Author Ольга Кияница
Pericarditis is an inflammatory process involving the pericardium as a result of a systemic disease or a primary violation of the structure of the pericardium. Most often, such an inflammatory pericardial reaction occurs in response to injury, of an infectious or non-infectious nature.
Pericarditis is classified according to morphological features into five types: (I) fibrinous, (II) serous, (III) purulent, (IV) hemorrhagic, and (V) caseous.
Fibrinous pericarditis is most difficult to diagnose, as it is necessary to obtain macro and micro preparations for making an accurate diagnosis. This is possible when performing histology of a part of a material taken during a pericardial biopsy.
Video: Histopathology Heart--Acute fibrinous pericarditis
Fibrinous pericarditis: description
Fibrinous pericarditis (AF) is an exudative inflammation that occurs against the background of pericardial infiltration with a fibrinous exudate. It consists of filaments of fibrin and leukocytes. Fibrin is an amorphous, eosinophilic network.Leukocytes (mostly neutrophils) are also detected in fibrin deposits and within the pericardial space. Additionally, vascular congestion is characteristic.
A specific feature of fibrinous pericarditis is that inflammatory cells do not penetrate into the myocardium (as occurs in other forms of pericarditis), and, as a result, there is no diffuse ST elevation on the ECG in AF (a classic sign of pericarditis, which is observed during stage I ECG). other types of disease).
Fibrinous pericarditis is also known as pericarditis “with bread and butter” (Bread-and-butter pericarditis), since it is characterized not by a smooth and even surface of the pericardium, but by opacity and granularity, due to which a similarity occurs in two pieces of buttered bread pressed together and then separated.
Morphology: The surface of the pericardium is dry with a coarse granular appearance caused by fibrinous exudate, as seen in this image. Over time, fibrinous exudate may become organized or undergo lysis with a decrease in inflammation. Image credit: Gonzalo de Toro, MD, Puerto Varas, Chile.
Fibrinous pericarditis: causes
fibrinous pericarditis is one of the most common form of acute pericarditis. The most common causes of fibrinous pericarditis:
- Acute myocardial infarction.
- Injury / Surgery.
- Infectious lesion.
- Systemic diseases.
Among oncological disorders, malignant neoplasms of the lungs and mammary gland become the cause of AF more often. They are followed by lymphomas and leukemia. Infiltration of pericardium with non-lymphocytic leukemia occurs even less frequently. In some cases, histopathological examination of the pericardium does not reveal tumor cells, microorganisms and viral inclusions; therefore, the exact etiology of the disease pericardium is not determined.
Video: Fibrinous pericarditis
Symptoms and diagnosis of fibrinous pericarditis
Symptoms that may be associated with pericarditis include:
- Rapid breathing.
- Dry cough.
- Fever and chills.
- Weakness and fatigue.
- Rupture of blood vessels (hemorrhages) on the mucous membrane of the eyes, back, chest, fingers and toes.
- Sense of anxiety.
Acute or dull pain often begins in the front of the chest under the sternum and extends to the left side of the neck, upper abdomen, and can be given to the left shoulder. The pain becomes less intense when the patient sits down or leans forward. Worsening of the condition occurs when the patient lies down, and it can also worsen with a deep breath, which is similar to pleurisy, which often accompanies pericarditis.
With cardiac tamponade, the neck veins become swollen (as if swollen), while the blood pressure drops to very low levels.
During the examination of a patient with suspected AF, the doctor must perform auscultation of the heart. In fibrinous pericarditis, the scraping sound is most often determined ( pericardial friction noise ). This sound arises because the rough surfaces of the pericardium rub against each other.
If necessary, additional studies are appointed to help diagnose pericarditis and its causes:
- Electrocardiography (ECG) - used to distinguish between pericarditis and heart attack.
- X-ray - with pericarditis, a traditional pattern of “water bottle” is seen around the heart. Its presence indicates adequate fluid accumulation.
- Computed tomography (CT) of the chest is performed for a more detailed examination of the organs of the chest cavity.
- Cardiac catheterization is necessary for careful and real-time viewing of chambers and heart valves.
- Pericardiocentesis is done to test the pericardial fluid for viruses, bacteria, fungi, cancer cells, and a tuberculosis pathogen.
Additionally, laboratory tests can be carried out according to the type of complete blood count, determination of LDH and CPK, to measure heart enzymes and to distinguish between heart attack and pericarditis. Also, if bacterial pericarditis is suspected, a bacterial blood test is performed to detect infection.
Patients have acute chest pain, which usually depends on the position. Fever and congestive heart failure are also present. The pericardial friction is initially heard, but it can disappear with sufficient accumulation of serous fluid separating the visceral and parietal layers of the pericardium.
Fibrinous pericarditis: treatment
Since most of the pericarditis is caused by viruses and is cured by natural means, special treatment is not performed to eliminate the disease. In other cases, the nature of the course of the disease must be established, since treatment is different if complications such as cardiac tamponade, symptomatic effusion, purulent or non-purulent pericarditis occur.
It is important to know some features of the treatment of fibrinous pericarditis:
- Traditional antibiotics do not work against viruses. Pericarditis, which has developed due to viruses, usually passes in two weeks or three months. However, medications can be used to reduce inflammation. Non -steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen and aspirin, are most commonly used for this purpose.
- Corticosteroids are used if pericarditis was caused by myocardial infarction or systemic lupus erythematosus.
- Analgesics (painkillers such as aspirin or acetaminophen) can also be prescribed to improve the patient's well-being.
If pericarditis is repeated, it may be necessary to remove all or part of the pericardium. Such an operation is called pericardectomy . In case of constrictive pericarditis adherence, pericardectomy may be necessary to remove congealed blood.
Heart tamponade occurs when fluid collects in the pericardial sac between the heart and the surrounding pericardium. In such cases, emergency medical care is urgently needed, because the heart does not provide the body with the necessary amount of oxygen during tamponade and requires immediate treatment. In the presence of cardiac tamponade, a drainage installation may be required to remove fluid from the pericardium.
Pericardiocentesis is performed in two cases: when it is necessary to perform diagnostic testing or for the purpose of taking fluid.
For most people, home care is enough with rest and medication to relieve pain. A warm water bottle or compress can also help relieve pain. Sitting upright and leaning forward help relieve discomfort. When pericarditis can also be in bed, with the upper part of the bed should be raised to reduce the hard work of the heart. Along with painkillers and antibiotics, if necessary, diuretic preparations can be used to remove excess fluid from the body.
In most cases, the forecast is good. Most people recover from three weeks to several months and do not need additional treatment. It is impossible to prevent the development of pericarditis, but a healthy lifestyle with proper nutrition and exercise will help strengthen the body's immune system and are more likely to fight pathogens.
Video: Pericarditis - Causes, Symptoms, Diagnosis, Treatment, Pathology