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Pericarditis



Pericarditis is an inflammation of the visceral and parietal leaf, it can be fibrinous, purulent, hemorrhagic, serous.

Etiology. Viral diseases, severe septic, more often staphylococcal, processes, rheumatism, diffuse connective tissue diseases.

Pathogenesis. Pathogenesis of the allergic or autoimmune nature, with infectious pericardial infection is a trigger mechanism, and direct damage to the membranes of the heart by bacterial or other agents is not excluded.

Clinical manifestations. Acute serous-fibrinous pericarditis manifests itself as the main symptoms - acute pain in the region of the heart radiating to the shoulder and epigastric region and passing in the vertical position and when tilted forward. It is associated with the lesion of the pleural and diaphragmatic pericardium. Sometimes abdominal pains that simulate an acute abdomen. The noise of friction of the pericardium - it is determined during systole and diastole, is heard during systole and diastole, is amplified in an upright position. Often not constant. Other symptoms: high fever, tachycardia, tachypnea.

Acute exudative pericarditis develops when the inflammatory process of the cardiac membrane is accompanied by total defeat.

Clinic: the apical impulse of the heart is shifted upward and inward from the lower-left border of dullness. The boundaries of the heart vary depending on the position of the patient's body: vertically, the zone of blunting in the 2nd and 3rd intercostal spaces is reduced by 2-4 cm from each side, and dullness in the area of ​​the lower intercostal spaces expands to the same distance. Cardiac tones in the lower-left divisions are weakened. X-ray picture: early signs and accumulation of exudate, change in cardiac shadow, chronic pericardial effusions of triangular shape. A spherical shadow indicates an active process with a rapid increase in the amount of effusion. With echocardiography, a layer of fluid in front and behind the heart contour is confidently visualized as an anechogenous space. Often there are also fibrous deposits in the form of inhomogeneous shadows and compaction of pericardial sheets, and with large effusions, the heart oscillations inside the stretched pericardial sac are characteristic.

Chronic exudative pericarditis. The clinical picture depends on the rate of accumulation of exudate. Usually the general condition sharply worsens, there is shortness of breath, dull pain in the heart area, the patient takes a forced position. The apical impulse is weakened, the heart sounds are sharply muffled. ECG: decrease of teeth, negative teeth T, shift of interval S-T Radiographic examination: enlargement of the shadow of the heart, which takes a triangular or trapezoidal shape.

Chronic adherent (adhesive, constrictive) pericarditis. The pericardium thickens, and both of its leaflets, visceral and parietal, fuse with each other as well as with the underlying myocardium.

Gradual onset, edematous syndrome develops, enteropathy with loss of proteins appears, leading to hypoalbuminemia with subsequent intensification of edematous syndrome, development of hepatomegaly, ascites and marked swelling of the extremities. Pulse small, low amplitude AD. Heart sounds are weakened, the rhythm of the canter.

Diagnostics. Diagnosis of acute pericarditis: with auscultation pericardial friction noise (single-, two- and three-phase).

ECG

Stage I: the concave rise of the ST segment in the anterior and posterior leads, the deviations of the PR segment are opposite to the polarity of the P wave

Early stage II: the ST connection returns to the contour, the deviation of the PR interval is retained.

Late stage II: the teeth of T gradually become smoother, their inversion begins.

Stage III: generalized inversion of teeth T

Stage IV: restoration of the initial ECG characteristics observed before the development of pericarditis.

Echo-KG: effusions of types B-D.

Symptoms of cardiac tamponade

Blood tests:

1) the determination of ESR, the level of C-reactive protein and lactate dehydrogenase, the number of leukocytes (markers of inflammation);

2) determination of the level of troponin I and MB-fraction of creatine-phosphokinase (markers of myocardial damage).

X-ray examination of the chest - the image of the heart can vary from normal to the appearance of the silhouette of a "bottle of water".
In this study, it is possible to identify concomitant diseases of the lungs and mediastinal organs. Diagnostic interventions, which are mandatory for cardiac tamponade, are an indication of class I; at the discretion of the doctor with large or recurrent effusions or if the information of the previous examination is insufficient, the indication of class Ha; and also with small exhalations - the indication of class IIb.

Pericardiocentesis with pericardial cavity drainage: results of polymerase chain reaction and histochemical analysis allow to determine the etiopathogenesis of pericarditis (infectious or tumor).

Diagnostic interventions, which are applied at the discretion of the doctor or if the previous survey is not sufficiently informative, is the indication of class Ha.

With computed tomography: effusions, peri-and epicardium.

With magnetic resonance imaging: effusions, the condition of the peri- and epicardium. During pericardioscopy, a pericardial biopsy is performed with the establishment of the etiology of pericarditis.

Diagnosis of constrictive pericarditis. The clinical picture is manifested by signs of severe chronic systemic venous stasis due to a low cardiac output: swelling of the jugular veins, arterial hypotension with low pulse pressure, increased abdominal volume, peripheral edema and muscle weakness. ECG results or normal, or a decrease in the amplitude of the QRS complex, generalized inversion (or flattening) of the T wave, changes in the electrical activity of the LP, atrial fibrillation, atrioventricular blockage, intraventricular conduction disorders, and pseudo-infarction changes in rare cases. Radiographic examination of the chest determines calcification of the pericardium, pleural effusion. Echocardiography is determined by the thickening of the pericardium and its calcification, as well as indirect signs of constriction: an increase in PP and LP in normal ventricular configuration and a preserved systolic function; early paradoxical movement of MZHP (a sign of "diastolic occlusion and plateau"); flattening of the waves of the posterior wall of the LV; no increase in LV size after the early rapid filling phase; the lower hollow vein and the hepatic veins are enlarged and their sizes vary little depending on the phases of the respiratory cycle. Limitation of LV and RV filling; when assessing blood flow through the atrioventricular valves, the differences in the level of inspiratory and expiratory filling exceed 25%. Doppler - Echo-CG is determined by measuring the thickness of the pericardium. With esophagogastric echocardiography, the thickening and / or calcification of the pericardium is determined, the cylindrical configuration of one or both ventricles, the narrowing of one or both atrioventricular furrows, signs of stagnation in the hollow veins, an increase in one or both atria. Computer and / or magnetic resonance imaging determine the sign of "diastolic occlusion and plateau" on the pressure curve in the prostate and / or LV. The alignment of the end-diastolic pressure in the LV and RV in the range <5 mm Hg. Art. With the angiography of the prostate and / or the left ventricle, a decrease in the size of the prostate and the left ventricle, an increase in the size of the PP and LP, is determined. During diastole, after a phase of early rapid filling, there is no further increase in the size of the ventricles (a sign of "diastolic occlusion and plateau"). Angiography of the coronary arteries is indicated to all patients older than 35 years, as well as at any age in the presence of an anamnesis of indications for irradiation of the mediastinum region.

Treatment. Therapeutic actions: general measures, suppression of the inflammatory reaction, etiotropic treatment, unloading therapy, symptomatic therapy.

Realization of tasks of complex therapy:

1) bed rest;

2) adequate nutrition;

3) NSAIDs;

4) glucocorticosteroids;

5) broad-spectrum antibiotic-antibacterial drugs;

6) pericardiocentesis;

7) diuretics;

8) relief of pain syndrome;

9) correction of hemorrhagic syndrome;

10) with ineffectiveness of conservative therapy - pericardectomy.

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Pericarditis

  1. Cardiac tamponade: acute pericarditis. Other diseases of the pericardium. Pericarditis in diseases classified elsewhere
    ICD-10 cipher Cardiac tamponade: acute pericarditis 130 Other pericardial diseases 131 Pericarditis in diseases classified elsewhere 132 Diagnosis When establishing the diagnosis Mandatory level of consciousness, frequency and effectiveness of respiration, skin color, heart rate, pulse, blood pressure, the presence of a paradoxical pulse , auscultation of the heart (pericardial friction noise, Evarth's symptom),
  2. Pericarditis
    ICD code: 130-132 130 Acute pericarditis 130.0 Acute nonspecific idiopathic pericarditis 130.1 Infectious pericarditis 130.8 Other forms of acute pericarditis 130.9 Acute pericarditis, unspecified B1 Other pericardial diseases 131.0 Chronic adhesive pericarditis 131.1 Chronic constrictive pericarditis 131.2 Hemopericard, not elsewhere classified
  3. PERICARDITIS
    Definition Pericarditis is an infectious or noninfectious inflammation of the visceral and parietal pericardial sheets, manifested by fibrous changes and / or accumulation of fluid in the pericardial cavity. Epidemiology Pericarditis is diagnosed very rarely in the clinic - in 0.1% of cases, its frequency according to autopsy data is 3-6%. Men get sick 1,5 times more often than women.
  4. Tumors of the pericardium
    Primary tumors of the pericardium are less common than tumors of the heart. Clinical manifestations. Clinically, they manifest symptoms of pericarditis of hemorrhagic or serous fibrous, sometimes with suppuration. The diagnosis of a tumor of pericarditis is established at a cytological examination of the puncture of the contents of the pericardial cavity, introduction of carbon dioxide into the cavity of the pericardium, a histological study
  5. DISEASES OF PERICARDS
    Eugene Braunwald Normal functions of the pericardium. The visceral pericardium is a serous membrane separated by a small amount of liquid, which is an ultrafiltrate of the plasma, from the fibrous sac, which is the parietal pericardium. Pericardium prevents the sudden expansion of the chambers of the heart during exercise and hypervolemia. Due to the development of negative
  6. Pericarditis
    Most patients with transmural myocardial infarction on the 2nd-4th day of the disease may develop reactive fibrinous or serous-fibrinous pericarditis with a small amount of effusion in the pericardium. In clinical practice, pericarditis is found only in 5-10% of patients with MI, which is associated with the difficulties of its diagnosis. Clinical picture Pericarditis in a patient with a Q-wave infarction can be suspected by the following
  7. 2. CONSTRUCTIVE PERICARDITIVE
    General information Constrictive pericarditis occurs as a complication of acute or recurrent pericarditis. The pericardium is thickened, fibrous and often calcified. The parietal leaf of the pericardium tightly adjoins the heart, which often leads to obliteration of the pericardial cavity. Too tight a pericardium restricts the diastolic filling of the heart, so that it can be filled only up to a certain
  8. HEART AND PERICARD
    Pericardium Pericardium (heart-shaped shirt) is a closed serous sac that surrounds the heart from all sides. The pericardial cavity also includes the pulmonary trunk up to its bifurcation and the ascending part of the aorta before going into the arc. In addition, the terminal segments of the pulmonary, upper and lower hollow veins are enclosed in the pericardial cavity, which are covered by the pericardium only along its anterior
  9. Birth defects of the pericardium
    Congenital defects of the pericardium include the following. 1. Partial left-sided absence of pericardium 70%. Complicated by the formation of a hernia, infringement of the heart in the place of the defect. There are pains in the chest, shortness of breath, fainting conditions or the onset of sudden death. Surgical treatment is pericardioplasty. 2. The complete absence of the pericardium manifests itself as a symptom of a "free heart": pain in the area
  10. PERICARD TAMPONADA
    Definition of tamponade pericardium is the accumulation of blood or fluid in a closed pericardial cavity, restricting the filling of the ventricles and leading to hemodynamic disorders. Etiology Bleeding after cardiac operations. Coagulopathy. Perforation of the heart. Rheumatological or autoimmune diseases. Tumor or metastasis of the pericardium. Infection of the pericardium,
  11. Diseases of the pericardium
    612. In the norm in the pericardial space is less than 1) 15 ml of liquid 2) 50 ml of liquid 3) 100 ml of liquid 4) 150 ml of liquid 5) 200 ml of liquid 613. Pericarda usually appears on 1) objective examination 2) ECG 3) chest x-ray 4) echocardiography 5) coronarography 614. THERAPY OF PERICARDIAL KISS INCLUDES 1) surgical excision 2)
  12. Anesthesia in pericardial surgery
    The parietal leaf of the pericardium is a fairly rigid fibrous membrane surrounding the heart. Between the parietal and visceral pericardial leaf there is a pericardial cavity containing a liquid (20-50 ml in adults). The pericardial stretch is small, which limits the acute dilatation of the ventricles and promotes diastolic conjugation between the ventricles (stretching one
  13. Friction of pericardium
    Occurs when the surface of the pericardium changes, what happens when dry pericardial-fibrinous inflammation of the pericardium. • It can be heard over any surface of the heart, but is more often heard in the area of ​​absolute cardiac dullness, • Pericardium friction noise is usually heard as a rustle in both phases of the heart. • By nature, it can be gentle or rough resembling the crunch of snow.
  14. Pericarditis
    Among the various diseases of the pericardium, the main place belongs to inflammatory - pericarditis proper; other forms of damage (cysts, neoplasms) are less common. PERICARDIT is an inflammatory disease of the pericardial bag and the outer shell of the heart, which is most often a local manifestation of some common disease (tuberculosis, rheumatism, diffuse connective diseases
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