Author Ольга Кияница
Pericarditis (PC) is an inflammation that affects the pericardium, consisting of two leaves, visceral and parietal. Under the influence of this or that etiological factor of influence, an exudate may accumulate in the pericardium or a fibrous pericardial lesion. This leads to the fact that the physiological possibilities of the myocardium are violated.
In the normal state of the pericardium, a small amount of fluid, which is a plasma ultrafiltrate, is detected. Its role is to reduce the friction between the leaves, which occurs at each contraction of the heart.
During the development of the disease, the volume of fluid in the pericardial bag increases, its composition changes, due to which the pressure on the heart first appears, and later adhesions are formed. On the background of pathological changes, a characteristic clinic appears. In severe cases, the disease is complicated by heart failure, which is why it is extremely important to consult a doctor in a timely manner and undergo treatment.
Differentiate the etiological and clinical classification of pericarditis. According to them, a final diagnostic conclusion is drawn up, respectively, which is subsequently prescribed treatment.
Etiological classification according to Gogin E. E. from 1979:
- Infectious PCs - are divided into bacterial, viral, tuberculous, rheumatic, rickettsia, fungal and caused by the simplest.
- Aseptic PCs - develop on the background of allergic, traumatic etiologic factors. Also, pericarditis is often associated with hypovitaminosis C, metabolic disorders, postinfarction states, malignant tumor processes, connective tissue diseases, or hemorrhagic diatheses.
- Unidentified PCs (idiopathic).
Clinical classification represented by Volynsky Z. M .:
- Acute pericarditis - proceeds in the form of exudative, dry, without tamponade or with tamponade of the heart. Exudative is sero-fibrinous, cholesterol, rotten, purulent and hemorrhagic.
- Chronic pericarditis - may develop with effusion, in the form of constrictive pericarditis, with functional cardiac disorders or with deposits of calcareous formations (then the muscular heart develops). Also isolated asymptomatic and adhesive chronic PCs.
There is a classification of Valigur J. S. from 1978, according to which the PC can be exudative compressing the chronic course, scarring, chronic flow and calcifications, when the armpit heart is determined.
There are many different reasons why pericarditis may occur. Some of them are associated with infectious factors of exposure, others are separate somatic pathologies, on the background of which developed pericarditis. In most cases, a violation of the heart or other organs results in inflammation of the pericardial leaves.
Pericardium is a hemorrhagic bag in which the vital organ is reduced. In a similar anatomical formation there is a special liquid - pericardial, which is formed by ultrafiltration of the plasma. The volume of this liquid is small - from 5 to 30 ml, but its function of "lubrication" is extremely important, because the heart can work with minimal friction on the pericardium leaf. If the amount of pericardial fluid increases or its composition changes, then the work of the entire system is broken.
Video The structure of the pericardium
The mechanism of pericarditis formation is as follows:
- Exudative pericarditis is associated with prolateing more fluid in the pericardial bag.
- In the pericardium, the pressure increases, due to which the heart begins to decrease less intensively.
- In most cases, a violation of heart relaxation in the diastole occurs, which leads to a disorder of diastolic function.
- The compensatory mechanisms are triggered in the form of a rapid heartbeat, which allows a person to first feel himself within the normal range.
- Prolonged course of pericardium contributes to cardiac failure.
With a relatively favorable flow of PCs, when the effluent was small, the exudate from the ocher-bag bag itself dissapears. On pericardial leaves there are protein inclusions, from which further adhesions are formed. The more such pathological formations, the more difficult it will be for the heart to perform its contractile function.
In severe cases, when the process of formation of pericardial exudate passes very fast and its amount is very large, tamponade of the heart develops. Such a complication causes the cessation of cardiac activity due to the strong depression of the myocardium in the diastole, which causes the cardiac muscle not to spread and ceases to work.
Kinds / photos
In the above classifications, there are many types of pericarditis, but the most common are:
- sharp PC;
- constriction PC;
- dry PC;
- Expiratory PC;
Separately, it's worth considering pericarditis in children, because there are features of its course and manifestations of the clinic.
There are many diseases that contribute to the appearance of acute PCs, but most often pericardial infections are common in myocardial infarction, viral and infectious processes, rheumatoid arthritis, allergies, renal failure.
Diagnosis of the disease is not easy, since the etiologic factors and the clinic are quite variable. Most often pathological process is acute, therefore it is extremely important not to allow development of tamponade. If the fluid has accumulated in large quantities, then pericardiocentesis, that is, a puncture of the myocardium. The treatment is mainly carried out by etiology, and, if necessary, glucocorticosteroids are injected into the pericardium.
Also known as fibrinous PC. It develops as a result of violation of the permeability of the vascular wall, due to which fibrinogen penetrates the pericardial cavity. One of his abilities is to fall precipitate, resulting in fibrin accumulating on the pericardium leaves. With its participation inflammatory infiltrates are formed, which promotes the development of the appropriate clinic.
The disease may have a favorable flow, unless the patient has timely turned to the doctor and has undergone appropriate treatment in full. Otherwise it is possible to develop complications in the form of exudative pericarditis, the course of which is much more complex and dangerous to health.
Also known as a squeezing PC. On the background of chronic inflammation of the pericardium, joints are formed, the pericardium itself thickens, sometimes it appears calcinatis and large scars. Cardiac activity is disturbed, in severe cases, the heart muscle deeply affects. The development of this type of PC is often associated with severe infections, uremia, scurvy, heart trauma, purulent inflammation.
In the clinical course, the constriction PC is often like heart failure, as well as edema, sometimes reaching the ascites, develops. The patient can not exercise physically because the heart is not able to contract normally. This kind of PC is treated operatively, because due to serious changes in the structure of the pericardium, conservative treatment is useless.
Can develop on the background of various diseases: infectious, allergic, viral. Often there is a connection with rheumatism, tuberculosis, streptococcal and staphylococcal infections. Pushkin, blood or transudates can be defined as effusion. The leaves under the pressure of the exudate are stretched, the pressure on the heart increases, which begins to decrease less intensively.
The clinical picture in many respects depends on the volume of the accumulated exudate. Some patients complain of severe weakness, often with a paroxysmal nature. Treatment is compulsory, as there is a high risk of tamponade of the heart with the subsequent termination of cardiac activity.
Pericarditis in children
In the presence of extensive staphylococcal infections in infants often develop pericarditis. In the main, it proceeds in an acute exudative form. In older children, pericarditis may be associated with viral diseases, rheumatism or rheumatoid arthritis. Often, the relationship between PC and heart tumor, thyroid disturbance, vitamin C, blood diseases or auto-reactive processes is often determined.
Clinical signs are the same as in adults, it is difficult for infants to immediately relate symptoms to pericarditis, as signs of viral or infectious disease are often prevalent. Timely diagnosis in the form of echocardiogram allows to reveal even a small effusion in the pectorals, whereas children over the age of five can assess the condition of the cardiovascular system at home using a cardiovisor.
Includes a variety of research methods, among which an objective examination is first and foremost only instrumental research is performed.
Visually the patient can be noted cyanosis, hepatomegaly, swelling of the lower extremities, which in severe cases becomes ascites. Swelling of the veins on the neck may also be noted. With percussion, the limits of the heart are enlarged. The tip of the tip also shifts to the side. The compensatory tachycardia may be noted. Auscultation with a dry pericardium, the noise of pleura friction is heard. The tones of the heart will be muffled.
Pericarditis most often acts as a complication of other diseases, which is why it does not have specific clinical signs. The light course of the PC is masked under the symptoms of the underlying disease, and the severe one often manifests itself as signs of heart failure.
The main complaints of patients with severe pericardium:
- attacks of rapid heartbeat;
- pain in the cardiac region;
- temperature increase;
- wrong pulse;
- dry cough
- shortness of breath
Increasing the liver in patients will cause a feeling of gravity on the right side. A change in the abdomen may indicate ascites. In some cases, on the contrary, there is a loss of weight, which is often associated with a long-running pathological process. Odd at first can occur only with physical activity, and with the progression of pericarditis begins to manifest in a calm condition.
The severity of the symptoms depends on the activity of the pathological process. The timing of PC development is largely dependent on the clinical form. An acute PC runs for six weeks or more, and a chronic one - at least two months.
Instrumental survey methods
All patients with cardiovascular diseases, including pericarditis, primarily use electrocardiography . With its help it is possible to determine the following changes in the electrical activity of the heart:
- extended tooth P;
- low-level QRS complex;
- Upper segment shift ST by arc type;
- the tooth T in the thoracic nodes is defined as sharpened and positive.
The examination of the patient is necessarily supplemented by the conduct of the echocardiogram as this method allows one to determine even a small amount of effusion in the pericardial bag. If necessary, echocardiography is combined with dopplerography. In particular, during the diagnosis, a reliable indication of the presence of tamponade can be determined - this is when the diastolic volume of the left ventricle decreases during inspiration.
X-ray of the chest gives an opportunity to estimate the size of the heart in general and its separate parts in particular.With pericardium, there may not be any significant changes, or structural disturbances reach the definition of a heartbeat by the type of "bottle of water".
The puncture of the pericardium is done not only with the therapeutic purpose, but also with the diagnostic. With the help of a puncture and biopsy a number of cytological, biochemical, immunological, bacteriological analyzes are carried out.
Video Pericardium puncture
To confirm the diagnosis, laboratory tests are performed, in which there will be signs of inflammation and other disturbed indicators. But because of their weak specificity, they are used only for the purpose of assessing the general condition of the patient.
The most severe complication is the heart tamponade and it develops mainly in the exudative pericardium. With constrictive PC, blood circulation insufficiency often occurs, when symptoms of false cirrhosis or right ventricular failure develop due to the transfusions of the veins coming from the liver or the lower extremities.
Prolonged pericarditis, even with a small amount of effusion, or its complete absence, promotes the development of myopericarditis. With the development of the adhesive process, the heart can be merged with the surrounding organs and even the spine, which leads to mediastin-pericarditis.
The clinical form of pericarditis, as well as the etiological factor contributing to the development of the PC, is key in the choice of therapy. In accordance with these criteria, the following types of pericarditis treatment are distinguished:
- Acute pericarditis - bed rest is recommended, the use of etiotropic drugs is recommended.
- Chronic - the activity of the patient is determined by its condition, while the amount of salt is regulated, a diet is prescribed, physical activity is limited.
- Dry non-pericardial pericarditis - symptomatic treatment is used, analgesics are used for pain relief, and agents for improving metabolism are also used.
- Exudative pericarditis - a treatment similar to that in dry PCs, the only indicators that indicate the condition of hemodynamics are controlled.
- Secondary pericarditis - the treatment of the underlying disease (allergy, SLE, rheumatoid fever) is carried out, while glucocorticoids and other hormonal drugs are often used.
- Constrictive pericarditis - only surgical treatment is used. As a rule, pericardectomy is performed, when removal of both welded pericardial leaves is performed.
The pericardium puncture can be performed in any form of pericardium if there is an increased amount of exudate.Manipulation is performed under the control of an ultrasound scan.
Forecast and prevention
It is important to begin treatment on time, then you can almost completely restore the shaken health. Some types of pericarditis, such as purulent or putrefactive, require immediate medical treatment, otherwise there is a risk to life. It is also necessary to avoid tamponade of the heart, because then the risk of ending cardiac activity is sharply increased.
Primary prophylaxis is absent, while using secondary it is possible to prevent relapse of the disease. For this purpose it is necessary to be at the clinic supervision at the cardiologist, if necessary - at the rheumatologist. Additionally, it is important to eat well, prevent physical overload. As needed, ECG and echocardiography are monitored.
Pericardial inflammation can develop in various forms and exudative pericarditis is one of the unfavorable ones. In this embodiment, the heart is compressed by the pericardial effusion, which negatively affects the general hemodynamics of the body. With timely treatment, the prognosis can be good.
Different forms of pericarditis can develop in different ways, but purulent pericarditis is noted the most unfavorable course. When it is high risk of mortality, especially in the absence of timely treatment. Therefore, operative diagnosis with subsequent thorough therapy is extremely important.
A disease such as pericardial inflammation can develop in various forms and one of the most difficult to predict is constrictive pericarditis. His treatment is often associated with surgery. Only in some cases, when the disease is not progressing and the cause of the disease requires it, medications can be used.