Pericarditis

Pericarditis is an acute or chronic inflammation of the pericardial sac. Distinguish fibrinous, serous-fibrinous, hemorrhagic, xanthomatous, purulent, putrefactive pericarditis.

Etiology: infection (viruses, bacteria, rickettsia, fungi, protozoa), rheumatism, rheumatoid arthritis, systemic lupus erythematosus, myocardial infarction, uremia, trauma, including operating, ionizing radiation, tumors and hemoblastoses, parasitic infestations; For some pericarditis, the causes of their occurrence are not established (idiopathic).

Pathogenesis is often allergic or autoimmune, with infectious pericardial infection can be a trigger; It is not excluded and direct damage to the membranes of the heart by bacterial or other agents.

Symptoms, flow are determined by the main disease and the nature of the effusion, its amount (dry, exudate pericarditis) and the rate of accumulation. Initial symptoms: malaise, fever, chest or precordial pains, often associated with respiratory phases, and sometimes resembling angina pectoris. Often a pericardial friction noise of varying intensity and prevalence is heard. Accumulation of exudate is accompanied by the disappearance of precardial pain and pericardial friction noise, the appearance of dyspnea, cyanosis, swelling of the cervical veins, weakening of the heart beat, expansion of cardiac dullness, but with a moderate amount of effusion, heart failure is usually expressed moderately. Due to a decrease in diastolic filling, the shock volume of the heart decreases, heart sounds become deaf, the pulse is small and frequent, often paradoxical (the fall of filling and pulse tension during inspiration). With constrictive (compressive) pericardial as a result of deforming fusion in the atrial region, atrial fibrillation or atrial flutter often occurs; At the beginning of diastole a loud pericardaton is heard. With rapid accumulation of exudate, cardiac tamponade can develop with cyanosis, tachycardia, impaired pulse, excruciating bouts of shortness of breath, sometimes with loss of consciousness, rapidly growing venous stasis. With a constructive pericarditis with progressive Rubtsov compression of the heart, there is an increase in blood circulation in the liver and in the portal vein system. Detect high central venous pressure, portal hypertension, ascites (pseudocirrhosis), peripheral edema appear; Orthopnea, as a rule, is absent. The spread of the inflammatory process to the mediastinal tissue and the pleura leads to mediastino pericarditis or pleurisy, with the transition of inflammation from the epicardium to the myocardium (surface layers), myocardial peritoneitis develops.

On the ECG in the first days of the disease there is a concordant rise in the segment of 5T in standard and thoracic leads, subsequently the segment S T is shifted to the isoelectric line, the prong T is flattened or subjected to inversion; With a significant accumulation of effusion, the voltage of the QRS complex decreases. Radiographic examination revealed an increase in the diameter of the heart and a trapezoidal configuration of the cardiac shadow with a weakening of the pulsation of the heart contour. With a long period of pericarditis, calcification of the pericardium (carapaceous heart) is observed. Echocardiography is a reliable method of detecting effusion, and jugular phlebography and phonocardiography are used for diagnosis. Differential diagnosis is performed with the initial period of acute myocardial infarction and acute myocarditis.

Treatment. In case of allergic or infectious-allergic nature of pericarditis, corticosteroid preparations (prednisolone 20-30 mg / day) and non-steroidal anti-inflammatory agents are used in the following daily doses: acetylsalicylic acid 3-4 g, rheopyrin 3-4 tablets, ibuprofen (brufen) according to 0.8-1.2 g, indomethacin 75-150 mg. In infectious and pyogenic pericarditis (staphylococcal, pneumococcal, etc.) antibiotics are used in accordance with an established or suspected pathogen (penicillins, aminoglycosides, cephalosporins, etc.). With parasitic pericarditis, antiparasitic agents are prescribed. In case of threat, cardiac tamponades produce a therapeutic puncture of the pericardium. When stagnant phenomena apply diuretics - furosemide (lasix) inside or / m 40 mg and more, hypothiazide 50-100 mg orally, etc. A sharp increase in central venous pressure is an indication for blood-letting (up to 400 ml). Surgical treatment (pericardectomy) is used with constructive pericarditis in case of significant circulatory disturbance and with purulent pericarditis.

The prognosis is most unfavorable for tumorous and purulent pericarditis.