Pericarditis with pneumonia. Acute fibrinous pericarditis. Pericarditis - symptoms

Pericarditis- inflammation of the visceral and parietal layers of the pericardium, which can manifest as fibrotic changes or accumulation of fluid in the pericardial cavity, which impairs the physiological function of the heart muscle.

The pericardium is necessary to maintain the correct orientation of the heart in the mediastinum and protect the myocardium from excessive growth during volume overloads. It consists of an outer fibrous part and an inner serous part, which can be divided into the serous sac of the pericardium itself and the epicardium, which is tightly adjacent to the heart muscle. Between them is a cavity containing approximately 20-30 ml of fluid that serves to moisturize the surface of the pericardium and reduce friction during heart contractions.
Many viral and bacterial infections, coronary heart disease (CHD), pneumonia, systemic diseases connective tissue, tumor or autoimmune processes, allergic reactions may provoke pericarditis.

In a healthy person, the amount of pericardial fluid is constant; its composition is plasma ultrafiltrate. With the development of the pathological process, there is an increase in the exudation of fluid and protein components of the blood into the pericardial cavity, which first leads to an increase in pressure and compression of the heart from the outside, and then, due to fibrin deposits, peculiar adhesions are formed. All of the above processes significantly reduce the efficiency of heart contractions, thereby creating a predisposition to the development of heart failure.

Symptoms of pericarditis

Pathology rarely occurs as independent disease, most often occurs against the background of other nosological units, as a complication. Accordingly, there is a characteristic absence of a specific clinic; in the most severe forms, a clinical picture of heart failure is formed. Most often patients complain:

• for pain in the chest area,
• shortness of breath,
• palpitations,
• irregular or fast pulse
• pericardial friction rub,
• dry cough,
• general malaise,
• fever.

Typically, symptoms may include varying degrees depending on the form of the disease: acute, which lasts less than six weeks, and chronic - lasting more than two months.

Diagnosis of pericarditis

To diagnose the disease, a comprehensive examination is used, consisting of an external examination of the patient, electrocardiography (ECG), echocardiography (EchoCG), blood test, and chest x-ray.

External examination reveals swelling of the neck veins, cyanosis, edema lower limbs. Auscultation reveals the presence of a one-, two-, or three-phase pericardial friction rub. An ECG is quite informative for diagnosis, allowing one to determine ST segment elevation in the anterior and posterior leads. The service provides a unique opportunity for early detection pathological changes cardiac muscle and pericardial sac. Using a cardiovisor, it is possible to identify minimal deviations from the norm in the structure and functioning of the myocardium, which makes it possible to increase the effectiveness of subsequent treatment. An echocardiogram shows the presence of effusion, as well as concomitant diseases of the cardiovascular system. A blood test detects markers of the inflammatory process (ESR, level C-reactive protein and lactate dehydrogenase, number of leukocytes) and markers of myocardial damage (determination of the level of troponin I and the MB fraction of creatine phosphokinase). During X-ray examination, the image of the heart varies from normal to resembling a “water bottle”.

Treatment of pericarditis

Treatment methods directly depend on the severity of the disease: in the acute form, hospitalization is indicated to exclude tamponade; in milder cases, it is possible to stay on an outpatient basis.

Non-steroidal anti-inflammatory drugs (NSAIDs) are used for therapeutic effect. Ibuprofen is used more often due to rare side effects, beneficial influence on coronary blood flow and a wide range of therapeutic doses. If the disease occurs against the background of the development of coronary artery disease, it is more advisable to use aspirin or diclofenac. Third-line drugs for the treatment of pericarditis include indomethacin, due to high frequency development of complications.

Together with NSAIDs, it is necessary to provide a course of taking drugs that protect the mucous membrane gastrointestinal tract, reducing the risk of gastric ulcers.
After just two weeks, you can evaluate the correctness of the chosen treatment regimen. In the case of the correct medication, therapy is continued until the symptoms of the disease completely disappear and for an additional one week, reducing the dose for the last 2-3 days of use until complete withdrawal. If the selected NSAID turns out to be ineffective, it must be replaced with an NSAID from another group.
It is also possible to use colchicine in addition to NSAIDs or alone, since this medicine often well tolerated and has fewer side effects than other drugs. To avoid relapses or constriction after recovery, a mandatory step is monitoring the patient and monitoring the physiological function of the myocardium, which can be done at home using a cardiovisor and service, if you have a personal computer.

Acute pericarditis

Acute pericarditis occurs as a result of previous infections (especially viral ones), acute myocardial infarction, chronic renal failure, rheumatoid arthritis, systemic lupus erythematosus, allergic reaction.

Clinical symptoms and etiological factors of this disease extremely variable, so it is often mistaken for other syndromes, which makes diagnosis very difficult. The initial stages of diagnosis include laboratory tests, chest X-ray examination and Doppler echocardiography. It is important to prevent cardiac tamponade - compression of the myocardium with blood or exudate, which gradually accumulates in the pericardial cavity. For this purpose, pericardiocentesis is often used, the resulting fluid is examined in the same way as pleural fluid. In cases of ineffectiveness of the above methods and relapses of cardiac tamponade, drainage of the pericardial cavity and biopsy are possible.

Treatment is carried out with antibiotics, NSAIDs, to prevent systemic side effects intrapericardial administration of glucocorticosteroids is indicated. To eliminate cardiac tamponade moderate degree severity, the use of diuretics with simultaneous treatment of the underlying disease is permissible. In the case of atrial fibrillation, antiarrhythmic drugs are often prescribed.

Constrictive pericarditis

Constrictive pericarditis (squeezing)- chronic adhesive, in which thickening of the pericardium develops (often with its calcification) and powerful cicatricial adhesions, leading to disruption of the heart. The most severe form of the disease, developing as a result of infection, closed and open injuries heart and pericardium, myocardial infarction, blood diseases, uremia, scurvy or most often as a result of rheumatic tuberculosis and purulent inflammation pericardium.

The pericardial layers are thickened to 2-3 cm and fused with the heart by coarse scar tissue. Later, deep damage to the heart muscle develops in combination with myocardial fibrosis, deterioration of the hepatic and portal circulation. Muscle fibers become significantly thinner, their atrophy and fatty degeneration are observed due to a decrease in the workload on the ventricles.

Diagnosis is often difficult because signs are similar to congestive heart failure, including edema, ascites, hepatic congestion, splenomegaly, and decreased exercise intolerance.

When examining the patient, cyanosis and swelling of the face, ears, and hands are determined. The main symptom of compressive pericarditis is increased venous pressure, with lower limits arterial norms, the apex beat is usually not detected. There is constant tachycardia, while maintaining sinus rhythm Paradoxical pulse is easily established, an additional tone appears in the protodiastolic phase. Characteristic ECG changes- this is an extended P wave (more than 0.1 s), high and clearly contrasts with the low-voltage QRS complex. On X-ray examination, a constant sign is the absence of a cardiac waist and differentiation of the arches, as the contours of the heart muscle straighten. With one-dimensional echocardiography, an increase in the thickness and intensity of echo signals from the pericardial layers with a small gap between them is indicated, reliable sign is the diastolic movement interventricular septum from the sensor.

Constrictive pericarditis It is futile to treat with conservative methods, it is necessary to resort to surgery. In preparation for surgery, the patient is prescribed diuretics, trying to reduce venous pressure and reduce ascites. The use of cardiac glycosides is unacceptable, since tachycardia is a compensatory factor that increases the cardiac output; accordingly, glycosides, by reducing the heart rate, can lead to negative consequences.

Dry pericarditis

Dry or fibrous pericarditis a disease in which, due to changes in permeability vascular wall Fibrinogen sweats into the pericardial cavity, precipitates and is deposited in the form of fibrin, forming an inflammatory infiltrate.

There are three main clinical symptoms - sudden pain V chest, pericardial friction noise and significant changes on the ECG. The pain occurs unexpectedly, is localized in the center of the sternum with irradiation to the dorsal region, is constant, has varying intensity, intensifies with coughing, sneezing, swallowing, breathing, lasts for several hours, and may temporarily weaken with the use of analgesics. The murmur is inconsistent, gradually spreads and intensifies, is heard in systole and diastole, and is better expressed in the zone of absolute dullness of the heart.

With timely access to qualified help, a correctly established diagnosis, and adequate treatment, the prognosis for most patients is favorable. However, relapses are possible due to autoimmune mechanisms, and worsening of the disease with the development of exudative pericarditis.

Effusion pericarditis

Effusion pericarditis occurs as a consequence of infectious, allergic inflammation, usually complicates the course of rheumatism, tuberculosis, staphylococcal and streptococcal infections and is characterized by the accumulation of exudate in the pericardial cavity or other biological fluid (transudate, pus, blood). Over time, this leads to a gradual stretching of its outer leaf. As a result of acute effusion pericarditis - complete or partial organization of effusion with the formation of pericardial adhesions. With an increase in intrapericardial pressure, compression of the heart increases, and hemodynamic disturbances appear.

The clinic depends on the severity of the disease infectious process, the amount of fluid accumulated in the pericardial cavity and the rate of increase in its volume. Due to the difficulty of myocardial expansion during diastole due to tamponade, patients are characterized by attacks of weakness and weakening of the pulse, cyanosis spreads, which can lead to loss of consciousness.

For the diagnosis of exudative effusion pericarditis important stages There will be percussion and auscultation of the chest. An increase in the size of the heart shadow is detected by fluoroscopy and radiography when 200-300 ml of fluid accumulates in the pericardial cavity, while the shadow is located in the middle, the contours are smoothed, and the boundaries are enlarged in both directions. EchoCG makes it possible to detect effusion in the pericardial cavity in small quantities (50-100 ml). Hyperkinesia of the entire cardiac circuit and interventricular septum, as well as dysfunction valve apparatus. The most important sign of myocardial tamponade is a decrease in left ventricular diastolic volume during inspiration.
The main treatment method in case of severe clinical picture exudative pericarditis - evacuation of fluid from the pericardial cavity by puncture. Indications for puncture will be the presence of symptoms of tamponade, the assumption of a purulent nature of the process, and the absence of a tendency for exudate to resolve over a certain period of time.

Pericarditis in children

Infants often develop or complicate the course of generalized staphylococcal infection spicy exudative pericarditis. Often the disease occurs with meningococcemia and streptococcal diseases (tonsillogenic sepsis, tonsillitis). In older children, pericarditis is observed with viral infections, rheumatism, rheumatoid arthritis and others diffuse diseases connective tissue, representing part of polyserosite. Specific and rare forms pathologies: toxic, in severe forms of nephritis with uremia; fungal, bacterial, autoreactive; may be a manifestation of blood diseases, vitamin C deficiency, dysfunction thyroid gland, tumors of the heart and pericardium, hereditary diseases and a consequence of drug or hormonal therapy.

The symptoms and clinical picture correspond to those described above; they may be complicated by the presence of an infectious or viral process in the body against the background of a weakened immune system.
Laboratory diagnostics and radiology are usually uninformative and do not allow an accurate diagnosis. An early sign detected on the ECG is an arcuate upward shift of the ST interval in standard and precordial leads with a high, pointed, positive T wave. Accordingly good helpers for parents, a cardiovisor can be used, which allows you to recognize the very first signs of cardiovascular pathology in children without leaving home and monitor the effectiveness of the proposed treatment. Moreover, the use of the device is permitted for children over five years of age. For infants, EchoCG indicators are especially informative, allowing one to determine even a slight effusion into the pericardial cavity; its quantity can be determined by the width of the echo-negative zone.

In the treatment of children, antibacterial and anti-inflammatory drugs are used, which are approved according to age criteria. The duration of the course depends on the form of the course and the severity of clinical syndromes. At correct diagnosis, timely treatment and the absence of complications, in most cases there is a complete recovery.

Rostislav Zhadeiko, especially for the project.

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Heart medications must be strictly followed by all instructions of the treating cardiologist. You cannot choose medications and determine the dosage on your own. After all, therapy for this disease involves the use of different groups drugs that have different therapeutic effect.

What drugs can be used: their mechanism of action and features of use

Basic treatment of cardiac pericarditis is based on eliminating symptoms. Additionally, medications are prescribed to neutralize the cause of the disease. Let's review drugs for basic circuit treatment.

Anti-inflammatory analgesics: Aspirin, Ibuprofen, Indomethacin, Diclofenac. This group refers to non-selective inhibitors of cyclooxygenase 1 and 2. Cyclooxygenase is an enzyme that is involved in reducing inflammatory processes. The drugs in question help thin the blood, eliminate the inflammatory process, relieve pain and increase effusion. Admission rules:

1. Acetylsalicylic acid should be taken up to 8 times a day, 500 mg. The duration of the course is 14-21 days.
2. Diclofenac is taken three times a day, 50 mg maximum. The course of treatment is 21 days.
3. Ibuprofen is prescribed 400 mg four times a day.
4. Indomethacin – 4 times a day, 50 mg.

These medications should be taken immediately after meals, as they have a negative effect on the stomach, developing gastritis and ulcers.

Non-steroidal anti-inflammatory drugs. TO selective inhibitors cyclooxygenase 2 include Lornoxicam, Meloxicam, Celecoxib. The drugs have anti-inflammatory properties. Unlike the previous group, the effectiveness is slightly lower, but the drugs do not have negative impact on the gastrointestinal tract. Therefore, they are prescribed even when ulcerative manifestations. Rules of application:

1. Lornoxicam is produced in tablet and injection form. Tablets are taken twice a day, 8 mg. An injection solution is also used. The duration of the course is 21 days.
2. Meloxicam should be taken twice a day, 7.5 mg.
3. Celecoxib – 200 mg maximum once a day.

Morphine is considered the most highly effective and fastest acting. If dosages are artificially increased, addiction may develop. Negatively affects the respiratory system. Therefore, strictly adhere to the prescribed doses.

The drug is available in an injection solution that can be administered either intramuscularly or intravenously. The lower the intensity of the pain threshold, the lower the dosage required. The minimum dose is 2 mg, the maximum is 15. The injection solution can be used up to 2 times a day.

Pentazocine is administered intramuscularly or taken orally up to 8 times a day. The maximum dose of solution is 60 mg, tablets – 100. Use orally after eating.

Tramadol is used for intramuscular injection and oral administration. The duration of treatment is 14 days. Take 50 mg tablets twice a day. With very strong pain threshold The dose is allowed to increase to 200 mg. Injections are also administered 2 times a day, but 100 mg maximum.

This group of medications can be addictive, so exceeding the dosage on your own is strictly prohibited.

Many basic therapy drugs have a negative effect on the gastrointestinal tract, so appropriate medications are additionally prescribed. And the main therapy is prescribed depending on the cause of cardiac pericarditis.

Features of treatment with drugs for various types of pericarditis

What to do when there is no cardiac tamponade? If there is no cardiac tamponade and the effusion is moderate, the doctor will prescribe diuretics that will quickly remove excess fluid from the body. The most commonly used is regular Furosemide. The duration of the course of treatment is 6-8 days. The dosage is gradually reduced towards the end of therapy.

Additionally, hormonal glucocorticosteroids are prescribed. They neutralize the inflammatory process. The most commonly used drugs: Prednisolone, products based on prednol, decortin and metipred. The greatest effect can be achieved by injecting the drug into the pericardial area.

What to do with cardiac tamponade? If cardiac tamponade is present, a puncture from the pericardium is performed, after which glucocorticosteroid solutions are administered directly into the pericardium.

Treatment infectious species pericarditis of the heart. In case of infectious damage to the pericardium of the heart, therapy is carried out in a hospital under the strict supervision of medical staff. The prescribed drugs are administered by injection - inside a vein.

The following antibiotics are used:

1. Benzylpenicillin is used for streptococcal infections. It is administered intravenously up to 6 times a day. The duration of treatment is 21 days maximum.
2. Vancomycin is used for staphylococcal bacteria. The drug is administered twice a day.
3. Amoxiclav (a mixture of clavulanic acid and amoxicillin). The minimum duration of therapy is 14 days. Administered intravenously up to 4 times a day.

Therapy of tuberculous pericarditis. For tuberculous lesions of the cardiac pericardium, the treatment method is selected based on the type of disease and the severity of the underlying pathology. Therapy is carried out in an isolated facility. The duration of treatment is long. Medicines:

1. Pyrazinamide is taken orally three times a day.
2. Isoniazid is also available in tablets, but you need to take it a maximum of twice a day.
3. Rifampicin is administered exclusively intravenously twice daily.

If a stable reaction to the prescribed drugs is detected, they are replaced with alternative ones. In each specific case, an individual dosage is selected.

Treatment of fungal pericarditis. At fungal infection intravenous administration of drugs is carried out. The duration of the course of treatment is at least one and a half months. The most commonly used are Flucytosine and Amphotericin B. The former is administered by drip over 6 hours. Another drug is also used as a dropper. Feature - in some cases specific treatment is not required at all, because the disease goes away on its own.

What to do with viral pericarditis? At viral infection heart disease, basic treatment is used, and antiviral drugs are not used. Additionally, for some types of virus, the following treatment is carried out.

For cytomegalovirus, hyperimmunoglobulin is used, which is administered intravenously. The therapy regimen is specific: the drug is used on the first, fourth, eighth day of treatment. Then, after another 4 days, a half-reduced dosage is administered.

For parvovirus B19 and adenovirus, an immunoglobulin solution is injected dropwise over 8 hours. Two procedures are enough: on the first day of general therapy and on the third.

For Coxsackie virus, a puncture of interferon beta or alpha is performed. The drug is injected into the organ cavity.

Therapy of autoimmune pericarditis. If pericarditis occurs against the background of autoimmune disorders, hormonal anti-inflammatory drugs are used. Cytostatics are also prescribed. They are needed to slow down the growth and process of cell division. Colchicine may also be used.

The therapy is quite complex, so it is extremely rare to completely get rid of the pathology. This is influenced by factors such as the amount of effusion, the ability of it to be absorbed, the presence of heart murmurs and the level of white blood cells in the blood.

Treatment of pericarditis with medications during pregnancy and lactation

It is known that during pregnancy and subsequent breastfeeding, many medications are strictly prohibited for a woman, as they can harm the fetus and child. But what to do if pericarditis is detected? After all, this disease is considered serious.

So, pericarditis can be treated only in the 3rd trimester, since there are great risks at other stages of pregnancy. For the same reason, if pericarditis is detected in the 1st and 2nd trimester, it is more advisable for a woman to have an artificial termination (abortion).

Therapy for a pregnant or lactating woman is aimed at neutralizing the causative agent of the disease, relieving symptoms and preventing the development of complications. Treatment is carried out in inpatient conditions. Primary requirements:

• compliance bed rest;
• exclusion of intensive physical activity;
• avoiding overwork;
• proper nutrition, rich in magnesium, potassium;
• exception stressful situations and any unrest in general;
• strict compliance with all instructions of the treating specialist.

If infectious pericarditis of the heart is detected, it is prescribed antibacterial treatment. Antibiotics are selected taking into account the pathogen and the absence of contraindications for use during pregnancy and lactation. Anti-inflammatory drugs, painkillers and immunomodulators are required.

If appointed strong antibiotics, breast-feeding should be cancelled. If secondary cardiac pericarditis is detected, it is necessary to achieve resorption of the effusion, therefore corticosteroids are prescribed. If there is a rapid accumulation of exudate or significant compression of the heart muscles, then surgical intervention.

In the treatment of cardiac pericarditis, early detection of the disease and timely treatment play a huge role. The earlier treatment for pericarditis is started, the better prognosis. Therefore, carefully study how the pathology manifests itself, and if you have such symptoms, go to a specialist who will prescribe you medication.

The heart allows blood to move through the vessels and carry useful material and oxygen, taking away carbon dioxide And unnecessary elements. The heart is one of the organs that, if it loses its functionality, will deprive a person of life. Thus, you need to take care of your heart organ. According to statistics, in 5-6% of cases people die only due to various heart diseases. This is a fairly high figure...

What is pericarditis?

What is pericarditis? This disease is called inflammation of the pericardium (heart sac) - the outer lining of the heart, in which the organ, in fact, is located.

Classification

The classification of pericarditis is very complex and varied:

Pericarditis of the heart sac is one of the group of diseases that can develop for many reasons. There are so many reasons that it is difficult to count them to give a specific description. However, this is precisely what complicates the process of treating the disease. If you do not establish an accurate diagnosis, then it is impossible to prescribe effective treatment. This means that relapses are possible – repeated manifestations of pericarditis.

Conventionally, all causes can be divided into infectious and non-infectious. With an infectious nature, pericarditis occurs due to the penetration of various microorganisms. If non-infectious - due to non-bacterial factors, for example, the effects of drugs or complications after surgery. It is noteworthy that one can flow into another. Non-infectious pericarditis can become infectious due to bacteria attaching to the affected area. The same thing happens in reverse: you can get rid of infections, but the area will be so affected that the disease will not go away.

Bacterial pericarditis must be preceded by the following factors:

• Presence of effusion or blood in the heart sac.
• Immunosuppressive therapy when glucocorticosteroid abuse occurs.
• Alcohol and drugs, which suppress the immune system and allow bacteria to invade weak organs.
• Open heart injuries and surgeries where bacteria can enter directly from environment to the organ

Autoimmune pericarditis develops against the background of the following diseases:

1. Rheumatoid arthritis;
2. Polymyositis;
3. Scleroderma;
4. Vasculitis;
5. Behçet's syndrome;
6. Sarcoidosis;
7. Lupus erythematosus;
8. Wegener's granulomatosis.

Metabolic pericarditis develops as a result of such pathologies in the body:

• Hypothyroidism;
• Kidney failure;
• Pregnancy;
• Because of high level cholesterol;
• Due to drug abuse.

Tumor pericarditis metastasizes against the background of such diseases:

1. Lung cancer (40%);
2. Breast cancer (22%);
3. Leukemia (15%);
4. Skin cancer (myeloma) (3%);
5. Cancers of the gastrointestinal tract (4%);
6. Malignant neoplasms in other organs (16%).

Symptoms and signs

Symptoms and signs of inflammation of the heart sac depend on the form of the disease. In acute pericarditis, the following symptoms can be observed:

• Heat;
• Heaviness in the chest;
• Chest pain.

The subacute form is less pronounced than the acute form.

The chronic form is determined by swelling of the veins in the neck, difficulty breathing, fatigue, and sudden weight loss.

Effusion pericarditis is characterized by the following symptoms:

• Dyspnea;
• Heaviness in the chest;
• Feeling of fullness.

The symptoms of adhesive pericarditis are similar to those of constrictive pericarditis, only less pronounced. The main symptom is chest tightness due to blood pooling in the heart.

Common symptoms of all types of pericarditis are:

• Chest pain;
• Temperature rises to 39ºС;
• Dyspnea;
• Swelling of the jugular veins;
• Cardiac irregularities in the frequency of contractions (arrhythmia);
• Swallowing problems (dysphagia);
• Possible cough. If, along with this, sputum comes out and the temperature rises, then pneumonia may develop;
• Enlarged liver, ascites, enlarged spleen;
• Pale skin;
• Swelling of the face and neck;
• Severe weight loss;
• Pain in the head;
• Fast fatiguability.

The symptoms described above are not specific, which makes diagnosing the disease difficult. You should go to a clinic, where laboratory tests and instruments can be used to determine the cause of these symptoms.

Pericarditis in children

If pericarditis occurs in children, it occurs after 6 years. It is often called by infectious causes for influenza, typhoid, tuberculosis, etc. Sometimes the disease goes away on its own. The child complains of shortness of breath and fatigue for some time. But in order to eliminate the disease, it is better to consult a pediatrician.

Pericarditis in adults

Pericarditis is common in adults for the reasons described above. Occurs in 55% of women, 45% of men. Often observed in older people whose organs have already worn out and lost their elasticity. There is no need to self-medicate, but it is better to be under the supervision of a cardiologist who will provide treatment.

Diagnostics

Diagnosis of pericarditis begins with interviewing the patient and some objective examinations: general examination, percussion, palpation, ausculation. If pericarditis is suspected, as well as to clarify the disease, instrumental and laboratory diagnostics are performed:

• Echocardiography.
• X-ray of the sternum.
• Electrocardiography.
• Blood, urine and stool analysis.
• Pericardial biopsy analysis.
• Analysis of fluid (exudate) from the pericardial cavity.

Treatment

Treatment of pericarditis is carried out both in a hospital setting and at home. None traditional methods will not help in healing. Treatment is carried out only with medication. The patient can be sent home only mild case forms of the disease (here, periodic visits to the doctor are mandatory). In severe forms, the patient is treated in a hospital.

Diet does not play an important role in the treatment of inflammation of the heart sac. However, some recommendations are given:

1. Products should be rich in proteins and vitamins;
2. Limit consumption fatty foods and animal fat;
3. Eliminate alcohol;
4. Limit water and salt in case of exudative pericarditis.

How to treat pericarditis? Only with the help of medications, physical therapy and surgery. The following medications are prescribed:

Surgical intervention is performed if the patient’s condition worsens, with cardiac tamponade and purulent exudate, when the heart tissue melts. Pericardiectomy and pericardiocentesis are performed here.

Lifespan

How long do they live with pericardium? Everything depends on the provision timely assistance. In some types, heart failure may suddenly occur, causing the patient to die. In other types, the disease either cures itself or is easily treatable. Life expectancy can range from a few days and months to years of full-fledged existence.

Much still depends on the complications that may arise during improper treatment or its absence:

• Thickening or sticking of the pericardium;
• Formation of fistulas;
• Cardiac tamponade;
• Ascites;
• Heart failure, obstruction of the heart.

After recovery, all symptoms of pericarditis disappear within about 3 months. It is necessary to periodically visit a cardiologist to confirm recovery and as a preventative measure for the disease (early detection).

Pericarditis is an inflammatory process in the pericardium, which is serosa hearts. The pathology is characterized by the accumulation of fluid in the pericardial cavity or the formation of fibrous strictures, which negatively affects the functional activity of the heart muscle.

Causes and types of pericarditis

Pericarditis can have a wide variety of etiologies. It usually develops as a complication of another pathology.

Much less often, pathology develops independently.

According to the accepted classification, it is customary to distinguish the following types of pericarditis:

• infectious;
• traumatic;
• autoimmune;
• idiopathic.

Congenital forms are extremely rare.

According to the nature of the flow in clinical practice There are acute, subacute and chronic pericarditis. The acute form is characterized by rapid development and... The subacute form develops several weeks or even months after exposure causative factor. Chronic pericarditis develops even more slowly.

Most often, cardiologists have to deal with the idiopathic type of pericarditis.

Pericarditis can cause significant thickening and decreased elasticity of the pericardium (the constrictive variety). Against the background of pathology, inflammation of the epicardial heart muscle (myopericarditis) is possible.

Symptoms of pericarditis

The leading symptoms of pericarditis include pain or a feeling of heaviness in the chest. They tend to intensify with a deep breath.

In case of acute development, the first symptoms may be shortness of breath, or cardiac tamponade, accompanied by a sharp decrease in blood pressure or

Pain stupid character may spread to the shoulders or neck. Its intensity varies from mild to very severe. The pain increases with coughing and swallowing, but decreases somewhat when the body bends forward. Sometimes rapid breathing, fever, general weakness and nonproductive cough.

Symptoms of constrictive pericarditis:

• pronounced
• an increase in the size of the abdomen due to the accumulation of fluid in it (as a result).

One of the leading signs of constrictive pericarditis is more or less pronounced swelling of the lower extremities.

With pericarditis due to myocardial infarction, a febrile reaction and. Specific symptoms develop in the period from 10 days to 2 months after a heart attack.

Diagnostics

The basis for diagnosis is characteristic symptoms, changes in, auscultatory signs (pericardial friction noise), as well as fluid accumulation in the pericardial cavity, which is detected during or. To clarify the cause of the disease, it is carried out additional examination sick.

note

Most important symptom is a precordial pericardial friction noise - systolic and diastolic or triphasic. IN in rare cases You can detect pleural noise if the area immediately adjacent to the pericardium is inflamed.

During radiography, congestion in the lungs and an increase in the cardiac shadow are clearly visible in the image.

In rare cases, surgery is required.

Colchicine (0.5-1 g) is administered orally once a day. It is considered a first-line drug. It helps reduce the frequency of relapses, and in patients with the first attack, the severity clinical symptoms in the next three days.

The patient must be prescribed drugs from the group and anti-inflammatory drugs, as well as drugs that normalize metabolism in the myocardium and drugs containing potassium. (acetylsalicylic acid) is prescribed in doses of up to 650 mg orally with a time interval of 4-6 hours. give the patient 600-800 mg per os every 6-8 hours. Excessively intense pain may require the use of narcotic analgesics - opioids.

In most cases, a positive effect can be achieved within a week of drug treatment, but the duration of the course can only be determined by the attending physician. As a rule, therapy is continued until C-reactive protein disappears in the blood, ESR normalizes, and effusion resolves.

For pain and inflammation, corticosteroid hormones, in particular prednisone, are often indicated. It is prescribed orally 1 time per day, 60-80 mg for a week. The dose is gradually reduced while simultaneously using colchicine. prescribed if no positive effect is observed after using colchicine or NSAIDs. Prednisone should also be prescribed for autoimmune or uremic origin or connective tissue diseases. Particular caution should be exercised when using corticosteroids because they increase viral replication.

If such a need arises, some drugs (triamcinolone) are injected directly into the pericardium (300 mg/m2). The procedure does not cause systemic side effects. Indications for its implementation are exacerbations of pericarditis and resistant (resistant to standard treatment) form of the disease.

At acute course pericarditis, anticoagulants are usually contraindicated, since they can cause tamponade or bleeding, but their use is justified in early pericarditis, which has become a complication of myocardial infarction.

Against the background of an exacerbation (relapse) if the patient has pain, non-steroidal anti-inflammatory drugs or colchicine are used. The single dose is 0.5 mg (orally), and the frequency is 2 r/day. Course therapy is carried out from 6 to 12 months, gradually reducing the dose. If these measures are ineffective or if non-infectious origin pericarditis, glucocorticosteroids may be prescribed.

Revealing infectious nature disease requires the use of antibiotics (intravenously). At idiopathic form or post-infarction syndrome there is no need for them. Choosing the optimal antibacterial agent carried out taking into account the sensitivity of pathogenic microflora to it. If pericarditis has developed against the background, parallel use of 2-3 for 7-8 months is indicated.

The pain syndrome is well relieved by NSAIDs and prednisone (20-60 mg daily for 3-4 days). At positive reaction drugs are often discontinued after 1-2 weeks of course therapy. The dosage is reduced gradually.

To reduce the severity of pericarditis against the background of uremia, frequent sessions of hardware blood purification (hemodialysis) are performed and glucocorticosteroids are administered into the pericardial cavity or systemically (intravenously). Intrapericardial triamcinolone also helps achieve a good therapeutic effect.

For the treatment of recurrent effusions as a result of the development of a malignant tumor process, sclerosing pharmacological agents can be used.

The use of prednisolone for the treatment of secondary pericarditis significantly accelerates the resorption of effusion, especially if there is allergic origin disease or it develops as a result of systemic (rheumatic) connective tissue diseases.

In the presence of congestive heart failure against the background of a chronic constrictive type of pathology, a sharp restriction of consumption is indicated table salt and use of diuretics (diuretics). If ventricular systolic dysfunction or atrial arrhythmia occurs, digoxin is prescribed.

note

Often, conservative (medicinal) treatment can take many months. After pericardial surgery, colchicine is prescribed from day 3 after surgery, and for 30 days the patient receives a “saturating” dose (2 g per day), after which it is reduced to 1 g.

Surgical treatment of pericarditis, pericardiocentesis

Most patients with acute pericarditis require urgent hospitalization in a specialized hospital department, especially if there is no response to NSAIDs or the temperature has increased. In conditions medical institution it is possible to conduct a full examination to establish the real reason pathology and monitoring for timely diagnosis of such dangerous complication, How cardiac tamponade, requiring urgent surgical intervention of pericardiocentesis (puncture of the pericardium to remove effusion).

Signs of impending cardiac tamponade:

• difficulty and rapid breathing superficial nature;
• paleness of the skin;
• severe general weakness;
• arrhythmia;

The indication for pericardiocentesis is the slow resorption of the effusion (over two weeks), as well as obtaining this biological material to determine the cause of its occurrence. The fluid in the pericardium may be chylous, serous, serous-hemorrhagic, or hemorrhagic in nature. Sometimes fibrin threads are found in the effusion.

Timely removal of fluid from the pericardial cavity can save the patient's life.

Tamponade occurs when a large volume of effusion prevents the heart from filling with blood, leading to sharp decline cardiac output. With the rapid accumulation of blood, even a relatively small volume (within 150 ml) can provoke this life-threatening complication, since the pericardial structures are not capable of such rapid stretching. If blood accumulates slowly, then tamponade may not occur even if blood accumulates in a volume of 0.5 liters or more.

Forecast

As a rule, patients experience clinical recovery within 3 months, and the disease does not lead to any complications. After graduation recovery period a person can lead a normal lifestyle. Recurrences of pericarditis – quite a rare event; in this case, you must definitely seek qualified medical help.

Prevention of pericarditis

To avoid pericarditis, you should not suffer from colds and others on your feet.

called pericardium outer connective tissue layer of the heart. Its main role is to maintain the position of the heart relative to the chest and protect against distension in response to a sudden volume load. Its serous inner layer is tightly connected to the heart muscles, and the outer fibrous layer surrounds the heart muscles loosely. The serous, in turn, is divided into the epicardium and the serous sac. The epicardium is closely connected to the myocardium.

During the contractile movements of the heart, a frictional force arises in its sac, which is overcome by the fluid between the epicardium and the heart muscle. U healthy people the amount of this liquor is constant and is no more than 20 ml.

The development of pericarditis leads to an increase in the amount of fluid, and the protein content in it increases. These processes provoke compression of the heart muscle, complicate its normal functioning and create conditions for the formation of adhesions.

Pericarditis is a fairly common disease, but statistics indicate difficulties in identifying it. Inflammation of the pericardium does not depend on the place of residence and race of a person; its causes can be determined age category patients. This disease is diagnosed more often in women than in men.

CAUSES

Inflammation of the outer lining of the heart is more common occurs as a result of the development of other pathological processes. The structure of the heart itself contributes to the appearance internal inflammation, which the most are capable of causing various diseases Therefore, pericarditis is usually classified as a polyetiological disease.

The most common cause of pericarditis is infectious factors such as rheumatism. Bacterial agents also play a certain role, but in most cases the nature of the disease remains unspecified. Currently, the number of aseptic (non-infectious) pericarditis, which is caused by allergic, drug and autoimmune factors, is increasing.

CLASSIFICATION

Factors for the classification of pericarditis are the etiology and its clinical and diagnostic manifestations.

Classification of pericarditis by origin:

• Infectious(bacterial, rheumatic, fungal, viral, rickettsial in origin and caused by protozoa).
• Non-infectious, or aseptic (allergic, traumatic, post-infarction, autoimmune, medicinal, caused by diseases of the blood, connective tissue, malignant neoplasms, arising after irradiation).
• Idiopathic(etiology unknown).

Clinical classification distinguishes acute and chronic forms of pericarditis. Acute can occur without fluid accumulation. Sometimes inflammation is accompanied by the formation of effusion, and cardiac tamponade may also accompany this condition.

Types of acute pericarditis:

• dry (fibrous);
• exudative (exudative);
• with cardiac tamponade;
• without cardiac tamponade.

Acute pericarditis has the property of transitioning to chronic.

Types of chronic pericarditis:

• asymptomatic;
• effusion;
• constrictive;
• sticky (adhesive);
• with lime deposits.

SYMPTOMS

Signs of pericarditis differ depending on the characteristics of the pathological process, its duration and the type of accumulated exudate. Often the disease does not occur independently, but against the background of other diseases, so it is clinical manifestations nonspecific.

Symptoms of the disease develop as follows:

• Initially, the inflammatory process occurs without the formation of exudate due to the deposition of fibrin in the affected areas of the epicardium. At this time the disease manifests itself as sharp or dull and squeezing pain in the chest. Deep breathing, sudden turns of the body and coughing can increase the pain syndrome. Taking nitroglycerin does not reduce the severity of symptoms. The pain can spread to the left subclavian region; the neck and shoulder area are also involved. Pain syndrome accompanied by a preliminary increase in body temperature, general weakness, myalgia, fast fatiguability and drowsiness.
• The defining symptom for a specialist is pericardial friction rub. The tissues of the heart sac, altered by the inflammatory process, create friction when the heart muscles contract. These sounds resemble creaking, grinding and scratching. After 2-3 weeks, fibrous pericarditis may heal or become exudative or adhesive.
• Almost simultaneously with the deposition of fibrin in the pericardial cavity, effusion begins to accumulate. At first, the pericardial leaves are still able to absorb it, so the amount of liquid is insignificant, its accumulation occurs gradually.
• The accumulation of effusion affects the reduction of pain, but other symptoms also develop in parallel: dyspnea, rapid heartbeat, extended jugular veins on the neck, impaired consciousness, cyanosis, pallor of the mucous membranes and skin. At this stage, the pericardial friction noise is no longer heard.
• The accumulation of exudate can lead to cardiac tamponade. The fluid pressure on it internal cavities prevents normal contractile movements, and the patient’s pulse may disappear when inhaling. Pallor and cyanosis are increasing, swelling in the neck and face is steadily progressing. Due to fluid pressure on the upper pericardium and cardiac veins, the patient may experience swelling of the left arm.
• As the pathological process develops, the liver becomes involved. It increases and becomes painful. In addition, effusion can collect in the lungs.

The acute stage ends with constrictive pericarditis, a sign of which is stagnation of fluid in all organs, with the exception of the lungs. This form of the disease develops chronically and gradually leads to an increase in heart failure.

DIAGNOSTICS

Timely detection of pericarditis is extremely important, as it poses a danger to the patient’s life. To identify pericarditis, instrumental methods are used, laboratory research and examination of the patient. The diagnosis is mainly differentiated to exclude infarction, hydropericardium and tumor process.

Tests for diagnosing pericardium:

• biochemical, immunological study blood;
• clinical urine and blood tests;
• phonocardiography;
• X-ray examination of the chest;
• MRI and MSCT of the heart;
• CT scan of the chest;
• pericardial puncture.

TREATMENT

The treatment method is selected depending on the type of pericarditis and its etiology. To determine the diagnosis, when the first symptoms appear, you need to seek help from a therapist and cardiologist. Self-medication is strictly not recommended, as certain forms of the disease pose a threat to life. Acute pericarditis requires hospitalization, while chronic is treated on an outpatient basis.

General principles of non-drug treatment of pericarditis:

• good nutrition;
• limiting animal fats;
• exclusion of alcoholic beverages;
• a diet with limited salty foods and any liquid.

The main importance in the treatment of pericarditis belongs to anti-inflammatory therapy, as well as the fight against primary disease, provoking the development of pericardial symptoms.

The main methods of treating pericarditis include medication and surgery. Basic therapy medicines indicated for patients with inflammatory processes. For this purpose, anti-inflammatory and painkillers are prescribed. Such therapy purposefully eliminates the symptoms of the disease and has a positive effect on the patient’s condition, but as an element symptomatic treatment does not eliminate the cause of inflammation.

Etiological treatment is carried out to eliminate the root cause of the disease. In this case, the prescription of drugs depends on the primary disease.

Treatment methods depending on the type of disease:

Surgery is indicated when severe complications that threaten the patient's life. Indications for surgical techniques treatment is profuse effusion into the pericardial cavity with cardiac tamponade, severe purulent lesion tissues, chronic constrictive pericarditis and signs of an “armored” heart. Drug treatment of these pathological conditions does not show a significant result.

COMPLICATIONS

Timely detection of the disease and qualified assistance leads to complete recovery in most patients. IN severe cases pericarditis there are likely complications that may cause disability.

The main complications of pericarditis:

• acute cardiac tamponade;
• development of circulatory failure;
• infectious;
• fusion or thickening of the pericardial layers;
• formation of fistulas (holes);
• disruption of cardiac muscle conduction.

PREVENTION

Measures to prevent pericarditis include preventing the development of precipitating diseases, as well as their timely diagnosis and treatment.

PROGNOSIS FOR RECOVERY

Forecast relatively favorable. Adequate treatment leads to full restoration normal life activity, but partial loss of ability to work is possible.

Purulent form of the disease in the absence of necessary therapeutic measures poses a serious threat to the patient's life. The results of adhesive pericarditis are permanent changes in the heart, and even surgical intervention in this case does not show high effectiveness.

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