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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, often staphylococcal, processes, rheumatism, diffuse diseases of the connective tissue.

Pathogenesis. The pathogenesis of an allergic or autoimmune nature, with infectious pericarditis, the infection is a trigger; direct damage to the membranes of the heart by bacterial or other agents is also 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 the epigastric region and passing in an upright position and leaning forward. It is associated with lesions of the pleural and diaphragmatic pericardium. Sometimes abdominal pains simulating a sharp stomach. Pericardial friction noise - determined during systole and diastole, heard during systole and diastole, amplified in an upright position. Often not permanent. Other symptoms: fever, tachycardia, tachypnea.

Acute exudative pericarditis develops when the inflammatory process of the heart membrane is accompanied by a total lesion.

Clinic: the apical impulse of the heart is shifted up and inside from the lower-left border of dullness. Borders of the heart vary depending on the patient's body position: vertically, the zone of dulling in the 2nd and 3rd intercostal spaces decreases by 2-4 cm on each side, and dullness in the lower intercostal space extends to the same distance. The heart sounds in the lower left are weakened. X-ray picture: early signs and accumulation of exudate, a change in heart shadow, chronic triic-shaped pericardial effusions. Spherical shadow indicates an active process with a rapid increase in the volume of effusion. During echocardiography, a layer of fluid in front and back of the heart contour is confidently visualized as an anechoic space. Fibrous deposits in the form of inhomogeneous shadows and thickening of the leaves of the pericardium are also often noted, and with large exudates heart vibrations inside the stretched pericardial sac are characteristic.

Chronic exudative pericarditis. The clinical picture depends on the rate of accumulation of exudate. The general condition usually worsens dramatically, shortness of breath appears, dull pains in the region of the heart, the patient assumes a forced position. Apical impulse weakened, heart sounds sharply muffled. ECG: reduction of teeth, negative teeth of T, shift of an interval S - T X-ray inspection: expansion of a shadow of heart which takes the triangular or trapezoid form.

Chronic adhesive (adhesive, constrictive) pericarditis. The pericardium thickens and both its leaves, visceral and parietal, grow together both with each other and with the underlying myocardium.

The onset is gradual, edematous syndrome develops, enteropathy appears with the loss of proteins, leading to hypoalbuminemia, followed by increased edema syndrome, the development of hepatomegaly, ascites and pronounced edema of the extremities. Small pulse, blood pressure with a small amplitude. Heart sounds are weakened, gallop rhythm.

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

ECG

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

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

Late Stage II: T teeth gradually smoothed out, their inversion begins.

Stage III: Generalized T Inversion

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

Echo-KG: effusion types B – D.

Signs of heart tamponade

Blood tests:

1) determination of ESR, C-reactive protein and lactate dehydrogenase levels, leukocyte numbers (inflammatory markers);

2) determination of the level of troponin I and the 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 "water bottle".
In the course of this study, it is possible to identify associated diseases of the lungs and mediastinal organs. Diagnostic interventions, which are applied necessarily with cardiac tamponade, are an indication of class I; at the discretion of the physician in case of large or recurrent effusions or in case of insufficient informativeness of the previous examination - indication of class Na; and also for small exudates - indication of class IIb.

Pericardiocentesis with drainage of the pericardial cavity: the 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 with insufficient informativeness of the previous examination, are indicated by the class Na.

With computed tomography: effusions, peri- and epicardial condition.

Magnetic resonance imaging: exudates, peri-and epicardium. With pericardioscopy, a pericardial biopsy is performed to establish the etiology of pericarditis.

Diagnosis of constrictive pericarditis. The clinical picture is manifested by signs of pronounced chronic systemic venous congestion caused by low cardiac output: jugular vein swelling, low pulse blood pressure, increased abdominal volume, peripheral edema, and muscle weakness. ECG results are either normal, or there is a decrease in the amplitude of the QRS complex, generalized inversion (or flattening) of the T wave, changes in the PL's electrical activity, atrial fibrillation, atrioventricular blockade, intraventricular conduction disturbances, in rare cases pseudo-infarction changes. X-ray examination of the chest is determined by the calcification of the pericardium, pleural effusion. Echo-KG 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 the normal configuration of the ventricles and the preserved systolic function; early paradoxical movement of IUP (a sign of “diastolic depression and plateau”); flattening of the LV posterior wall waves; no increase in LV size after the phase of early rapid filling; the inferior vena cava and hepatic veins are enlarged and their sizes change little depending on the phases of the respiratory cycle. Limiting the filling of the left ventricle and pancreas; when assessing blood flow through the atrioventricular valves, differences in the level of filling during inspiration and expiration exceed 25%. Doppler - Echo-KG is determined by measuring the thickness of the pericardium. With transesophageal Echo-KG, thickening and / or calcification of the pericardium, cylindrical configuration of one or both ventricles, narrowing of one or both atrioventricular sulci, signs of congestion in the vena cava, an increase in one or both atria are determined. Computed and / or magnetic resonance imaging determine the sign of “diastolic depression and plateau” on the pressure curve in the pancreas and / or LV. Leveling end-diastolic pressure in the left ventricle and pancreas in the range of <5 mm Hg. st. When angiography of the pancreas and / or LV is determined by the decrease in the size of the pancreas and the left ventricle, an increase in the size of the PP and LP. During diastole after the phase of early rapid filling, there is no further increase in ventricular size (a sign of "diastolic depression and plateau"). Angiography of the coronary arteries is shown to all patients over 35 years of age, as well as at any age, with a history of indications of irradiation of the mediastinal area.

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

Implementation of the tasks of complex therapy:

1) bed rest;

2) good nutrition;

3) NSAIDs;

4) glucocorticosteroids;

5) broad-spectrum antibiotic bacteria;

6) pericardiocentesis;

7) diuretic drugs;

8) relief of pain;

9) correction of hemorrhagic syndrome;

10) with the ineffectiveness of conservative therapy - pericardectomy.

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Pericarditis

  1. Heart 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 Diagnostics When making a diagnosis Mandatory Level of consciousness, frequency and effectiveness of respiration, skin color, heart rate, pulse, blood pressure, paradoxical pulse , auscultation of the heart (pericardial friction noise, a symptom of Ewart),
  2. Pericarditis
    Code ICD: 130-132 130 130.0 Acute pericarditis Acute nonspecific idiopathic peri carditis 130.1 Infectious pericarditis 130.8 Other forms of acute pericarditis Acute pericarditis, unspecified 130.9 Other diseases of pericardium B1 131.0 Chronic adhesive pericarditis Chronic constrictive pericarditis 131.1 131.2 hemopericardium, not elsewhere classified
  3. PERICARDITIS
    Definition of Pericarditis - an infectious or non-infectious inflammation of the visceral and parietal pericardial sheets, manifested by fibrous changes and / or accumulation of fluid in the pericardial cavity. Epidemiology In the clinic, pericarditis is rarely diagnosed - in 0.1% of cases, its frequency according to autopsy is 3-6%. Men get sick 1.5 times more often than women.
  4. Pericardial tumors
    Primary pericardial tumors are less common than heart tumors. Clinical manifestations. Clinically, they manifest symptoms of pericarditis hemorrhagic or serous fibrous, sometimes with suppuration. The diagnosis of a pericarditis tumor is established by cytological examination of punctate of the contents of the pericardial cavity, introduction of carbon dioxide into the pericardial cavity, and histological examination
  5. Pericardial Diseases
    Eugene Braunwald Normal functions of the pericardium. The visceral pericardium is a serous membrane, separated by a small amount of fluid, which is plasma ultrafiltrate, from the fibrous sac, which is the parietal pericardium. Pericardium prevents the sudden expansion of the heart chambers during exercise and hypervolemia. Due to the development of negative
  6. Pericarditis
    In most patients with transmural myocardial infarction, a reactive fibrinous or serous fibrinous pericarditis with a small amount of pericardial effusion may develop on days 2-4 of the disease. In clinical practice, pericarditis is found only in 5-10% of patients with MI, which is associated with the difficulties of its diagnosis. The clinical picture of pericarditis in a patient with myocardial infarction with a Q wave can be suspected by the following
  7. 2. Constructive Pericarditis
    General Constrictive pericarditis occurs as a complication of acute or recurrent pericarditis. The pericardium is thickened, fibrotic and often calcified. The parietal leaf of the pericardium fits tightly to the heart, which often leads to obliteration of the pericardial cavity. Too hard a pericardium limits the diastolic filling of the heart, so that it can be filled only up to a certain
  8. HEART AND PERIKARD
    Pericardium Pericardium (heart shirt) is a closed serous bag, surrounding 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 arch. In addition, the terminal segments of the pulmonary, superior and inferior vena cava are enclosed in the pericardial cavity, which are covered by the pericardium only along its anterior
  9. Congenital pericardial defects
    The following are attributed to congenital pericardial defects. 1. Partial left-side absence of pericardium 70%. Complicated by the formation of a hernia, infringement of the heart at the site of the defect. There are chest pains, shortness of breath, fainting or sudden death. Surgical treatment - pericardioplasty. 2. The complete absence of the pericardium is manifested by the symptom of a “free heart”: pain in the area
  10. PERICARDA TAMPONADA
    The definition of pericardial tamponade is the accumulation of blood or fluid in a closed pericardial cavity, which limits the filling of the ventricles and leads to hemodynamic disturbances. Etiology Bleeding after cardiac operations. Coagulopathy. Perforation of the heart. Rheumatological or autoimmune diseases. Tumor or metastasis of the pericardium. Pericardial infection,
  11. Pericardial Diseases
    612. IN NORMAL IN PERICARDIARY SPACE CONTAINS LESS 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. PERICARD CYST Normally appears on 1) objective examination 2) ECG 3) chest radiography 4) EchoCG 5) coronary angiography 614. Pericardial therapy. INCLUDES 1) surgical excision 2)
  12. Anesthesia during pericardial surgery
    The parietal leaf of the pericardium is a fairly rigid fibrous sheath surrounding the heart. Between the parietal and visceral leaflets of the pericardium, there is a pericardial cavity containing a liquid (20–50 ml in adults). The pericardial distensibility is small, which limits the acute dilatation of the ventricles and promotes diastolic conjugation between the ventricles (stretching one
  13. Pericardial friction noise
    Occurs when the surface of the pericardium changes, what happens when the so-called dry pericarditis; fibrinous inflammation of the pericardium. • It can be heard over any surface of the heart, but is more often heard in the region of absolute cardiac dullness. • Pericardial friction noise is usually heard as a rustle in both phases of the heart. • The character can be gentle or rough resembling a snow crunch.
  14. Pericarditis
    Among the various diseases of the pericardium, the main place belongs to the inflammatory - pericarditis proper; other forms of damage (cysts, neoplasms) are less common. Pericarditis is an inflammatory disease of the pericardium and the outer lining of the heart, which is often the local manifestation of a common disease (tuberculosis, rheumatism, diffuse diseases of the connective
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