Pericardial consequences. Pericarditis

Given that pericarditis is usually diagnosed quite late, they can become a cause of disability in the future. According to statistics, neglected pericarditis accounts for 0.05 - 0.5% of all cases of disability due to cardiovascular diseases. Disability is defined cardiovascular insufficiency. It is observed mainly in constrictive and recurrent pericarditis.

To undergo a medical and social examination to determine the disability group, it is necessary to provide the results of the following studies:

• general and biochemical analysis blood;
• general and biochemical analysis of urine;
• results of 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 distributed is different for each country. The first group usually includes patients with constrictive pericarditis or shell heart, who various reasons no surgical treatment was performed pericardectomy).

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

The heart is in a kind of bag, which is commonly called a heart bag. An inflammatory process that is localized in the pericardium or heart sac (outer shell) is called pericarditis. The treatment of pathology, which is quite common, is carried out by cardiologists, often cardiac surgeons and oncologists.

Very often, the disease can be detected only after the death of the patient and his autopsy. The prevalence of pathology does not depend on the territory of residence and gender, although in women the problem occurs a little more often.

AT different periods of life, patients have pericarditis 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 different reasons one of which is tumor formation. It is not difficult to identify it with the help of ultrasound of the heart, X-ray, echocardiography, MRI.

In this case, as in many others, treatment should be aimed at eliminating the cause, if the inflammatory process is removed with the help of medications, this will bring temporary relief, 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, during the formation of a tumor, direct mechanical compression of the tissues of the pericardium affects, which are subsequently destroyed and compacted.

Tumor-like formations have two natures of the lesion:

Primary	appear as a result of the fact that the cells of the pericardium mutate; the detection of such a pathology in patients during life is insignificant, therefore, very often (in 75% of cases) it is determined by an autopsy; only 3-5% can be diagnosed; 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 metastasis is helped by blood flow, so it moves in the body, like an infection; once in the pericardium, the cell begins to divide, a malignant neoplasm is formed; metastases in the heart sac appear due to lung cancer(40%), breast (22%), leukemia (15%), gastrointestinal tract (4%), melanoma (3%), other organs (16%).

On the 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 mechanism of the inflammatory process can affect the coronary (heart) vessels and own tumors, squeezing and damaging them, pericardial sheets, tissues surrounding the neoplasm.

A healthy heart contains 5–30 ml of pericardial fluid in the pericardium, which reduces friction between the layers of the heart 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, pressure increases there, which leads to squeezing the heart from the outside. The diastolic function of the heart muscle is impaired, the heart cannot fully relax.

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

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

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

Having 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 work of the heart, but can lead to serious complications.

The method of treating tumor pericarditis depends on the inflammatory process that is caused by the neoplasm, 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 by medicines. To remove a benign and malignant formation, the complications that they caused, surgical intervention is required.

With drug therapy:

• inflammation is removed;
• symptoms of pericarditis are eliminated;
• the 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 aimed at relieving the patient of the complications caused by tumor pericarditis. These include accumulation of extra fluid (effusion) in the heart sac, tamponade (blood in the chambers of the heart due to vascular damage), purulent injury tissues, the development of chronic, 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 shell of the heart, which has thickened, will lead to real therapeutic effect and relieve the symptoms of pericarditis. Operation is prohibited when respiratory failure, bleeding disorder, chronic diseases at the stage of exacerbation. Methodology surgical intervention involves two types of pericardectomy: total, when the heart bag is removed, but its back part is preserved; subtotal, when the heart sac is removed different areas where 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 exudative pericarditis has just developed. The technique of pericardiocentesis is fraught with serious complications, so it is rarely used.

If the pericardial effusion (filling of the heart sac with fluid) is malignant, 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, appointed radiation therapy which can lead to the development of radiation pericarditis

Effects

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

Thickening of the layers of the pericardium	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 for some time in the heart bag and is not absorbed. On the walls of the pericardium, a dense plaque forms from it. When listening in patients until the end of life, there is noise in the pericardium, pain may appear behind the sternum after physical exertion. The heart may get a little bigger because the muscles need to increase their oxygen intake. At the same time, the sheets of the heart bag, which have thickened, fit snugly against each other. The complication does not require treatment.
Cardiac tamponade	For pathological condition characterized by accumulation of blood in the pericardial cavity, which is the most dangerous complication. As a result of filling the heart sac with blood, pressure is created in it, which greatly compresses the heart. Tamponade occurs due to rupture of blood vessels that can be injured by the tumor. To prevent the patient from dying of heart failure, an urgent puncture (pericardiocentesis) of the heart is required, this increases the risk of developing infectious pericarditis in addition to aseptic.
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. because of pyogenic microorganisms holes are formed in the tissues of the pericardium through which the heart bag and pleural cavity or esophagus communicate naturally. After graduation purulent process 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.
Violation of the conduction of the heart	After suffering pericarditis, a violation of the electrical conduction of the heart may persist for a long time. This will be expressed by bouts of rhythm disturbance, especially after physical exertion. The reason lies in the defeat of the muscles of the outer shell of the heart (pericardium). At normal operation cardiomyocytes conduct electrical impulses evenly. During and after the inflammatory process, their electrical conductivity changes, the impulses propagate 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 with the accumulation of fluid in the cavity of the heart shirt (hydropericardium, hemopericardium, exudative pericarditis). The presence of an effusion should be confirmed by echocardiography and radiography. Pericardial puncture can be emergency (performed with cardiac tamponade) and planned (performed with effusion pericarditis).

Puncture technique. The patient, when performing a puncture of the pericardium, should be in a semi-sitting position with the head thrown back and a pillow placed under the lower back (Marfan's position). Regardless of whether the intervention is performed on a patient lying on a bed or operating table, this provision is mandatory.
For anesthesia, local infiltration anesthesia with a 0.5% solution of novocaine is used. For 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. In the V-VI intercostal space on the left along the mid-clavicular line or somewhat outward from it, a needle is inserted. The direction of the needle should be strictly perpendicular to the chest wall. Consistently pass through the skin, subcutaneous tissue, muscles, intrathoracic fascia, parietal pleura and pericardium.

Method 2. A 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. Pierce the skin, subcutaneous tissue, rectus abdominis muscle with aponeurosis. This depth at medium thickness abdominal wall is, as a rule, 1.5-2 cm. After puncturing the inner edge of the rectus abdominis muscle (or white line), the needle is advanced almost parallel to the chest wall up and inward. By advancing the needle in this way at a depth of about 2-3 cm, the pericardium is punctured. The approach to the pericardium is determined by the beginning fluctuations of the needle in the rhythm of the contractions of the heart. In the presence of significant amount liquid is well felt as if the needle is falling into the cavity. If there is purulent fibrous pericarditis the thickened epicardium rubs against the tip of the needle, as if it were being rhythmically drawn over sandpaper. To clarify the position of the needle, you can use an electrocardiograph.
If the needle is in the accumulation 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 hemopericardium, as a temporary measure, when preparing the patient for surgery, a catheter is inserted into the cavity of the heart shirt according to the Seldinger method for permanent aspiration blood. A similar manipulation is performed with progressive exudative pericarditis. When sucking blood with a syringe during a 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 differs sharply from stagnant hemolyzed lacquer blood.

Complications. When performing a puncture of the pericardium, one should be wary of injuring the heart with a puncture needle and damaging the internal thoracic artery. When the needle enters the cavity of the heart, it is necessary to slowly remove the needle, holding the syringe in the suction position, since it is possible that the needle will fall into the pericardial cavity during the return.

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

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

Operation technique. The operation is performed under endotracheal anesthesia. Total pericardectomy is performed only through a median sternotomy. After breeding the edges of the sternum, the mouths are sequentially isolated main vessels and chambers of the heart. A pericardial incision is made in a scar-modified, hard, but possibly non-calcified area to such a depth that a beating heart appears. It is fundamentally important to strictly observe the sequence of allocation of heart departments. 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, right ventricle and right atrium. The operation is completed by release from compression of the mouths of the hollow veins. The areas of the pericardium that squeezed the shell are removed.

A feature of this operation is that it is necessary to correctly find the layer between the pericardium and the epicardium. After that, the edges of the dissected pericardium are grasped with clamps and gradually blunt and sharp way release the epicardium. Calcified areas that penetrate deeply into the myocardium are not isolated, but go around, leaving them on the epicardium.

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

It is necessary to manipulate extremely carefully when excising the pericardium in the area coronary vessels, atria and vena cava. The posterior part of the pericardium is usually left in place.

In addition, the removal of the pericardium is carried out with care in order not to damage the phrenic nerve. The operation ends with the drainage being left 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. Mechanical, toxic, immune (autoimmune and exoallergic), as well as infectious factors lead to this disease. They cause primary damage to the serosa of the heart.

Disease pathogenesis

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

Infection enters the pericardial cavity in two ways:

1. Lymphogenic, most often spread through it various infections subphrenic space, lung and pleura, mediastinum;
2. Hematogenous, on it there is a lesion 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 extends directly to the pericardium. Develop the following forms pericarditis:

• fibrinous, which is characterized by a hairy appearance of visceral sheets due to deposits of fibrinous filaments 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 fibrinous filaments.
• Serous, with the formation of serous exudate protein origin high density with the ability to be completely resorbed. This type of pericarditis is characterized by the growth of granulations during the resorption of exudate and the formation of scar tissue. As a result, soldering of visceral sheets occurs, in some cases, the pericardial cavities are completely overgrown. An impenetrable membrane forms around the heart. This pathology is called "armored heart". Sometimes adhesions form with outside when the pericardium fuses with the diaphragm, mediastinum, or pleura.
• With hemorrhagic diathesis, tuberculosis, inflammatory processes that occur with various injuries in the chest area (for example, postoperative), 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 cloudy effusion containing increased amount fibrin and neutrophils.
• Putrefactive developing due to anaerobic infection.

Clinical manifestations

The symptoms of pericarditis are especially pronounced in the acute form of the disease. Very severe, sharp pain occurs in the area of ​​\u200b\u200bthe heart apex or lower part of the sternum, similar to pain in pleurisy or myocardial infarction. It may irradiate 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 in the chest. When an effusion occurs, severe shortness of breath occurs during walking or static vertical position, which increases as the amount of exudate increases. When a person sits or leans forward slightly, shortness of breath decreases. This is due to the fact that purulent exudate descends to the lower parts of the pericardium, freeing 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 exerts pressure on the upper Airways which causes a dry cough. Because of this, the phrenic nerve is stimulated, and vomiting may occur.

An increase in the amount of purulent contents accumulating in the pericardial sacs causes, accompanied by difficult filling of the left ventricle with blood when it relaxes. And this, in turn, causes circulatory failure in big circle. This is manifested by the appearance of edema, an increase in veins cervical(without pulsation), ascites (abdominal dropsy) and liver enlargement. Exudative pericarditis develops against the background of subfebrile (37 ° - 37.5 ° C) temperature, displacement leukocyte formula to the left. There is a paradoxical pulse (decreased on inspiration). The BP also goes down.

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

1. With adhesive pericarditis, the patient experiences aching pains in the heart, he has a dry cough, with an increase during exercise.
2. With the constrictive type, the patient's face becomes puffy, with signs of cyanosis, the veins on the neck increase, 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. May lead to pericarditis, although in 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. Often, pericarditis occurs as a result of drug allergy. It arises as a result allergic lesion pericardial sac.

The course of particular types of pericarditis

The classification of pericarditis is carried out:

• According to clinical manifestation: on fibrinous pericarditis (dry) and exudative (effusion);
• By the nature of the flow: acute and chronic.

Acute fibrinous pericarditis

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

Acute infectious pericarditis

Acute pericarditis due to infectious diseases(for example, pneumonia) proceeds without bright severe 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 is treated only by surgical methods.

Effusive (exudative) pericarditis

Effusive pericarditis (exudative) most often occurs in a subacute or chronic form, relapses and accumulation in the pericardial cavity a large number liquids. Clinically, it manifests itself in the form of adhesive (adhesive) and squeezing (constrictive) pericarditis:

1. Adhesive pericarditis is characterized by rough extrapericardial fusion or deposition of lime in scar tissue with the formation of a shelled heart. At the same time, the amplitude of heart contractions has no restrictions, it is often noted sinus tachycardia and a sharp muffled heart tones. In some cases, the disease may be asymptomatic.
2. Constrictive (compressive) pericarditis is more common in males. With the development of this form of the disease, squeezing of the heart occurs, which causes a decrease in blood filling of cardiac diastole. The vena cava is also compressed, as a result, blood flow to the heart is disturbed. Developing. The danger of constrictive pericarditis is that the inflammatory process can move to the hepatic 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 region of the angle of the left scapula.

Exudative purulent pericarditis

Exudative purulent pericarditis is caused by coccal pyogenic microflora that enters the pericardial cavity by hematogenous route. Most often, it occurs in an acute, severe form, accompanied by intoxication of the body and elevated temperature, the phenomena of cardiac tamponade in acute and subacute form. Purulent course often accompanies traumatic pericarditis. At the same time, the liquid in large quantities accumulates in the pericardial cavity. Save the life of a patient with a diagnosis of "purulent pericarditis" can only be timely diagnosis and surgery. The highest mortality rate is observed with purulent pericarditis, which develops very quickly. Medical therapy in this form of the disease is not effective.

Hemorrhagic pericarditis

Pericarditis can also develop against the background oncological diseases. Cancer tumors give metastases to the visceral sheets of the heart membrane. This causes hemorrhagic pericarditis. It is distinguished from other species by the presence of bloody exudate. Often it develops against the background of renal failure.

Tuberculous pericarditis

With the penetration of a tubercle bacillus into the cavity of the pericardium by the lymphogenous route or by its direct transition from the affected areas of the pleura, lungs and bronchi, tuberculous pericarditis develops. It is characterized by a slow flow, accompanied by sharp pains in initial period. As the fluid accumulates, the pain subsides, but returns again with a significant accumulation of purulent contents. To the blunt pressing pain shortness of breath is added. Treatment includes glucocorticoid steroids, protease inhibitors, penicillin series to inhibit collagen synthesis.

Pericarditis in children

Pericarditis in children usually develops against the background of septic diseases and inflammation of the lungs, due to the penetration of coccal infection through the bloodstream into the pericardial cavity. Clinical manifestations practically do not differ from the symptoms of the disease in adults. Sharp forms cause diseases in a child severe pain in the region of the heart, 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, does not sleep well. The diagnosis is established on the basis of differential diagnosis, X-ray kymography and. Treatment of pericarditis in children is recommended only medical methods. The puncture is not done.

Pericarditis in animals

Pericarditis is very often diagnosed in animals. It develops when they swallow various small sharp objects. They enter the heart from the side of the stomach, esophagus and wall. The disease wears traumatic nature. His treatment is ineffective. The animal usually dies on its own (cats, dogs) or must be slaughtered. Meat can be eaten.

Medical therapy

Treatment of pericarditis consists in 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 they are canceled. medical preparations and consulted with the attending physician. Self-treatment traditional medicine may exacerbate the course of the disease.

The exception is an infusion of young coniferous needles, which has both sedative, anti-inflammatory and antimicrobial properties. It can be used as an adjunct to the main treatment. For cooking you will need:

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

Cooking order:

Grind needles, pour boiling water, cook for 10 minutes over very low heat. Insist night. Drink throughout the day (half a glass at a time).

Diagnosis of pericarditis

When examining a patient, the following is revealed:

1. Dry pericarditis is accompanied by slightly muffled or unchanged, with a pericardial friction rub (due to a small effusion). In this case, the friction noise is heard in the form of a scratching sound, the frequency of which is higher than the others. It is best heard on inspiration. Heart sounds with exudative pericarditis are muffled, friction noise is practically absent.
2. The radiograph 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 accumulating fluid, the cardiac contour becomes more round with a shortening of the shadow of the vascular bundle. With an increase in the amount of exudate, the expansion of the boundaries of the heart and a decrease in the pulsation of the shadow of the cardiac contour are noticeable. Chronic pericarditis causes the outline of the heart to look like a bottle or triangle on x-ray. On X-ray kymographic recording, the amplitude of the teeth of the left ventricle is reduced.
3. ECG shows changes caused by damage surface layers myocardium in 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 is normalized, but the prong T can take a negative value. Unlike the electrocardiogram in myocardial infarction, the ECG in pericarditis has a complex QRS and prong Q not changed, but in the segment ST there are no discordant shifts (below the isoline). With exudative pericarditis, the voltage of all teeth is reduced.

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

• Availability of communication pain syndrome with the position of the body of a sick person: strengthening in the “standing” position and when moving; weakening in the sitting position.
• Well auscultated loud, diffuse pericardial friction rub.
• Heart failure is caused by impaired blood flow in a large circle.
• On the ECG, an elevated segment in all leads ST, lack of discordance, prong T negative.
• The enzymatic activity of the blood is unchanged.
• On the radiograph, the expansion of the boundaries of the heart and the weakening of the pulsation are noticeable.

structure of the heart

It is most difficult to distinguish pericarditis from, since both diseases are accompanied by heart failure and. Therefore, differential diagnosis pericarditis, which includes listening and percussion of heart sounds, blood tests (general, biochemical and immunological), echocardiographic, radioisotope, and. The following indicates the formation of an effusion:

1. The presence between the pericardium and epicardium, around the heart or behind the wall of the left ventricle, echo-free space;
2. Epicardium and endocardium of the heart walls with increased excursion;
3. The amplitude of movement of the pericardium is reduced;
4. 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 membrane of the heart, the general reactivity of the organism 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 transition to adhesive pericarditis.

The highest percentage lethal 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 allow in many cases to save the life 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 or more months. But after completion treatment course she fully recovers.

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

Exudative pericarditis is an inflammatory process that affects the serous pericardium and is accompanied by a profuse 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 exudative pericarditis in advance by reading the article.

Features of the disease

In children, pericarditis is diagnosed extremely rarely: in about 1% of cases. Most common cause children's 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 established before death.

Children's and adult pericarditis also differ in symptoms. So, in children, the disease is often manifested by fever, pain in the heart and high blood pressure. Treatment of pericarditis is the same in all groups.

Schematic representation of effusion pericarditis

Types and forms

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

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

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 the development of the disease.
• Serous-fibrous. It has a high number of fibrin strands.
• Hemorrhagic. Appears in the background severe damage vessels, in its composition a significant number of erythrocytes is found.
• Purulent. The composition contains enough leukocytes and parts of necrotic tissues.
• Putrid. Appears due to the ingress of anaerobic microflora into the effusion.
• Cholesterol. The effusion is characterized high content cholesterol.

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

You can learn about what exudative 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 manifests itself and is usually the result of a disease.

At different forms disease etymology varies. So, the non-specific form is often caused by bacteria and viruses like:

1. staphylococcus;
2. streptococcus;
3. pneumococcus;
4. flu
5. ECHO;
6. coxsackie virus;

The background for specific pericarditis is more 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 tuberculous 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 with a breakthrough of a pulmonary abscess.
• Non-infectious forms of the disease are found in oncology, allergic processes like 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 was observed earlier, but also patients with hypothyroidism, people with impaired cholesterol metabolism, and early dates heart attack.

Symptoms and signs of exudative pericarditis

Symptoms largely depend on parameters such as:

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

Most early symptom- Feeling of heaviness and aching pain in the chest. Gradually, the fluid accumulates, so other symptoms appear, such as shortness of breath, dysphagia, cough, hoarseness. Pericarditis acquires symptoms similar to, for example, puffiness appears in the face and neck. At a certain position, a pericardial friction rub may be heard.

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

1. chills
2. fever;
3. sweating;
4. loss of appetite;
5. orthopnea;
6. swelling of the veins of the neck;

There are no specific symptoms, so it is important to consult a doctor in time for the diagnosis of exudative pericarditis.

Diagnostics

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

For differentiation, an anamnesis of symptoms is used, as well as an examination. Patients have a small protrusion of the anterior chest wall, edema in the precordial region, as well as weakening or complete disappearance of the apex beat.

To confirm the diagnosis, the following studies are prescribed:

• Chest x-ray. It reveals an increase in shadows and smoothing of cardiac contours, as well as a change in the shape of an organ against the background of a large volume of fluid.
• EchoCG. Allows you to detect if there is free space between the sheets of the pericardium 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 sheets.

A rare but accurate study is a pericardial puncture. The puncture is allowed to examine the pericardial fluid and with 100% probability to identify the disease.

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

Treatment

Treatment of exudative pericarditis is carried out in a hospital and under medical supervision. The basis of treatment is the reception medical preparations but sometimes surgery is indicated for patients. cure pericarditis therapeutic method, and even more so folk remedies, impossible.

In a medical way

Medical treatment. drugs aimed at eliminating pericarditis and its causes. To eliminate pericarditis, the patient is prescribed:

• NSAIDs. Ibuprofen is often used because it rarely gives side effects. If pericarditis has developed against the background of ischemia, then ibuprofen is replaced by diclofenac and aspirin. Third-line drugs include indomethacin.
• Glucocorticosteroid preparations. Prednisolone is prescribed in cases of a neglected condition of the patient.

Together with this, the underlying cause is treated with antibacterial, cytostatic and anti-tuberculosis drugs. Hemodialysis may be used to purify the blood.

Operation

• Often, pericarditis is accompanied by a very large volume of fluid. To pump it out, doctors use the evacuation of the effusion through a biopsy. The liquid is pumped out through a needle, so the operation is completely safe.
• Sometimes drug treatment does not give results, in this case a thoracotomy is prescribed. chest the patient is dissected, and the pericardium is removed, while not affecting the areas where the nerve passes. Mortality from such an operation is less than 10%.

Main prophylactic to prevent pericarditis competent treatment viral diseases and/or their complications. Also important:

1. timely treat diseases of connective tissues;
2. treat complications of myocardial infarction;
3. at the rate prescribed by the doctor;
4. avoid trauma to the chest as much as possible;
5. use radiation protection if there is a danger radiation injury body;

General recommendations boil down to compliance healthy lifestyle life and measures to boost immunity. So, it is important to observe moderate physical exercise, especially cardio exercises, as well as monitor nutrition and weight, take vitamins at the rate.

Complications

Most frequent complication pericarditis (more than 40%) - cardiac tamponade. In this case, fluid accumulates between the sheets of pericarditis, which interferes with the normal functioning of the heart muscle. In about 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 will talk about this at the end.

Forecast

The prognosis largely depends on the cause of the disease and treatment. It is generally rated as benign, as more than 70% of patients survive for 5 years. On the other hand, if tamponade develops, then the probability of death is high (more than 50%).

Even more useful information on exudative and other types of pericarditis, we will be provided by a well-known TV presenter in the following video: