Pericarditis is called acute or chronic inflammation of the outer lining of the heart – the pericardium resulting from infection, rheumatic lesions, or other influences.
Pericarditis is manifested mainly by pain in the heart area, as well as by accumulation of fluid in the pericardial cavity, which can lead to cardiac tamponade (emergency pressure) of the heart, an emergency with the need for emergency care.
The pericardium (pericardial sac) is the outer shell in which the heart is located. The pericardial cavity due to the special structure allows the heart to actively contract, without causing much friction.
In pericarditis, the normal structure and functioning of the lining of the heart is disturbed, and inside the pericardial cavity a secret (effusion) of a purulent or serous character can accumulate. This fluid is called exudate.
As a result of the accumulation of excess fluid, the heart is squeezed, and can no longer properly perform its functions of pumping blood. Then there are manifestations of pericarditis. In some cases, the fluid accumulates a lot, and so that a person does not die, immediate intervention is required to remove exudate from the pericardial cavity.
Pericarditis may be:
- manifestation of systemic diseases,
- a sign of heart disease,
- a symptom of infectious diseases,
- complication of the pathology of internal organs,
- the result of injury.
Pericarditis is a fairly serious condition, and sometimes its manifestations become the leading symptom of the disease, and the rest of the signs can fade into the background. Unfortunately, sometimes pericarditis is the cause of the death of patients and is found already at the autopsy.
Occurs more often in women, men suffer less frequently. Usually it is adults and the elderly, very rarely, pericarditis occurs in children.
Pericardial inflammation can be:
- non-infectious (aseptic, non-purulent).
Infectious lesions include pericarditis in:
- viral infections ( influenza, measles, herpes, enterovirus and other infections),
- microbial diseases (scarlet fever, sore throat , tuberculosis),
- fungal infections
- parasitic invasions.
In addition, pericarditis can develop due to drug allergy or serum sickness.
Aseptic inflammation is formed as a result of:
- systemic diseases affecting the connective tissue, including the heart.
- heart disease: heart attack , myocarditis ( myocardial inflammation) or endocarditis – inflammation of the inner lining of the heart,
- toxic and metabolic disorders in the development of uremia, gout, as a result of radiation or chemotherapy.
A separate plan is the pericarditis, developing as a result of the formation of pericardial defects with the formation of cysts, diverticula, as a result of pericardial tumors, heart injuries and surgeries, general edema with accumulation of sterile fluid in the pericardial cavity.
There are acute, subacute chronic and recurrent pericarditis. They differ in the degree of activity of the process and the duration of the symptoms.
Acute pericarditis can develop quickly, and is active up to 6 weeks, and can be:
- dry (fibrinous) – while in the pericardial cavity there is a lot of fibrin (adhesive substance from the blood plasma) and little liquid,
- effusion (exudative) – there is a lot of fluid in the pericardial cavity (blood plasma, bloody contents or pus).
Subacute pericarditis – something between acute and chronic variants. Lasts from 6 weeks to 6 months and it happens:
- constrictive (squeezing – due to the formation of hard adhesions, calcifications in the pericardial cavity);
- constrictive- expired.
Chronic pericarditis develops gradually, lasts more than 6 months, and sometimes over the years, and can be in several forms:
- exudative (effusion), an accumulation of fluid, similar to the acute forms.
- adhesive (adhesive form), adhesions and scars are formed.
Recurrent course is one of the most serious complications of the disease. As soon as the patient stops taking the medication, pericarditis, from which the person seems to have recovered, judging by the symptoms and analyzes, immediately returns and develops with a new force. It is divided into pericarditis with:
- asymptomatic periods;
- continuous flow.
Symptoms of pericarditis depend on the form and stage of the process.
Acute inflammation of the pericardium usually produces fibrin secretions, and as the process progresses, inflammatory fluid accumulates.
There are pains in the heart and a pericardial rub. The pains are usually dull and pressing, given to both shoulders, the left scapula or the subclavian area.
Important! Pericardial pain can resemble angina , but with pericarditis there is no reaction to taking nitroglycerin. However, painkillers temporarily help.
- dry cough,
- temperature rise.
The pains are aggravated by deep breathing and coughing, in the supine position and are relieved by sitting, the breathing is frequent and shallow.
Fibrous pericarditis can in a couple of weeks turn into exudative (the fluid inside the cavity begins to accumulate).
When exudative pericarditis may occur:
- pain in the heart,
- chest tightness
- if fluid accumulates, there is a disturbance in the movement of blood through the veins, resulting in shortness of breath,
- dysphagia (a violation of swallowing food) may develop,
- all patients have a fever,
- obsessive hiccup
- the appearance is typical – the face, neck and front of the chest are swollen, the veins swell on the neck,
- pale skin with cyanosis
- intercostal spaces are smoothed.
Pericarditis is treated by cardiologists, general practitioners, and in some cases cardiac surgeons.
Initially, the diagnosis begins with the examination and questioning of the patient, it is important to carefully listen to the heart and determine its boundaries.
Complementary diagnosis analyzes:
- complete blood count ( blood reaction to inflammation: an increase or rarely a decrease in the number of leukocytes, a shift of the leukocyte formula to the left, an increase in the ESR) and urine,
- immunological analysis,
- biochemical studies of blood and urine.
When biochemistry determined:
- amount of total protein and protein fractions,
- C-reactive protein,
- troponins, CK-MB (signs of myocardial damage),
- urea, creatinine (kidney function evaluation),
- ALT , AST (assessment of liver function),
- thyroid hormones,
- lupus cells.
It is important to conduct a detailed study using an ECG, which is in many ways similar to the changes in myocardial infarction.
X-ray examination for the diagnosis of an increase in heart size The most accurate method is ultrasound of the heart. Additionally, computed tomography or MRI of the heart is prescribed to clarify the amount of fluid, changes in the heart and its envelope.
In order to study the exudate, a pericardial puncture with fluid extraction and a pericardial biopsy are performed.
Treatment of pericarditis largely depends on the stage, form and cause of the disease. The basis of therapy is the choice of the mode of activity of the patient, the search for the most appropriate method of treatment: drug, surgical or mixed.
In acute pericarditis shows strict bed rest. In chronic – mode is chosen based on the degree of damage to the heart and well-being of the patient. Salt intake is limited, diet food and exercise restrictions are shown.
For acute dry pericarditis, aspirin, nonsteroidal anti-inflammatory drugs (ibuprofen) and colchicine (with the exception of the infectious nature of the disease) are prescribed.
If the process is purulent, it is necessary to take antibiotics orally or intravenously, sometimes injected through the catheter into the pericardial cavity, after removing pus from it.
For tuberculous lesions, two or three anti-tuberculosis drugs are prescribed for six months or longer.
For pericarditis caused by an allergic process or developed due to a systemic disease of the connective tissue, glucocorticoids are used, and this is complemented by treatment of the process that caused the pericarditis.
With the rapid accumulation of fluid in the cavity, a pericardial puncture is performed with a needle with the introduction of a catheter and removal of fluid. In the formation of adhesions, an operation on the heart is performed, removing parts of the deformed pericardium and adhesions.
The prognosis for pericarditis depends on the cause of it and the number of relapses. As with all diseases, the prognosis is the better, the earlier the exact diagnosis is made and the treatment is started.
The most dangerous complications are purulent pericarditis and acute cardiac tamponade, which can be life-threatening, so they require the most rapid and clear treatment tactics.