissue.

Without proper treatment, exudative pericarditis can cause large fluid accumulations in the area of ​​the heart muscle, which worsens the work of the organ. Ultimately, this can be fatal. Therefore, if the first symptoms of this disease are found in oneself, the patient should seek qualified help as soon as possible.

Non-pharmacological treatment of pericarditis of the heart (in mild forms) is aimed at the general improvement of the body:

  • Bed rest (if necessary);
  • physical load reduction;
  • restriction of fluid, sodium salts (if necessary).

Pharmacotherapy for heart pericarditis:

  • Antibiotics – for infections;
  • antiviral agents – with the viral nature of the disease;
  • antimycotic drugs – with fungal origin of pericarditis;
  • non-steroidal anti-inflammatory drugs – for pain relief, relieving inflammation;
  • glucocorticoid drugs – also to combat the inflammatory process (according to indications);
  • diuretics – to remove excess fluid (according to indications).

Surgical treatment of pericarditis:

  • Pericardial puncture with fluid evacuation (with a high probability of development of cardiac tamponade, with cardiac tamponade);
  • complete or partial removal of pericardial leaves (with chronic pericarditis, constrictive pericarditis).

Prevention of pericarditis of the heart

Significantly reduces the risk of developing cardiac inflammation, timely diagnosis of pericarditis and treatment of diseases that can involve this organ in the pathological process.

Causes of the disease in adults

Inflammation of the outer heart membrane of tuberculosis and rheumatic etiology usually indicates the presence of an infectious-allergic process. Also, tuberculous damage to the pericardium can be a consequence of the spread of infection from the foci of the lymph nodes or lungs through the lymphatic ducts.

The likelihood of getting pericarditis increases with:

  • bacterial and viral infections (tonsillitis, scarlet fever, measles, flu, tuberculosis);
  • sepsis
  • parasitic and fungal organ damage;
  • endocritis, pleurisy, pneumonia (inflammation can pass from organs located near the heart to the pericardium);
  • allergies to medicines, serum sickness;
  • heart disease (myocarditis, endocarditis, myocardial infarction);
  • malignant neoplasms;
  • systemic pathologies of connective tissue (rheumatoid arthritis, rheumatism, etc.);
  • heart injuries;
  • heart surgery;
  • metabolic disorders;
  • radiation damage;
  • hemodynamic disorders leading to fluid accumulation in the pericardial cavity;
  • pericardial malformations (diverticulums, cysts).

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This disease can develop for a number of reasons:

  1. Against the background of rheumatoid arthritis.
  2. Due to bacterial or viral ailments. These include brucellosis, typhoid fever, tuberculosis, tularemia, smallpox, etc.
  3. If the cancerous tumor that developed in the lung provoked oncological seeding of the pericardium.
  4. Due to perforation of the esophagus.
  5. As a complication of hypothyroidism.
  6. For injuries of the chest, such as bruises, penetrating wounds, squeezing.
  7. As a result of iatrogenic injuries caused by the actions of doctors performing a surgical operation.
  8. With irradiation.
  9. Against the background of pneumonia, as well as severe intoxication of the body.
  10. As a complication of severe myocardial infarction.
  11. Also, the cause of the disease can be viral idiopathic pericarditis.

Despite the fact that exudative pericarditis occurs against the background of any disease, the symptoms of the underlying ailment recede into the background, being suppressed by more pronounced manifestations of the pathological process. Therefore, it is very important for the patient to recognize the changes in his body in time, which will allow him to begin timely treatment.

Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.