Pericardial consequences. Pericarditis

Considering that pericarditis is usually diagnosed quite late, it can become a cause of disability in the future. According to statistics, advanced pericarditis accounts for 0.05 - 0.5% of all cases of disability due to cardiovascular diseases. Disability is determined cardiovascular failure. It is observed mainly in constrictive and recurrent pericarditis.

To undergo a medical and social examination to determine the disability group, you must provide the results of the following studies:

general and biochemical analysis blood;
general and biochemical urine analysis;
microbiological and cytological examination pericardial effusion ( if a puncture was performed);
ECG results at various stages of treatment;
echocardiography results;
chest radiographs;
blood test for systemic lupus erythematosus cells ( LE cells).

Depending on the severity of structural and functional changes the patient at the end of treatment can be assigned I, II or III group disability. The criteria by which groups are allocated are different for each country. The first group usually includes patients with constrictive pericarditis or armored heart, who various reasons no surgical treatment was performed ( pericardectomy).

If the patient remains able to work, he should pay attention to some restrictions that should be adhered to. They relate to the organization of the labor process. Patients should avoid working in areas with large changes in temperature, humidity or pressure. These factors environment affect hemodynamics ( blood pumping process), and the heart's ability to adapt to environmental changes after pericarditis is limited. In addition, excessive nervous or mental stress can affect blood pressure and, therefore, the work of the heart. Work that requires prolonged forced positioning of the body is also contraindicated, since static loads can cause serious violations hemodynamics.

The heart is located in a kind of sac, which is commonly called the cardiac sac. The inflammatory process, which is localized in the pericardium or heart sac (outer membrane), is called pericarditis. The pathology, which is quite common, is treated by cardiologists, often cardiac surgeons and oncologists.

Very often, the disease can only be identified after the patient’s death and autopsy. The prevalence of the pathology does not depend on the area of residence and gender, although in women the problem is slightly more common.

IN different periods life, patients are diagnosed with pericarditis of different nature. Pericarditis can be an independent disease, in which case its clinical picture comes to the fore.

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But if the disease is a consequence of another pathology, cardiac, infectious or systemic disease, then the symptoms of this disease will be most pronounced, and the signs of pericarditis will fade into the background.

Pericarditis belongs to the group of polyetiological diseases precisely because it can be caused for various reasons, one of which is tumor formation. It is not difficult to detect using cardiac ultrasound, x-ray, echocardiography, MRI.

In this case, as in many others, treatment should be aimed at eliminating the cause, if the inflammatory process is relieved with the help medications, this will bring temporary relief, but there will be an even greater risk of relapse.

Tumor pericarditis refers to diseases of a non-infectious (aseptic) nature that are not caused by microorganisms. But at some stage of development, the disease can be complicated by microbes, then its course will take on an infectious character.

Most often, pericarditis caused by a tumor can be characterized by:

intense pain in the chest;
general increasing weakness in the body;
shortness of breath;
unproductive cough.

Flow mechanism

For development inflammatory process in the pericardium, the formation of a tumor is affected by direct mechanical compression of the pericardial tissues, which are subsequently destroyed and compacted.

Tumor-like formations have two types of lesions:

Primary

appear as a result of pericardial cells mutating;
detection of such pathology in patients during life is insignificant, therefore very often (in 75% of cases) it is determined by autopsy;
only 3–5% are diagnosable;
the tumor can be benign (fibroma, angioma) or malignant (mesothelioma, sarcoma).

Metastatic

in this case, cancer cells from other organs enter the pericardium;
the spread of metastases is helped by blood flow, so it moves in the body, like an infection;
Once in the pericardium, the cell begins to divide and a malignant neoplasm is formed;
metastases in the cardiac sac appear due to lung cancer(40%), breast (22%), leukemia (15%), gastrointestinal tract (4%), melanoma (3%), other organs (16%).

On Clinical signs pericarditis does not affect whether the lesion is primary or metastatic, because the pathology occurs later than the neoplasm. Due to the growth of the tumor, the inflammatory process mechanism can affect the coronary (heart) vessels and its own tumors, squeezing and damaging them, the pericardial layers, and the tissues surrounding the tumor.

A healthy heart contains 5–30 ml of pericardial fluid in the pericardium, which reduces friction between the layers of the cardiac sac when contractions occur. When inflammation occurs in the pericardium, the process is disrupted.

First, it is customary to consider the development of exudative pericarditis, when additional fluid “sweats” into the cavity of the heart sac, where the pressure increases, which leads to compression of the heart from the outside. The diastolic function of the heart muscle is impaired and the heart cannot relax completely.

With the slow development of the inflammation process, the patient may not have complaints until the body’s compensatory capabilities are exhausted, which will subsequently lead to the development of heart failure.

If the process develops quickly (several hours or days), this will lead to tamponade, a deadly complication.

At the second stage, when a small amount of fluid has accumulated in the pericardium, dry pericarditis develops. In this case, the patient may also not notice the development of the inflammatory process, after which subsides, the amount of fluid in the pericardium will return to its original state. But the protein that was part of the additional fluid will remain in the cavity of the heart sac.

Having been deposited in some areas of the pericardium, it will lead to their adhesion and fusion, resulting in the formation of fibrin adhesions. They will not only interfere with the functioning of the heart, but can lead to serious complications.

The method of treating tumor pericarditis depends on the inflammatory process caused by the tumor, the location and nature of the tumor, and the symptoms that accompany the pathology.

The inflammatory process, and in some cases the tumor, is eliminated with medications. Surgery is required to remove benign and malignant tumors and the complications they cause.

With drug therapy:

inflammation is removed;
the symptoms of pericarditis are eliminated;
pain syndrome is relieved.

Pericardial mesiothelioma cannot be removed with radiation therapy, so several courses of chemotherapy are necessary. But if the localization of the tumor allows radical treatment, it can be removed surgically.

Otherwise surgical interventions are aimed at saving the patient from complications that resulted from tumor pericarditis. These include the accumulation of additional fluid (effusion) in the heart sac, tamponade (blood in the cavities of the heart due to vascular damage), purulent damage tissues, chronic development, armored heart. Similar complications occur due to tumor growth.

Surgical treatment is usually carried out in two ways:

Pericardectomy

The method allows you to remove the outer layer of the pericardium. It is usually prescribed for constrictive pericarditis, one of the causes of which is malignancy in any organs and metastases in the heart. Resection of the outer lining of the heart, which has thickened, will lead to real therapeutic effect and relieve the symptoms of pericarditis.

The operation is prohibited when respiratory failure, bleeding disorders, chronic diseases at the acute stage.

Methodology surgical intervention involves two types of pericardiectomy:

total, when the cardiac sac is removed, but its posterior part is preserved;
subtotal, when the heart sac is removed various areas, in which inflammation progresses the most.

Pericardiocentesis

The technique involves removing fluid from the pericardium using a catheter. In this case, the anterior wall of the chest is pierced with a special needle. Pericardial puncture is indicated for tamponade, as a complication of tumor pericarditis and other forms of pathology.
The second option is the inability of the heart muscle to contract, despite the spread of electrical impulses, which can also be caused by a growing tumor or an inflammatory process. Most often, the technique is used when pericardial effusion has just developed.
The pericardiocentesis technique is fraught with serious complications, so it is rarely used.

If pericardial effusion (filling of the heart sac with fluid) is malignant in nature, but there are no signs of tamponade, doctors, in addition to pericardiocentesis, offer the patient:

Malignant tumors affecting the myocardium are not removed surgical methods, is appointed radiation therapy which can lead to the development of radiation pericarditis

Consequences

Tumor pericarditis, like other forms of this pathology, is treated with modern medical methods. Patients usually make a full recovery. Unless the nature of the disease is malignant. In some cases, after an illness, complications develop that can even become a reason for disability.

Thickening of the pericardial layers	Fibrinous inflammation of the pericardium occurs because after the end of the process of inflammation and recovery normal amount fluid in the pericardium, fibrinogen or protein still remains in the heart sac for some time and is not absorbed. A dense plaque forms from it on the walls of the pericardium. When listening, patients experience a murmur in the pericardium for the rest of their lives, and pain may appear behind the sternum after physical exertion. The heart may become slightly larger because the muscles need to increase their oxygen consumption. In this case, the leaves of the heart sac, which have thickened, fit tightly to each other. The complication does not require treatment.
Cardiac tamponade	For pathological condition characteristic accumulation of blood in the pericardial cavity, which is the most dangerous complication. As a result of the filling of the heart sac with blood, pressure is created in it, which greatly compresses the heart. Tamponade occurs due to rupture of blood vessels, which can be injured by the tumor. To prevent the patient from dying from heart failure, urgent cardiac puncture (pericardiocentesis) is required; this increases the risk of developing infectious pericarditis in addition to aseptic pericarditis.
Fistula formation	They are formed when purulent pericarditis. But it, in turn, can be triggered by a tumor that compresses the tissues, leading to their necrosis and biological release active substances. All this can cause inflammation, including purulent inflammation. Because of pyogenic microorganisms holes form in the pericardial tissue through which the heart sac and pleural cavity or esophagus communicate naturally. After graduation purulent process the holes remain, which leads to severe pain and disruption of the heart in the future. This complication must be treated surgically to close the holes in the pericardium.
Cardiac conduction disorder	After pericarditis, disturbances in the electrical conductivity of the heart may persist for a long time. This will be expressed by attacks of rhythm disturbance, especially after physical exertion. The reason lies in damage to the muscles of the outer lining of the heart (pericardium). At normal operation Cardiomycytes conduct electrical impulses evenly. During and after the inflammatory process, their electrical conductivity changes, impulses spread unevenly. There is no treatment for the complication, so the patient long time may use antiarrhythmic drugs. When an arrhythmia significantly impairs the quality of life and affects the ability to work, a person may be assigned a disability group.

Pericardial puncture

Indications. Pericardial puncture is performed with diagnostic and therapeutic purpose. It is carried out only when fluid accumulates in the cavity of the cardiac membrane (hydropericardium, hemopericardium, exudative pericarditis). The presence of effusion should be confirmed by echocardiography and radiography. Pericardial puncture can be emergency (performed for cardiac tamponade) and planned (performed for effusion pericarditis).

Puncture technique. When performing a pericardial puncture, the patient should be in a semi-sitting position with his head tilted back and a pillow placed under the lower back (Marfan position). Regardless of whether the intervention is performed on a patient lying on bed or operating table, this provision is mandatory.
For pain relief, local infiltration anesthesia with a 0.5% solution of novocaine is used. To perform a puncture, a long needle connected to a syringe is used. The puncture is carried out in the deepest part of the pericardium to avoid getting into chest cavity. Pericardial puncture can be performed in several ways.

Method 1. A needle is inserted into the V-VI intercostal space on the left along the midclavicular line or slightly outward from it. The direction of the needle should be strictly perpendicular to the chest wall. Sequentially pass through the skin, subcutaneous tissue, muscles, intrathoracic fascia, parietal pleura and pericardium.

Method 2. The puncture can also be made from an injection into the angle formed by the costal arch and the xiphoid process (Larrey's method), or under the apex of the xiphoid process (Marfan's method).
In both cases, the skin is punctured at a right angle in the cranial direction. The skin, subcutaneous tissue, and rectus abdominis muscle with aponeurosis are pierced. This depth with average thickness abdominal wall is, as a rule, 1.5-2 cm. After puncturing the inner edge of the rectus abdominis muscle (or linea alba), the needle is advanced almost parallel to the chest wall upward and inward. In this way, advancing the needle to a depth of about 2-3 cm, the pericardium is punctured. The approach to the pericardium is determined by the beginning of the needle oscillations in the rhythm of heart contractions. In the presence of significant amount liquid is clearly felt as if the needle is falling into the cavity. If available purulent fibrous pericarditis the thickened epicardium rubs against the tip of the needle, as if it were being rhythmically drawn along sandpaper. An electrocardiograph can be used to clarify the position of the needle.
If the needle is located in a collection of pericardial fluid, the electrocardiographic curve will not change. As soon as the tip of the needle comes into contact with the epicardium, characteristic changes occur in the form of deformation of the QRS complex, expressed in a pathological Q wave and a decrease in the R wave. In case of hemopericardium, as a temporary measure in preparing the patient for surgery, a catheter is inserted into the cavity of the heart sac using the Seldinger method for continuous aspiration blood. A similar manipulation is performed with progressive exudative pericarditis. When sucking blood with a syringe during pericardial puncture, it is necessary to immediately decide whether this blood is the contents of the pericardium (hemorrhagic pericarditis). To do this, the sucked liquid must be collected in a test tube or on a piece of white gauze.

Fresh blood from bloodstream scarlet color sharply differs from stagnant hemolyzed lacquer-like blood.

Complications. When performing pericardial puncture, one should be wary of injury to the heart with the puncture needle and damage to the internal thoracic artery. When the needle penetrates into the heart cavity, it is necessary to slowly remove the needle, holding the syringe in the suction position, since it is possible that when it comes back, the needle will enter the pericardial cavity.

If this fails, then the intervention is stopped, and the patient needs intensive monitoring. In most cases, there is no bleeding when the heart wall is punctured.

Pericardectomy
The operation is performed for chronic adhesive inflammation of the pericardium, which is often accompanied by compression of the heart and vena cava. The pericardium adheres to the epicardium, and lime deposits occur in this scarred tissue. The heart is, as it were, in a stone bag. The essence of compressive pericarditis is that the heart is unable to expand during diastole, and therefore its diastolic filling decreases to a greater extent.

Technique of the operation. The operation is performed under endotracheal anesthesia. Total pericardiectomy is performed only through a median sternotomy. After spreading the edges of the sternum, the orifices are sequentially isolated great vessels and chambers of the heart. An incision of the pericardium is made in a scarred, hard, but, if possible, non-calcified area to such a depth that the contracting heart can be seen. It is fundamentally important to strictly observe the sequence of isolating the parts of the heart. They begin with the separation of adhesions that compress the outflow tract from the heart. First, the aortic root is released, pulmonary artery, and then the lateral wall of the left ventricle, the right ventricle and right atrium. The operation is completed by releasing the compression of the mouths of the vena cava. The areas that have compressed the pericardial shell are removed.

The peculiarity of this operation is that it is necessary to correctly find the layer between the pericardium and epicardium. After this, the edges of the dissected pericardium are grabbed with clamps and gradually blunt and sharp way release the epicardium. Calcified areas penetrating deeply into the myocardium are not isolated, but are bypassed, leaving them on the epicardium.

These places look like islands protruding from the surface. Calcified areas of the pericardium are bitten with Luer or Liston forceps.

Extreme caution must be used when excision of the pericardium in the area coronary vessels, atria and vena cava. The posterior part of the pericardium is usually left in place.

In addition, removal of the pericardium is done with caution to avoid damaging the phrenic nerve. The operation ends by leaving the drainage in anterior mediastinum to control bleeding and exudative process.

Pericarditis: causes, types, signs, diagnosis and treatment

Inflammation serous membrane heart (its visceral layer) is called pericarditis. This disease is caused by mechanical, toxic, immune (autoimmune and exoallergic), as well as infectious factors. They cause primary damage to the serous cardiac membrane.

Pathogenesis of the disease

The mechanism of occurrence and development of pericarditis includes the following points:

Infection enters the pericardial cavity in two ways:

Lymphogenic, most often spread through it various infections subphrenic space, lung and pleura, mediastinum;
Hematogenous, damage occurs along it viral infection or septic diseases.

With the development of diseases such as, purulent pleurisy, abscesses and tumors of the mediastinum and lung, the inflammatory process spreads directly to the pericardium. Are developing following forms pericarditis:

Fibrinous, which is characterized by the hairy appearance of the visceral layers due to the deposits of fibrinous threads on them, as well as a slight formation of fluid.
Serous-fibrinous, in which a small amount of relatively dense protein exudate is added to the fibrinous threads.
Serous, with the formation of serous exudate protein origin high density, having the ability to be completely absorbed. Pericarditis of this type is characterized by the proliferation of granulations during the resorption of exudate and the formation of scar tissue. As a result, the visceral layers are soldered; in some cases, the pericardial cavities are completely overgrown. An impenetrable membrane forms around the heart. This pathology is called “shell heart”. Sometimes adhesions are formed with outside when the pericardium fuses with the diaphragm, mediastinum, or pleura.
With hemorrhagic diathesis, tuberculosis, inflammatory processes that occur as a result of various injuries in the chest area (for example, postoperative), it develops hemorrhagic pericarditis, accompanied by a sharp increase in the number of red blood cells.
Serous-hemorrhagic, with the formation of serous purulent contents and an increase in the number of red blood cells in the blood.
Purulent accompanied by a cloudy effusion containing increased amount fibrin and neutrophils.
Putrefactive, developing as a result of an anaerobic infection.

Clinical manifestations

The symptoms of pericarditis are especially pronounced in the acute form of the disease. Very strong, acute pain occurs in the area of the cardiac apex or lower part of the sternum, similar to the pain syndrome of pleurisy or myocardial infarction. It may irradiate into epigastric region, left hand, neck or left shoulder. This is a manifestation of dry pericarditis.

With exudative (effusion) pericarditis, aching pain occurs or a feeling of heaviness appears in the chest. When effusion appears, severe shortness of breath occurs during walking or static vertical position, which intensifies as the amount of exudate increases. When a person sits down or leans forward slightly, shortness of breath decreases. This is due to the fact that purulent exudate descends to the lower areas of the pericardium, clearing the way for blood flow. Therefore, the patient instinctively tries to take the position in which it is easier for him to breathe. The fluid formed in the pericardium puts pressure on the upper Airways, which causes a dry cough. Because of this, the phrenic nerve is excited and vomiting may occur.

An increase in the amount of purulent contents accumulating in the pericardial sacs causes, accompanied by difficulty filling the left ventricle with blood when it relaxes. And this, in turn, becomes the cause of circulatory failure in big circle. This is manifested by the appearance of edema, enlarged veins cervical spine(without pulsation), ascites (edema of the abdomen) and enlarged liver. Exudative pericarditis develops against the background of subfebrile (37°-37.5°C) temperature, displacement leukocyte formula to the left. A paradoxical pulse occurs (decreased on inspiration). Blood pressure also decreases.

The chronic form of the disease is characterized by two types clinical development: adhesive and constrictive.

With adhesive pericarditis, the patient experiences aching pain in the heart, he develops a dry cough, which intensifies during physical activity.
With the constrictive type, the patient’s face becomes puffy, with signs of cyanosis, veins enlarge in the neck, and trophic disorders may appear on the skin of the legs, turning into ulcers. Beck's triad is also observed: increased venous pressure, ascites and a decrease in the size of the ventricles of the heart.

Causes of pericarditis

There are also metabolic causes pericarditis. These are thyrotoxicosis, myxedema, gout, chronic renal failure. It can lead to pericarditis, although last years Cases of rheumatic pericarditis are very rare. But inflammation of the visceral layer, caused by collagenosis or systemic lupus erythematosus, began to be diagnosed more often. Pericarditis often occurs as a consequence drug allergies. It arises as a result allergic lesion pericardial sac.

The course of particular types of pericarditis

Classification of pericarditis is carried out:

According to clinical manifestation: for fibrinous pericarditis (dry) and exudative (exudative);
According to the nature of the course: acute and chronic.

Acute fibrinous pericarditis

Acute fibrinous pericarditis (if it is independent disease) has a benign course. Its treatment is not difficult and ends in one to two months. favorable outcome(not the slightest trace remains of the disease). It has a viral etiology and occurs due to hypothermia of the body against the background of acute respiratory diseases. Young people are more susceptible to the disease. It is characterized sudden occurrence pain in the heart area (behind the sternum), accompanied by slight increase temperature.

Acute infectious pericarditis

Acute pericarditis arising from infectious diseases(for example, pneumonia) occurs without pronounced symptoms. This often makes it difficult to diagnose, which leads to the development of adhesive chronic pericarditis with the formation of a “shell heart” and adhesions. This form of the disease is dangerous because a complication may develop in the form of purulent pericarditis, which can only be treated with surgical methods.

Exudative pericarditis

Effusion pericarditis (exudative) most often occurs in subacute or chronic form, with relapses and accumulation in the pericardial cavity large quantity liquids. Clinically, it manifests itself in the form of adhesive (adhesive) and compressive (constrictive) pericarditis:

Adhesive pericarditis is characterized by rough extrapericardial fusion or deposition of lime in scar tissue with the formation of an armored heart. At the same time, the amplitude of heart contractions has no restrictions; it is often noted sinus tachycardia and a sharp muffling of heart sounds. In some cases, the disease may be asymptomatic.
Constrictive (compressive) pericarditis is more often detected in males. With the development of this form of the disease, compression of the heart occurs, which causes a decrease in blood filling in cardiac diastole. The vena cava is also compressed, resulting in decreased blood flow to the heart. Developing. The danger of constrictive pericarditis is that the inflammatory process can spread to the liver capsule and lead to its thickening. This causes compression of the hepatic veins. Pick's pseudocirrhosis occurs. In some cases, large volumes of effusion compress the left lung, leading to bronchial breathing in the area of the angle of the left scapula.

Exudative purulent pericarditis

Exudative purulent pericarditis is caused by coccal pyogenic microflora, which enters the pericardial cavity hematogenously. Most often it occurs in an acute, severe form, accompanied by intoxication of the body and elevated temperature, phenomena of cardiac tamponade in acute and subacute form. A purulent course often accompanies traumatic pericarditis. In this case, the liquid in large quantities accumulates in the pericardial cavity. Only timely diagnosis and surgery. The highest mortality rate is observed with purulent pericarditis, which develops very quickly. Drug therapy is not effective for this form of the disease.

Hemorrhagic pericarditis

Pericarditis can also develop against the background oncological diseases. Cancerous tumors give metastases to the visceral layers of the cardiac membrane. This causes hemorrhagic pericarditis. It is distinguished from other species by the presence of bloody exudate. It often develops against the background of renal failure.

Tuberculous pericarditis

When the tuberculosis bacillus penetrates the pericardial cavity by lymphogenous route or by direct transfer from the affected areas of the pleura, lungs and bronchi, tuberculous pericarditis develops. It is characterized by a slow course, accompanied by sharp pains V initial period. As fluid accumulates, the pain subsides, but returns again with a significant accumulation of purulent contents. To the stupid one, pressing pain shortness of breath is added. The treatment uses glucocorticoid steroids, protease inhibitors, drugs penicillin series to inhibit collagen synthesis.

Pericarditis in children

Pericarditis in children usually develops against the background of septic diseases and pneumonia, due to the penetration of coccal infection through the bloodstream into the pericardial cavity. Clinical manifestations practically no different from the symptoms of the disease in adults. Acute forms diseases cause in a child severe pain in the heart area, uneven heartbeat, pallor skin. The pain may radiate to the left arm and epigastric region. The child coughs and vomits. It is difficult for him to find a comfortable position, so he becomes restless and sleeps poorly. The diagnosis is established on the basis of differential diagnosis, X-ray kymographic examination, etc. It is recommended to treat pericarditis in children only using medicinal methods. No puncture is performed.

Pericarditis in animals

Pericarditis is very often diagnosed in animals. It develops when they ingest various small sharp objects. They penetrate the heart from the stomach, esophagus and wall. The disease carries traumatic nature. Its treatment is ineffective. The animal usually dies itself (cats, dogs) or is subject to slaughter. Meat can be eaten.

Medical therapy

Treatment of pericarditis consists of symptomatic, pathogenetic and etiotropic therapy.

Video: puncture for pericarditis (eng)

Folk remedies and pericarditis

It should be noted that the use of folk remedies in the treatment of all types of pericarditis is recommended only after the medications and a consultation was held with the attending physician. Self-treatment traditional medicine may worsen the course of the disease.

An exception is an infusion of young pine needles, which has both sedative, anti-inflammatory and antimicrobial properties. It can be used as an adjunct to primary treatment. To prepare you will need:

Young needles of juniper, fir, pine or spruce- 5 tbsp. spoon;
Water- 0.5 l.

Preparation procedure:

Chop the pine needles, pour boiling water over them, and cook over very low heat for 10 minutes. Leave overnight. Drink during the day (half a glass at a time).

Diagnosis of pericarditis

When examining the patient, the following is revealed:

Dry pericarditis is accompanied by slightly muffled or unchanged sounds, with a pericardial friction rub (due to a small effusion). In this case, friction noise is heard in the form of a scratching sound, the frequency of which is higher than the others. It is better heard on inspiration. Heart sounds with exudative pericarditis are muffled, friction noise is practically absent.
The x-ray clearly shows a change in the configuration of the shadows of the heart: the ascending aorta has practically no shadow, and the left contour of the heart is straightened. With an increase in the amount of accumulated fluid, the cardiac contour becomes more round with a shortening of the shadow of the bundle of blood vessels. With an increase in the amount of exudate, there is a noticeable expansion of the boundaries of the heart and a decrease in the pulsation of the shadow of the cardiac contour. Chronic pericarditis causes the heart to appear bottle-shaped or triangle-shaped on an x-ray. On X-ray kymographic recording, the amplitudes of the waves of the left ventricle are reduced.
An ECG can show changes caused by damage. surface layers myocardium with dry pericarditis. This is indicated by the elevation above the isoline of the segment ST in all leads. Gradually, with the development of the disease, its position returns to normal, but the tooth T can take a negative value. Unlike the electrocardiogram for myocardial infarction, the ECG for pericarditis has a complex QRS and prong Q not changed, but in the segment ST there are no discordant displacements (below the isoline). With exudative pericarditis, the voltage of all teeth is reduced.

The symptoms of acute exudative pericarditis are similar to the symptoms of myocarditis, cardialgia, dry pleurisy and myocardial infarction. The main difference from these diseases is following signs pericarditis:

Availability of connection pain syndrome with the position of the sick person’s body: increased in the “standing” position and when moving; weakening in the sitting position.
Clearly audible loud, diffuse pericardial friction noise.
Heart failure is caused by impaired blood flow in the systemic circle.
The ECG shows an elevated segment in all leads ST, absence of discordance, prong T negative.
Blood enzyme activity remains unchanged.
The x-ray shows an expansion of the borders of the heart and a weakening of the pulsation.

structure of the heart membrane

The most difficult thing to distinguish between pericarditis and, since both diseases are accompanied by heart failure and. Therefore, it is carried out differential diagnosis pericarditis, which includes listening and percussing heart sounds, examining blood tests (general, biochemical and immunological), echocardiographic, radioisotope, etc. The formation of an effusion is indicated by the following:

The presence of an echo-free space between the pericardium and epicardium, around the heart or behind the wall of the left ventricle;
Epicardium and endocardium of the heart walls with increased excursion;
The amplitude of pericardial movement is reduced;
The image of the right ventricle (its anterior wall) is at a greater depth.

Forecast

The prognosis of pericarditis is based on its clinical picture, which depends on the phase of the inflammatory process, the degree of sensitization of the tissues of the serous cardiac membrane, the general reactivity of the body and the nature of the inflammatory process.

The most favorable prognosis is given if cardiac pericarditis is diagnosed as a symptom of the underlying disease and during its course there is no tendency to transform into adhesive pericarditis.

Highest percentage fatal outcome observed with the development of purulent, hemorrhagic and putrefactive pericarditis. Fears for the patient’s life often arise with constrictive pericarditis, with progressive heart failure. But modern techniques surgical treatment In many cases, they can save the lives of patients even with very severe forms of the disease. Patients diagnosed with acute dry (fibrinous) pericarditis usually lose their ability to work for 2 months or more. But after completion treatment course she is fully restored.

Video: pericarditis and its treatment in the program “Live Healthy!”

Exudative pericarditis is an inflammatory process affecting the serous pericardium and accompanied by abundant accumulation of effusion. The main problem with diagnosing pericarditis is that patients often ignore symptoms until it is too late. To prevent this from happening, learn about the symptoms and treatment of pericardial effusion in advance by reading the article.

Features of the disease

In children, pericarditis is diagnosed extremely rarely: in approximately 1% of cases. Most common reason childhood pericarditis - viral diseases, such as influenza or Epstein-Barr. In adults, the list of causes is much longer, although in some cases they cannot be identified before death.

Pediatric and adult pericarditis also differ in symptoms. Thus, in children, the disease often manifests itself with fever, heart pain and high blood pressure. Treatment of pericarditis is the same in all groups.

Schematic representation of effusion pericarditis

Types and forms

Typically, doctors use the classification according to Z. M. Volynsky, which distinguishes pericarditis:

Spicy:
1. effusion or exudative;
2. with tamponade;
3. without tamponade;
Chronic:
1. effusion;
2. adhesive;
3. asymptomatic;
4. with functional disorders of the heart;
5. with lime deposits;
6. with extrapericardial adhesions;

In turn, effusion pericarditis, chronic and acute, is distinguished by the nature of the inflammatory fluid, and it can be:

Serous. Consists of water and albumin, formed on early stages development of the disease.
Serous-fibrous. It is distinguished by a high number of fibrin strands.
Hemorrhagic. Appears in the background severe damage vessels, a significant number of red blood cells are found in its composition.
Purulent. The composition contains enough leukocytes and parts of necrotic tissue.
Putrid. Appears due to the entry of anaerobic microflora into the effusion.
Cholesterol. Effusion is characterized high content cholesterol.

So, what are the reasons for the appearance of exudative pericarditis in the medical history?

You can learn about what ecdysatic pericarditis looks like from the following video:

Causes

In many cases, determine exact reason the occurrence of exudative pericarditis is impossible. However, scientists have found that pericarditis rarely occurs on its own and is usually a consequence of some disease.

U different forms Disease etymology varies. Thus, the nonspecific form is often caused by bacteria and viruses like:

staphylococcus;
streptococcus;
pneumococcus;
flu;
ECHO;
Coxsackie virus;

The background for specific pericarditis is often: tuberculosis, tularemia, Brucella and typhoid fever, candidiasis, histoplasmosis, amoebiasis and other conditions.

If we develop the theme of forms, we can see the following connections:

The tuberculosis form often appears due to the penetration of bacteria from the lymph nodes into the pericardium.
The purulent type often appears against the background of operations performed in the cardiac region, when the patient is already undergoing immunosuppressive therapy, as well as when a pulmonary abscess breaks through.
Non-infectious forms of the disease are sometimes found in oncology, allergic processes such as serum sickness, after irradiation of the mediastinum.

The risk group for those who may develop pericarditis includes not only those in whose families the disease has been observed previously, but also patients with hypothyroidism, people with impaired cholesterol metabolism, and early stages heart attack.

Symptoms and signs of pericardial effusion

Symptoms largely depend on parameters such as:

rate of fluid accumulation;
degree of compression of the heart muscle;
severity of the inflammatory process in the pericardium;

Most early symptom- a feeling of heaviness and aching pain in the chest. Gradually, fluid accumulates, causing other symptoms such as shortness of breath, dysphagia, cough, and hoarseness. Pericarditis acquires symptoms similar to, for example, swelling in the face and neck. In certain positions, a pericardial friction rub may be heard.

Depending on the cause of pericarditis, other symptoms such as:

chills;
fever;
sweating;
decreased appetite;
orthopnea;
swelling of the veins of the neck;

There are no specific symptoms, so it is important to consult a doctor promptly for a diagnosis of pericardial effusion.

Diagnostics

Diagnosis of the disease begins with an examination by a cardiologist. The doctor’s task is to identify pericarditis and differentiate it from other diseases of cardio-vascular system like a heart attack.

For differentiation, a history of symptoms and an examination are used. Patients experience a small protrusion of the anterior chest wall, edema in the precordial region, as well as weakening or complete disappearance of the apical impulse.

To confirm the diagnosis, the following studies are prescribed:

Chest X-ray. Reveals an increase in shadows and smoothing of the cardiac contours, as well as a change in the shape of the organ against the background of a large volume of fluid.
EchoCG. Allows you to detect whether there is free space between the pericardial layers and diastolic separation, which indicates pericarditis.
ECG. Indicates the presence of a decrease in the amplitude of the teeth.
Multislice CT. Helps confirm the presence of effusion and increased thickness of the pericardial layers.

A rare but accurate study is pericardial puncture. Puncture allows you to examine the pericardial fluid and with 100% probability identify the disease.

If it is impossible to conduct other studies, the patient is prescribed a pericardial biopsy.

Treatment

Treatment of exudative pericarditis is carried out in a hospital and under the supervision of a doctor. The basis of treatment is taking medical supplies, but sometimes patients are advised to undergo surgery. Cure pericarditis therapeutic method, and even more so folk remedies, impossible.

By medication

Treatment honey. drugs are aimed at eliminating pericarditis and its causes. To eliminate pericarditis, the patient is prescribed:

NSAIDs. Ibuprofen is often used because it rarely produces side effects. If pericarditis develops against the background of ischemia, then ibuprofen is replaced by diclofenac and aspirin. Third-line drugs include indomethacin.
Glucocorticosteroid drugs. Prednisolone is prescribed in cases of advanced patient condition.

At the same time, the root cause is treated with antibacterial, cytostatic and anti-tuberculosis drugs. Hemodialysis can be used to cleanse the blood.

Operation

Pericarditis is often accompanied by a very large volume of fluid. To pump it out, doctors use evacuation of effusion through a biopsy. The liquid is pumped out through a needle, so the operation is completely safe.
Sometimes drug treatment does not produce results, in which case a thoracotomy is prescribed. chest the patient is incised and the pericardium is removed, without affecting the areas where the nerve passes. The mortality rate from such an operation is less than 10%.

Basics prophylactic, warning pericarditis - competent treatment viral diseases and/or their complications. Also important:

promptly treat connective tissue diseases;
treat complications of myocardial infarction;
according to the course prescribed by the doctor;
Avoid chest trauma as much as possible;
use radiation protection if danger arises radiation injury bodies;

General recommendations boil down to compliance healthy image life and measures to boost immunity. So, it is important to observe moderate physical exercise, especially cardio exercises, and also monitor nutrition and weight, take vitamins according to the course.

Complications

Most common complication pericarditis (more than 40%) - cardiac tamponade. In this case, fluid accumulates between the layers of pericarditis, which interferes with the normal functioning of the heart muscle. In approximately 30% of cases, pericarditis is complicated by paroxysmal atrial fibrillation or supraventricular tachycardia, but only if.

Sometimes pericarditis changes appearance, which is also a complication. Often the disease becomes chronic and constrictive.

Recurrent, idiopathic, adhesive, exudative and other types of pericarditis have their own prognosis and also affect a person’s life expectancy. We'll talk about this at the end.

Forecast

The prognosis largely depends on the cause of the disease and treatment. Generally, it is assessed as favorable, since more than 70% of patients survive for 5 years. On the other hand, if tamponade develops, the probability of death is high (more than 50%).

Even more useful information a well-known TV presenter will provide us with information on exudative and other types of pericarditis in the following video: