Inflammation of the pericardium may have different causes. Most often this condition is secondary, that is a complication of other diseases. There are several forms of pericarditis, characterized by the symptoms and treatment. Signs and symptoms of this disease are varied. Often it is not immediately diagnosed. Suspicion of inflammation of the pericardium - the basis for patient referral to a cardiologist.
What it is?
Pericarditis - inflammation of the serous membrane of the heart, the most common visceral leaf that occurs as a complication of a variety of diseases, rarely as an independent disease.
Etiology distinguish infectious, autoimmune, traumatic and idiopathic pericarditis. Morphologically, manifested by an increase of fluid volume in the pericardial cavity or formation of fibrotic strictures, resulting in difficulty of the heart.
The causes of pericarditis
The most common pericarditis in adults caused by Escherichia coli, meningococci, streptococci, pneumococci, and staphylococci. Pericarditis caused by other representatives of the microflora, are much less common, but they are also recorded in the statistics. For example, tuberculosis contributes to pericarditis in 6 out of 100 cases. Approximately 1% of patients with pericarditis caused by dwelling in the body of parasites and fungal diseases. Cause of idiopathic (non-specific), pericarditis can be the causative agents of influenza group A or B, ECHO viruses and enteroviruses Coxsackie group A or B rapidly proliferating in the digestive tract.
There are metabolic causes of pericarditis. It - hyperthyroidism, Dressler's syndrome, myxedema, gout, Chronic renal failure. By pericarditis can cause rheumatic fever, although in recent years, cases of rheumatic pericarditis observed very rarely. But inflammation of visceral leaf, caused by collagen diseases or systemic lupus erythematosusIt became increasingly diagnosed. Pericarditis often occurs as a result of drug allergy. It arises as a result of an allergic lesion of pericardium.
Classification
Classification divides disease acute (lasting up to six months) and chronic forms.
| chronic pericarditis | It has a long duration, typical for infections such as rheumatic fever, tuberculosis. With slow filling liquid pericardium can accommodate a large number of, sometimes without sharp circulatory disorders. |
| acute pericarditis | occurs when a sufficiently strong infection or sudden weakening of the body, in traumatic pericardial leaflets during penetrating wounds. It is characterized by more severe course. It depends on the rapid filling of the pericardium and the inflamed fluid caused by circulatory disorders. |
Anatomical differences are distinguished:
- dry, fibrinous pericarditis - in the cavity bags falls fibrin, which leads to a subsequent fusion of the sheets;
- pericardial, accompanied by accumulation of fluid.
Pericarditis distinguished by the nature of fluid (exudates): fibrinous, seroplastic, serous, purulent, hemorrhagic (bloody), putrid.
The disease can develop without inflammatory reaction, for example, hydropericarditis with heart failure, decrease thyroid function characterized by a gradual accumulation of fluid. In this case the treatment needs correction hormonal composition.
Hemopericardium with blood in the heart cavity bags arises in wounds, bleeding, blood diseases, tumors germination.
The symptoms of pericarditis
Pericarditis in adults rarely develop as an independent disease, most often a complication of common diseases. For pericarditis is characterized by a slight increase in body temperature. Intense pain in the sternum, which by their strength and intensity reminiscent of the pain of angina or myocardial infarction, but continues for a longer time. Painful sensations are not associated with physical activity, may increase during inhalation, ingestion, change of body position.
The key, "breast", pericarditis symptoms in adults include:
- Sharp, knife-like pain behind the breastbone. It caused by friction of the pericardium of the heart.
- The pain can be amplified when coughing, swallowing, deep breath, trying to go.
- The pain becomes less when a person sits tilted forward.
- In some cases, the patient holds the chest with your hand or tries to squeeze something to it (eg, a pillow).
Other symptoms of pericarditis may include:
- Chest pain, radiating to the back, neck and left arm.
- Shortness of breath, worse lying down.
- Dry cough.
- Anxiety, fatigue.
Some people with pericarditis may appear swelling in the legs. Usually it is a symptom of constrictive pericarditis, a very severe form of the disease.
Constrictive pericarditis, pericardial tissue thickens, compacted and does not allow the heart to work normally, limiting its range of motion. In this case, the heart can not cope with the volume of blood pumped into it. Because of this, and there is swelling. If such a patient will not receive adequate treatment, it may develop pulmonary edema.
Pericarditis or any suspicion at him - a reason to call an ambulance immediately or get in the hospital on their own (with the help of friends and relatives), t. To. This condition is very dangerous and requires treatment.
Diagnostics
Examination starts with listening thorax suspected pericarditis through a stethoscope (auscultation). The patient should be lying on your back or lean back with a support on the elbows. Thus you can hear the distinctive sound, which publishes the inflamed tissue. This noise resembles the rustling of fabric or paper, called a pericardial friction.
Among the diagnostic procedures that can be performed within the differential diagnosis with other diseases of the heart and lungs:
- Ultrasound provides an image of the heart and its structures in real time.
- Chest X-ray to determine the size and shape of the heart. When the liquid volume in a 250 ml pericardial heart image in the picture is increased.
- Electrocardiogram (ECG) - measurement of cardiac electrical impulses. The characteristic features of the ECG pericarditis help distinguish it from myocardial infarction.
- Magnetic resonance imaging - stratified body of an image obtained by magnetic fields and radio waves. It allows you to see the thickening, inflammation and other changes in the pericardium.
- Computed tomography is useful if you need to get a detailed image of the heart, for example, in order to avoid thrombosis of the pulmonary artery or aortic dissection. Using CT also determine the degree of thickening of the pericardium for diagnosis of constrictive pericarditis.
Blood tests typically include: a general analysis, determination of ESR (inflammatory process indicator), the level of urea nitrogen and creatinine to assess renal function, AST (aspartate aminotransferase) for analysis of the liver, heart lactate dehydrogenase as the marker.
pericarditis treatment in adults
Hospitalization and inpatient treatment is the preferred form of care. However, after the first days of the examination the patient can be discharged home for outpatient medical treatment (treatment at home with periodic visits to outpatient clinics). This is possible with mild disease when doctors are convinced that this disease is not prone to complications.
Methods of treatment of pericarditis in adults and its duration determines the cause, cause inflammation and the development of certain complications. When the first signs and symptoms of pericarditis should consult a doctor or therapist-cardiologist. These experts can identify the disease at an early stage and to determine further tactics of diagnosis and treatment. Self-medication with pericarditis invalid because some forms of the disease may jeopardize the patient's life.
The general principles of non-drug treatment of pericarditis:
- nutrition;
- restriction of animal fats;
- the exclusion of alcoholic beverages;
- diet with restriction of salt products and any liquid.
The major importance in the treatment of pericarditis belongs to anti-inflammatory therapy, as well as the fight against primary disease, provokes the development of pericardial symptoms.
Among the main methods of treatment of pericarditis include medication and surgery. Basic Drug therapy is indicated in patients with inflammatory processes. For this purpose, be appointed inflammatory and analgesic drugs. Such therapy specifically eliminates the symptoms of the disease and has a positive effect on the condition of the patient, but as an element of symptomatic treatment does not eliminate the causes of inflammation.
Etiological treatment is carried out to eliminate the root causes of the disease. In this case prescriptions depend on the primary disease.
- If purulent process is required antibiotics orally or intravenously through the catheter into the pericardial cavity, after removing pus from it.
- Acute pericarditis dry treated symptomatically - prescribed analgesics, antiinflammatories, drugs to maintain normal metabolism in the heart muscle, magnesium and potassium formulations.
- In allergic pericarditis used glucocorticoids, and supplement this treatment of the process that caused pericarditis.
- In tuberculous lesions appoint two or three anti-TB drugs for six months or longer.
With the rapid accumulation of fluid in the pericardial cavity of a puncture needle is performed with the introduction of the catheter and removing the liquid. In the formation of adhesions is performed heart surgery, removing the deformed sections of the pericardium and adhesions.
Forecast
Relatively favorable prognosis. Adequate treatment leads to the full restoration of normal life, but it is possible partial disability.
Purulent form of the disease in the absence of the necessary remedial measures poses a serious threat to the life of the patient. The results are resistant adhesive pericarditis changes in the heart, and even surgery in this case does not show high efficiency.
