Pericarditis - Causes, Symptoms and Treatment .MF .
Pericarditis - an inflammatory disease of the pericardium.Pericardium - a connective outer shell of the heart, which covers it from all sides, is attached to the inner surface of the chest, diaphragm, and partly to the vessels extending from the heart.The outer shell of the heart is designed to perform two main functions: to maintain a certain position in space of the heart and prevent stretching of the heart in the event of sudden volume overload.
pericardium consists of two layers: an inner (serous), closely connected with the heart and the external (fibrous), loosely surrounding the heart.Between these layers is normally up to 20 ml liquid, which serves as a "lubricant" for reducing the frictional forces during motion of the heart.
Causes of pericarditis
Depending on the cause, there the following classification of pericarditis:
• Infectious pericarditis, a viral (Coxsackie virus, Epstein-Barr virus), bacteria (streptococcus, Neisseria), fungal (fungi genus Candida), parasite (Echinococcus, Tox
• Pericarditis associated with systemic autoimmune or connective tissue diseases such as systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma.Pericarditis develops due to damage to the cells of the connective tissue with its own protective cells in the immune system breakdown.
• In the propagation of the inflammatory process with the adjacent areas also may develop pericarditis.This pattern is characteristic of acute myocardial infarction with a large amount of tissue damage or myocarditis.
• Pericarditis can be a complication of diseases associated with severe metabolic disorders, such as renal failure, end-stage, myxedema, Addison's disease.
• Traumatic pericarditis occurs when the injuries or wounds of the chest cavity, as well as a complication of surgical procedures this area.Under
• pericarditis understand tumor infiltration pericardial leaflets tumor cells in the primary neoplasm pericardium, and, more often, with the appearance of metastases in other organs (lung cancer, breast cancer).
Depending on the nature of the flow all pericarditis can be divided into (Figure 1..):
1. Acute pericarditis: • dry or fibrinous;• -c pericardial tamponade heart -without cardiac tamponade.
2. Sub-acute pericarditis: • exudative;• adhesive;• c constrictive cardiac tamponade -without cardiac tamponade.
3. Chronic pericarditis: • exudative;• adhesive;• • constrictive compressing with obzystvleniem ( "stone heart") -with cardiac tamponade -without cardiac tamponade.
Figure 1. Classification of morphological forms of pericarditis.
and - dry (fibrinous) pericarditis;
b, c - pericardial effusion;
g - adhesive (adhesive) pericarditis;
d - constrictive pericarditis
symptoms of pericarditis
Within 6 weeks from the start of pericardial disease called acute .At the forefront complaints of chest pain.The pain is intense, monotonous, almost constant.The pain is most expressed in the heart, increases with movement, deep breathing, can be given in the left arm, neck, in the area of the left shoulder blade.The intensity of pain is somewhat reduced in a sitting position while bending forward, while taking non-steroidal anti-inflammatory drugs, is amplified in the supine position.The emergence or intensification of pain is not related to physical activity, the use of nitrates without effect.These specific symptoms allow to distinguish between ischemic heart disease and pericarditis.In addition to the pain of the patient concerned about a rise in body temperature, may cause arrhythmia, drop in blood pressure and shortness of breath at rest.
During an inflammatory response in the pericardial leaflets falls fibrin (Fig. 1a).The emergence and permanent nature of pain associated with stimulation of the nerve endings of the pericardium fallen fibrin, as well as friction thickened layers of the pericardium in the heart movement.With the deposition of fibrin related to the emergence of a specific symptom - Noise pericardial friction, which is listened only at this stage of pericarditis.
next stage of pericarditis is an accumulation of fluid in the pericardial cavity with the development of exudative pericarditis (Fig. 1b, c).With a slow accumulation of fluid significant hemodynamic changes can not be, while the rapid accumulation of fluid under certain conditions quickly leads to development of cardiac tamponade. tamponade heart - heart compression exudate is threatening complication that threatens the life of the patient.
cardiac tamponade.The arrow shows the fluid in the pericardial cavity
Thus by reducing the filling of the right heart shaped blood stasis in the systemic circulation with an increase in the liver, the appearance of edema of the lower limbs and fluid in the abdominal cavity.Due to the decrease in volume of blood that is ejected from the left ventricle, impaired nutrition of all organs and tissues, particularly brain cells.Cardiac tamponade as a complication of pericarditis, can be suspected with an increase in venous pressure (bulging of the jugular veins, fluid appearance of abdominal pain in the right upper quadrant due to increase in liver) due to the fall of blood, occurrence of palpitations, shortness of breath without wheezing.
Appearance patient with
cardiac tamponade Without treatment, cardiac tamponade results in death of the patient.
Subacute pericarditis diagnosed over a period of 6 weeks to 6 months from the onset of the disease.This chest pain, weakness, fever, shortness of breath are mild.Symptoms depend on the severity of morphological changes of pericardial leaflets.For adhesive pericarditis is characterized by the occurrence of adhesions between the layers of the pericardium, as well as the formation of adhesions between the heart and the wall of the thoracic cavity, as well as with nearby organs (Fig. 1d).Only at a much pronounced adhesions observed symptoms of heart failure associated with impaired heart or location in space, with its lack of mobility.
constrictive pericarditis occurs when the fusion of the big over the outer and inner layer of the pericardium (Fig. 1, etc.).Formed thick armor covering the heart, makes it difficult to fill with blood.The result is a heart disease with blood stasis in the systemic circulation.In a significant expression constrictive pericarditis process can also be complicated by tamponade due to compression of the heart rigid pericardium.
Chronic pericarditis diagnosed with the disease during more than 6 months.It is characterized by morphological changes in the same as in the subacute form.Special attention should be chronic constrictive pericarditis with obezystvleniem , which is also often complicated by cardiac tamponade.
diagnosis of pericarditis
laboratory and instrumental methods are widely used for the diagnosis of pericarditis.
In the analysis of blood observed increase the indicators characterizing the presence of inflammation in the body, such as erythrocyte sedimentation rate, white blood cells, lactate dehydrogenase, C-reactive protein and others.High blood troponin I and creatine kinase MB fraction indicates damaged heart tissue.
Electrocardiography (ECG) to diagnose inflammatory changes in the heart, as well as the presence of fluid in the pericardial cavity.
When radiography of the chest is determined by an increase of the heart during the acute phase, when pericardial effusion due to fluid buildup.
Chest X-ray with pericardial effusion
When compacting pericardial heart shrinks, you may receive obezystvleniya foci. Echocardiography is the gold standard for determining the pericardial effusion and, subsequently, assess the dynamics of the treatment of the disease.In difficult cases, the recommended computed tomography and magnetic resonance imaging heart.
Treatment of pericarditis
For the treatment of pericarditis is widely used non-steroidal anti-inflammatory drugs (indomethacin), in conjunction with colchicine in a specific pattern.In the case of a proven infectious nature of the disease it is recommended antibiotic.Efficacy of treatment is assessed at 2 weeks after initiation of therapy.While improving the state of preparations is gradually canceled.It indicates no effect on the wrong diagnosis of disease or for joining pyogenic complications.
as diagnostic procedures for unclear reasons the formation of exudate, as well as with the purpose of treatment to prevent the development of cardiac tamponade with a large amount of effusion, pericardiocentesis is used (puncture of the pericardial cavity).
Technique of pericardiocentesis
Pericardiocentesis performed only in a hospital.The only contraindication for this manipulation is a dissecting aortic aneurysm.When ultrasound is defined on the body surface point closest to the accumulation zone of exudate.Typically, this is an area of attachment of the cartilage VII ribs to the sternum.After local anesthesia is performed layered puncture tissue and the needle enters the pericardial cavity.After that, the evacuation of a certain quantity of liquid.Then, the needle is removed, superimposed aseptic bandage.For a while the patient is under the supervision of a constant visualization of the pericardial cavity.Preparation of the patient to this manipulation and subsequent rehabilitation is necessary.In the case of severe heart failure due to adhesions or adhesions of the pericardium sheets, surgical removal of adhesions, dissection of adhesions of the pericardium.
forecast pericarditis favorable with adequate treatment.In elderly or debilitated patients may prolonged, relapsing course of disease with the formation of constrictive forms.
therapists Sirotkin EV