Pericarditis symptoms and treatment in children. Get treatment in Korea, Israel, Germany, USA. Treatment and prognosis

Inflammation of the pericardial sac most often occurs in adults. It is believed that pericarditis occurs in only 5-6% of babies. Only acute form The disease manifests itself with typical symptoms.

In some cases, the disease proceeds almost unnoticed and without necessary treatment may cause serious complications and a threat to the child's life. That's why timely diagnosis pericarditis in children is very important.

Causes

This disease rarely occurs on its own. Pericarditis is a consequence of various infectious and chronic diseases of the child.

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Most often, inflammation of the pericardial sac is caused by the following reasons:

• streptococcal or staphylococcal bacterial infection;
• tuberculosis;
• rheumatism;
• frequent viral diseases, enteroviruses and influenza are especially dangerous for the pericardium;
• heart surgery or severe chest injury;
• kidney dysfunction;
• cancerous tumors;
• metabolic disorders due to poor nutrition;
• improper use of certain medications, especially hormonal ones, their overdose.

Pericarditis is most common in very young children. bacterial origin. It can develop due to nosocomial infection even in the maternity hospital.

Symptoms

Parents should notice the first signs of the disease. It is important to make a timely diagnosis and begin treatment.

The peculiarity of pericarditis in children is that it is quite difficult to recognize the disease. Infants simply show restlessness and often cry. If the disease occurs in, it is often mistaken for other diseases.

Even if the child can already explain what hurts, parents may miss the onset of the disease. After all, the main symptom of pericarditis—pain—in children under 5 years of age is localized in the abdomen.

It is accompanied by flatulence and intensifies with movement. Therefore, it is often mistaken for a digestive disorder. And only in children over 7 years old, the signs of pericarditis are the same as in adults: pain is felt in the chest and radiates to the scapula, left shoulder and a hand.

U infants up to a year, symptoms of the disease often resemble meningitis. Due to compression of the heart, blood circulation is impaired and intracranial pressure increases.

And swelling in such young children is more often found on the face, rather than on the limbs. The disease develops very quickly in infants, so it is important to make a diagnosis in time.

Kinds

There are several types of pericarditis in children, which differ slightly in symptoms and nature of inflammation:

Treatment of pericarditis in children

It should be aimed not only at eliminating symptoms, but also at treating the underlying disease that caused the inflammation.

Acute pericarditis is easiest to recognize and treat. If the disease becomes chronic, the child may be given disability, as this condition is life-threatening. The earlier treatment is started, the greater the opportunity to get rid of the disease without complications.

Unlike adults, pericarditis in children very rarely goes away on its own and without consequences. This is due to the characteristics of the child’s immunity. For acute pericarditis in children, bed rest and medical supervision are important. The primary diagnosis can be made by a pediatrician, but further treatment is prescribed by a cardiologist.

Features of therapy depend on the type of disease. The most commonly used methods are:

In case of serious damage to the tissues of the heart sac, when its leaves are fused, it is required surgery.

An unfavorable prognosis in children can only be with purulent and adhesive pericarditis. Other forms of the disease are completely curable. The main thing is to make a timely diagnosis and eliminate the cause of inflammation.

It is very important to choose the right drug therapy. The choice of medications depends on the patient’s age and general health, the type of pericarditis and the severity of symptoms.

Several groups of drugs are used for treatment:

For problems with metabolism and allergic reactions, the patient is advised to special diet. The diet should be rich in proteins and vitamins. It is important to give your child foods with high content potassium salts: apples, apricots, bananas, raisins, nuts, herbs, grain bread.

As adjuvant therapy can be used folk remedies. But most often they are used after the course drug treatment. Decoctions of young pine needles or birch catkins are useful.

The following fees are more affordable:

• herbs of motherwort, cudweed, hawthorn and chamomile flowers;
• anise fruits, valerian roots, yarrow and lemon balm herbs.

If with early age accustom the baby to healthy image life and protect him from provoking factors, the disease will not affect him

Prevention

To prevent inflammation, it is very important to strengthen the child’s immunity. To do this, from an early age you need to accustom your baby to healthy eating and proper daily routine. You need to take your child for walks more often. fresh air, harden it and not limit freedom of movement.

Pericarditis is a disease that occurs against the background of other diseases. Therefore, it is necessary to promptly and correctly treat colds, intestinal infections and chronic ailments.

It is especially important for parents to closely monitor their baby if he has autoimmune diseases, metabolic disorders or kidney disease. You should not give your child any medications without a doctor’s prescription.

After suffering from pericarditis, the child should be regularly examined and monitored by a cardiologist. He is prescribed dosed physical activity and proper nutrition.

It is necessary to protect the child from diseases that can cause inflammation of the pericardium. And viral and infectious diseases treat on time.

Pericarditis in children is quite rare. But this disease is dangerous, so it is very important for parents to carefully monitor the child’s condition and show him to the doctor in time.

With timely treatment, pericarditis resolves without complications.

Pericarditis- this is fibrous, serous, purulent or hemorrhagic inflammation of the visceral and parietal layers of the pericardium, caused by infectious or non-infectious causes and acting more often as a symptom of the main pathological process, less often as an independent disease.

Acute pericarditis - acute inflammation visceral and parietal layers of the pericardium of various etiologies, which may be independent disease or manifestation of systemic diseases.

ETIOLOGY

About 90% of isolated acute pericarditis have a viral or unknown etiology. Idiopathic acute pericarditis is diagnosed if a complete standard examination does not establish a specific etiology.

Uremic in terminal chronic renal failure (20% of cases)

Primary pericardial tumors

Secondary (metastatic) pericardial tumors

Blunt chest trauma

Postpericardiotomy occurs after heart surgery, which is accompanied by opening of the pericardium (in children 35-39% of interventions) Acute idiopathic pericarditis diagnosed when it is impossible to confirm its etiology.

EPIDEMIOLOGY

Accurate information about frequency of pericarditis absent, but in autopsies it occurs in 2-12% of cases. Its prevalence is significantly greater than clinically diagnosed. This is due to the fact that pericarditis accompanies most infectious myocarditis, endocarditis, and often occurs with systemic diseases connective tissue, rheumatism, leukemia, cancer (as metastases), after cardiac surgery, chest injuries.

Viral: enteroviruses, adeno-, CMV, herpes, EBV, influenza, Hepatitis A, B, C, parvovirus B19, HIV. Viral P. are always combined with viral M.

Bacterial: 40% - Staphylococcus aureus, Haemophilus influenzae (2nd most common in children), other cocci and Gr-flora

Tuberculous - a complication of TV of other localizations (1%).

Fungal: usually a manifestation of a generalized fungal infection infections. Autoimmune occur in almost all rheumatic diseases, more often in SLE, RA and nodular PA. Allergic

Medications are described in adults after the administration of procainamide, hydralazine, isoniazid, penicillins, etc.

PATHOGENESIS

1.Invasion of the infection into the pericardial cavity by lymphogenous or hematogenous route

2. Development of inflammatory changes caused by

Direct cytotoxic effect of the infection

Immune-mediated damage

Their combination

3. Contact inflammation and germination of tumor tissue from neighboring organs

4.Aseptic reaction under the influence of toxicants.

CLASSIFICATION

According to etiological principle

Infectious (viral, bacterial, tuberculosis)

Allergic

Autoimmune

Aseptic

According to the clinical and morphological principle

Dry (fibrinous)

Exudative (exudative)

Constrictive

Constrictive-exudative

Adhesive (adhesive, adhesive, non-constrictive)

Downstream: sharp (< 1 нед.), подострые (до 3 мес.), хронические (>3 months)

CLINIC

The clinical picture of acute pericarditis consists of the manifestations of the underlying disease and the actual symptoms of pericarditis.

Main criteria for dry (fibrinous) pericarditis

2. Pericardial friction noise

3. Dynamic changes on the ECG

Main criteria for exudative (effusion) pericarditis

1. Clinical equivalents of effusion (discomfort, pain in

chest, palpitations, shortness of breath, dry cough)

2. There is no pericardial friction noise

3. Hemodynamic disorders in the BCC, in severe cases signs of cardiac tamponade

4.Dynamic ECG changes

5. Characteristic X-ray and EchoCG changes

6. In severe cases, the results of pericardiocentesis

The pain ranges from moderate to very severe, even “heart attack-like.” They are monotonous, increase gradually, last for hours, and only temporarily weaken under the influence of analgesics. Characterized by dependence on breathing, movements, changes in body position, irradiation to the left shoulder, left supraclavicular region, upper edge of the trapezius muscle. Gehrke's sign is an increase in pain when the head is quickly tilted back.

IN younger age Abdominal pain, dyspesia, vomiting, and tenderness on palpation are often noted, which simulates surgical pathology or gastrointestinal diseases.

Pain equivalents in infants: sudden motivated attacks of severe anxiety, pallor, increased shortness of breath and tachycardia, and sometimes vomiting.

Pericardial effusion. The clinic depends on its volume and rate of accumulation. With slow accumulation there are often no symptoms, with rapid accumulation there are signs of cardiac tamponade.

Signs of a hemodynamically significant effusion

1. Deafness of heart sounds

2. Disappearance of pericardial friction noise

3.Swelling of the neck veins, drop in SBP during inspiration by 12-15 mm and > (Beck's triad)

The presence of a large effusion is characterized by an increase in right ventricular HF with hepatomegaly, edema, ascites due to compression of the RA and vena cava with impaired venous flow to the RV. In this case, there is no left ventricular HF.

Pericardial friction rub at the height of pain it is gentle and limited in extent, difficult to distinguish from a short syst. noise. As fibrous deposits increase, it becomes coarse, heard over the entire AST area, is not associated with the phases of the cardiac cycle, and is heard in both systole and diastole. It has been compared to the “rhythm of a steam locomotive.”

Features:

Heard only on inspiration or expiration

Limited to the AST zone or some part of it

Practically it is not carried out even in the OST zone (“he dies where he was born”).

Inspection. A forced sitting position with the torso tilted forward (the “deep bow” pose), sometimes with the forehead resting on a pillow (Breitman’s pose) is typical. There may be a protrusion in the area of ​​the heart and xiphoid process(Auenrugger's sign). There are no active respiratory movements in the epigastric region due to limited mobility of the diaphragm (Winter’s sign) Palpation. The apical impulse is weakened and shifted upward and inward from the lower left border of the OST. Its location may change due to the accumulation of fluid when

body position (Oppolzer's sign).

Percussion. The boundaries of the OST are sharply expanded and change with changes in body position. The left border of the OST can be to the left of the upper impulse (Jardin's sign), the right - to the right of the sternum in the 5th intercostal space (Rotch's sign), AST in lower parts comes close to the border of the OCT, a sharp transition to tympanitis occurs over the compressed lung (Poten's sign). With large effusions behind the angle of the scapula to the left and downwards, Ewart's syndrome occurs (dullness of sound +

bronchial tone of breathing + bronchophony) due to compression of the lower lobe of the left lung by effusion accumulated posterior to the heart. When the patient bends forward, it shifts, the lung straightens, dullness disappears during percussion, and fine rales and crepitus appear (Pince's sign).

Auscultation sounds are muffled, tachycardia is noted without signs of heart failure.

Cardiac tamponade

Develops with the rapid accumulation of fluid and (or) a decrease in the extensibility of the pericardial layers. Is a phase of decompensation of compression of the heart, the filling of the chambers is impaired, a decrease cardiac output. Classically manifested by Beck's triad: a drop in blood pressure, an increase in central venous pressure and dullness of heart sounds.

Constrictive pericarditis

This is a complication of acute and chronic effusion pericarditis. Granulation tissue forms and is replaced rough scars with obliteration of the pericardial cavity → increased compression of the heart, impaired ventricular filling and decreased cardiac output.

Constrictive pericarditis

Characterized by fatigue, loss of appetite, orthopnea, swelling of the neck veins, ↓ PP, in 30% of cases a paradoxical pulse is detected (decreased pulse wave on inspiration), normal or slightly increasing the border of the OST, weakening of the upper. shock, muffled tones, noise is not typical. The ECG shows a decrease in the amplitude of the QRS complexes, a decrease or inversion of T, and in 70% of patients atrial fibrillation develops. Characteristic changes on EchoCG, CT and MRI. Possible hepatomegaly portal hypertension, splenomegaly, ascites, partial nephropathy (proteinuria).

DIAGNOSTICS

A blood test in the acute period is nonspecific and reflects the presence of inflammation. process determined by its etiology (bacteria, viruses, non-infectious) and activity

Blood chemistry an increase in acute phase proteins also reflects the inflammatory process. Activity of cardiac isoenzymes: troponin, CPK CV, LDH 1.2 increases in half of the patients (involvement of the myocardium in the process). Other laboratory tests to clarify the etiology, Mantoux test, diaskintest, blood culture (suspicion of E), virological methods (ELISA, PCR), exclusion of intracellular infections (ELISA, PCR), testing for RF, ANF, antibodies to cardiolipin (suspicion of TS disease), ASL titer -0, thyroid hormones, etc.

The ECG changes in 90% of patients. With large effusion, total ↓ amplitude of ECG waves, trough-shaped rise of the ST segment without reciprocal inversion in other leads and without pathological Q. An early sign of acute P. is a high +T (concordant rise) in standard leads, max. in II followed by isoelectricity and inversion. Through

1-2 days ST drops below the isoline, followed by a return to it for several days (despite the ongoing inflammation process in the pericardium).

EchoCG reveals fluid in the pericardium; its quantity and even its nature can be determined by the presence of clots of fibrin, blood, air, etc.

Radiography. The pulmonary pattern is slightly changed; with large effusion, atelectatic foci may appear (usually on the left due to compression of the lower lobe

bronchus). An early sign is a change in the shape of the heart (spherical, trapezoidal, triangular), the boundaries of the shadow may also increase. MRI - to clarify the presence of effusion, if it is not detected by echocardiography. Pericardiocentesis (puncture of the pericardium) - final

diagnostic and healing method. Allows for biochemical, bacteriological, serological methods).

PERICARDIAL FLUID ANALYSIS

Density, pH, number of blood cells and their composition, levels of protein, glucose, triglycerides, cytology, and bacteriology are assessed.

Bacterial - the nature of the effusion is purulent, the leukocyte protein level is > 10,000/ml, due to macrophages and granulocytes.

Viral - serous effusion, protein > 30 g/l, leukocytes > 5000/ml due to lymphocytes.

Tuberculosis - serous-hemorrhagic effusion, high or medium protein level, leukocytes > 8,000 predominantly granulocytes and macrophages, mycobacterium tuberculosis.

Pathognomonic of adenosine deaminase levels > 30 U/L.

DIFFERENTIAL DIAGNOSIS

It is carried out with the accumulation of fluid of non-inflammatory origin in the pericardial cavity - Hydropericardium. It is an accumulation of fluid without fibrin admixture. As a rule, it is a consequence of heart failure with edema, ascites, effusion in the cavities (right ventricular). There is no pain in the heart area, pericardial friction noise, ECG changes are not typical for P, the volume of effusion is small, the pericardial layers are not changed. Examination of the punctate confirms that it is non-inflammatory. Cardiac tamponade does not develop.

When HF is relieved, the exudate is completely absorbed. NB! Hydropericardium can be a symptom of hypothyroidism; treatment with thyroid hormones has a + effect.

Hemipericardium occurs after blunt trauma or injury, is possible after chest compressions, when the pericardium is perforated during catheterization or cardiac probing.

Chylopericardium occurs when the pericardial cavity and thoracic cavity communicate lymphatic duct as a result of injury, congenital anomaly, as a complication of cardiac surgery, mediastinal lymphangioma, lymphangiectasia and lymphatic duct obstruction. To clarify its topic and place of communication with the pericardial cavity, a CT scan of the chest organs and lymphography are performed.

TREATMENT

Diet with potassium enrichment and restriction (sometimes complete exclusion of salt), split meals 5-6 times a day, drinking according to diuresis (per 200-300 ml< выделенного) НПВП - основа pathogenetic therapy most pericarditis.

The timing depends on the etiology: from 2-4 weeks. up to 3-6 months

Ibuprofen is the drug of choice from 3 months of age. Dose 30-50 mg/kg/day, maximum 2.4 g. in 3-4 divided doses with ↓ doses every 3 days after normalization of CRP levels. Course 3-4 weeks.

Naproxen from 1 year to 5 years - 2.5-5 mg/kg, > 5 years - 10 mg/kg

Nimesulide > 2 years at a dose of 3-5 mg/kg in 3 doses.

Diclofenac > 6 years at a dose of 1-2 mg/kg

Indomethacin from 2 years 1-2 mg/kg in 2-4 divided doses not > 200 mg for 1-2 weeks. with a gradual dose reduction every 3 days.

Long-term use of NSAIDs requires gastroprotection: antacids, proton pump inhibitors.

Colchicine is effective in eliminating acute symptoms and relapse prevention. Children< 5 лет 0,5 мг в день в 2 приема, >5 years 1-1.5 mg per day in 2-3 doses.

Glucocorticoids indicated when NSAIDs are ineffective, except in cases of purulent P. Doses of prednisolone 1.0-1.5 mg/kg with a gradual dose reduction until discontinuation.

With proven viral P. - interferons-α and interferon inducers, specific immunoglobulins and human immunoglobulin.

With bacterial P. - protected penicillins in combination with aminoglycosides. Course up to 4 weeks. In case of severe pericarditis and the absence of a confirmed etiology, as well as the ineffectiveness of these a/b - vancomycin, 3rd generation cephalosporins.

Use diuretics with caution if there is a large amount of effusion. Prescribe furosemide 1-4 mg/kg in 2-4 doses Pericardial puncture (pericardiocentesis)) - with cardiac tamponade.

DISPANSERIZATION

For 3 years after discharge from hospital.

EchoCG - once every 6 months. in the first year

X-ray of the chest organs - once a year (monitoring the size of the heart.

Cardiac MRI is prescribed if the presence of effusion is suspected, which is not visualized by echocardiography.

Vaccination is limited to 1 year.

> Pericarditis in children

Cardiac pericarditis is an inflammatory process in the heart sac, pericardium. This is the name of the special outer shell in which the heart is located. This disease is rarely diagnosed in children due to difficulties in recognition.

The consequences of pericarditis can be the most unfavorable: it worsens general state and well-being, there are reflex and mechanical hemodynamic disorders, compression of the heart, acute and chronic heart failure - all this creates an immediate threat to the baby’s life. Therefore, it is so important to understand the essence of this disease, protect the child from it and, if necessary, carry out a course of timely and effective treatment.

The causes of inflammation of the pericardium in children can be factors such as:

• infections - streptococcal, staphylococcal (read how to recognize it at the link);
• tuberculosis;
• heart surgery;
• rheumatic diseases (already at school age);
• HIV infections;
• injuries to the chest, pericardium or heart;
• renal failure;
• cancerous tumors;
• incorrect, uncontrolled or too long intake of the series medicines powerful action.

As can be seen from listed reasons, this disease most often does not develop independently, but only as a concomitant, against the background of other pathologies and diseases. This makes diagnosis difficult, as do the symptoms, which can be either obvious or hidden.

If the disease is in the acute phase of its course, the first symptoms will appear immediately. However, often the disease develops at a slow pace and starts because the symptoms appear some time after its onset. Parents need to be very careful about the following ailments of their babies, which may be symptoms of pericarditis:

After going to the hospital, based on the results of the examination, the doctor identifies several more symptoms of childhood pericarditis:

• increase in liver size;
• muffled heart sounds;
• X-ray reveals expansion of the borders of the heart in all directions;
• Echocardiography reveals fluid in the pericardium.

If a child experiences sudden but short-lived attacks, this is acute pericarditis. The gradual appearance of symptoms, as well as their regularity, indicate that the disease has most likely entered a chronic stage.

Doctors distinguish several types of childhood pericarditis, each of which has a different character. inflammatory process, which arose in the cardiac sac. This classification as follows.

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Classmates

One of the most dangerous is pericardial effusion in children. It is characterized by a significant increase in fluid that accumulates in the heart sac. This leads to obstruction of blood flow and gradual compression of the heart. Such violations can cause death.

Fibrinous, on the contrary, is a consequence of a decrease in fluid in the pericardium. At the same time, fibrin is deposited in the form of villi on the inner surface of the heart sac, which is why in medicine this form of the disease is called “villous heart.”

Often, the inflammatory process in the pericardium leads to the fact that parts of the heart sac grow together - thickenings are formed. The consequence is an increased load on the heart and disruption of its activity.

Purulent pericarditis in children is caused by infectious diseases: bacteria penetrate the heart sac, complicating the inflammatory processes occurring there. I can't help but be glad that infectious species This disease is diagnosed quite rarely.

Tuberculous pericarditis is not always a consequence of tuberculosis: it can occur in children who have nothing to do with this disease. This inflammation is often observed in HIV-infected children. Leaks in severe form, which requires immediate and timely treatment.

Doctors can diagnose pericardial fibrosis, a disease of the connective tissue that makes up the heart sac.

In order to determine the specific form of pericarditis in a child, he is prescribed inpatient examinations and numerous tests are performed. With correct and timely diagnosis, the further prognosis can be quite favorable.

Cardiac pericarditis in children is a serious disease requiring hospital treatment. Depending on the type of disease and the nature of its course, they may prescribe various methods therapy.

Drug treatment

• painkillers;
• antibiotics;
• antihistamines;
• diuretics;
• Hormones are prescribed to children only at an older age, and then only with great caution.

Pericardial puncture (Larrey method)

• pumping out fluid from the heart sac through a needle.

Surgical intervention

• if pericarditis has already reached the stage chronic disease, a dissection operation is performed chest wall to remove affected areas of the pericardium.

In rare cases, the disease is mild and goes away on its own. The sooner parents recognize the disease, send the child for diagnosis and begin timely treatment of pericarditis under the supervision of doctors, the greater the child’s chances of further course illness without consequences and complications.

Pericarditis - acute or chronic inflammation epi and pericardial layers. Pericarditis can be clinically asymptomatic or develop acutely, leading to cardiac tamponade and sudden death.

From this article you will learn the main causes and symptoms of pericarditis in children, how pericarditis is treated in children and the diagnosis of pericarditis.

Treatment of pericarditis in children

Treatment of the underlying disease - antimicrobial and antihistamines, chemotherapy, dialysis, etc. Puncture and drainage of the heart cavity (for purulent pericarditis) against the background of antibacterial therapy. Surgical treatment (for adhesive pericarditis).

In acute pericarditis, bed rest is required for the entire duration of the process. In chronic pericarditis, the regimen depends on the patient's condition. Limit physical activity. The diet should be complete, food should be taken in small portions. Limit the consumption of table salt.

Treatment for acute dry pericarditis or with a small effusion is predominantly symptomatic (anti-inflammatory drugs, analgesics for severe pain, drugs that improve metabolic processes in the myocardium, potassium supplements, vitamins). When the pathogen is identified, etiotropic therapy is carried out.

Treatments for pericarditis in children

Antibiotics for bacterial pericarditis are prescribed for treatment according to the same principles as for infective endocarditis, taking into account the sensitivity of the pathogen.

For pericardial tuberculosis, two (or three) drugs (isoniazid, rifampicin, pyrazinamide) are prescribed for 6-8 months.

In case of effusion of pericarditis with rapidly increasing or recurrent accumulation of fluid, there may be a need for urgent puncture (paracentesis) of the pericardium.

With purulent pericarditis, it is sometimes necessary to drain the pericardial cavity and inject antibiotics into it.

In case of constrictive pericarditis with compression of the cavities of the heart, surgical intervention is necessary (pericardotomy with maximum removal of adhesions and scarred pericardial layers).

Treatment of pericarditis in children with secondary pericarditis is included in the treatment program for the underlying disease (acute rheumatic fever, SLE, JRA, etc.) and includes the prescription of NSAIDs, prednisolone, cardiac glycosides, and drugs that improve metabolic processes in the myocardium.

Prevention of pericarditis in children

Prevention is only possible secondary: dispensary observation in the cardio-rheumatology office, regular conducting an ECG and echocardiography, elimination of foci chronic infection, recreational activities, dosed physical activity.

Treatment prognosis. In most cases acute pericarditis the prognosis is favorable. With secondary pericarditis, it depends on the course of the underlying disease. The outcome of any variant of pericarditis can be a transition to a chronic course, the organization of effusion with the formation of adhesions and adhesions of the leaves, the formation of an “armored” heart (constrictive, adhesive, adhesive pericarditis). Acutely developed cardiac tamponade poses a danger to life. Chronic pericarditis, especially with compression of the cavities of the heart, can lead to disability of the patient.

Symptoms of pericarditis in children

Pericarditis manifests itself the following symptoms: chest pain, fever, deterioration of health, weakness, irritability, shortness of breath, cough, forced semi-sitting position, hoarseness, hiccups, abdominal pain, vomiting, refusal to eat, swelling of the face and neck, pallor and moderate cyanosis.

Signs of exudate accumulation

Pain syndrome: pain is constant; in young children, abdominal pain, flatulence, increased pain upon palpation of the abdomen are determined; in older children, pain is localized in the chest with irradiation to the left shoulder and neck; the pain intensifies with changes in body position and deep breathing.

Pericardial friction rub is heard at the base of the heart along the left edge of the sternum with the patient sitting.

An increase in the size of the heart - primarily due to absolute cardiac dullness, and in the presence of significant effusion and relative cardiac dullness; the apical impulse is weakened, heart sounds are sharply muffled.

Upper blood pressure is reduced, lower blood pressure is normal.

Signs of compression of the cavities of the heart

• An increase in venous pressure in the superior vena cava system in infants causes an increase in intracranial pressure and a complex of neurological symptoms (vomiting, stiffness of the neck muscles, bulging of the fontanel, etc.). The veins of the neck, cubital veins and veins of the hands swell;
• Peripheral cyanosis - usually determined in the area of ​​the nail beds and ears;
• an increase in the size of the liver and spleen simultaneously with the appearance of cyanosis;
• Swelling appears first on the face and then spreads to the neck.

Main symptoms of pericarditis

The clinical picture depends on the form of pericarditis, as well as its etiology (Table). However, it should be borne in mind that both acute dry and long-term chronic adhesive pericarditis may not have any clinical manifestations. Basic clinical symptoms pericarditis are associated with fibrin deposition or fluid accumulation in the pericardial cavity, as well as with compression of the heart cavities by large effusion and impaired diastolic function of the heart.

Table. Some clinical features acute pericarditis associated with their etiology

Clinical symptoms, course

Sudden onset: fever,
pain syndrome, friction noise
pericardium above the base of the heart

Serosofibrinous effusion,
small in volume

Residual effects of ARVI or influenza, myalgia

Chills, profuse sweat

Pericardial friction rub

The effusion is significant, purulent
or putrid

The course is severe, often becoming chronic

In young children it usually develops against the background of sepsis, staphylococcal destruction of the lungs, in older children - against the background of osteomyelitis B peripheral blood leukocytosis, neutrophilia, shift leukocyte formula to the left, high ESR

Rheumatic (for acute rheumatic fever, JRA, SLE, SSD)

At 1-2 weeks of acute attack
rheumatic fever; at
exacerbation of other rheumatic diseases

Pain syndrome is minor

Pericardial friction rub is intermittent

The effusion is moderate, serous or serous fibrinous

The course is usually favorable

Clinical syndromes of the underlying disease; pericarditis - part of the general reaction of the serous membranes

Acute dry pericarditis

Acute dry pericarditis in children usually begins with the following symptoms: fever, tachycardia and almost constant pain. In young children, the pain syndrome manifests itself as periodic restlessness and crying. The pain is most often localized in the navel area. Palpation of the abdomen is painful, especially in epigastric region. Older children complain of pain in the chest, behind the sternum, aggravated by deep breathing and changes in body position, radiating to the left shoulder. In half of the patients, at the onset of the disease, it is possible to listen to a pericardial friction rub (varying from gentle crepitus to a rough systole-diastolic noise - “snow crunching”) at the base of the heart along the left edge of the sternum. It is best to listen to the murmur with the patient sitting. The friction noise is often heard for a very short time.

Acute effusion pericarditis

Acute effusion pericarditis in children, especially with a rapid increase in the volume of exudate, causes sharp deterioration the patient's condition. The following symptoms of pericarditis appear: shortness of breath, dull pain in the heart area, the child takes a forced semi-sitting position with the head tilted forward. Some patients experience hoarseness, cough, hiccups (irritation of the phrenic nerve), nausea, vomiting, and abdominal pain. Objectively, smoothness of the intercostal spaces and swelling are detected subcutaneous tissue on the left, weakening or upward displacement of the apical impulse, expansion of the boundaries of the heart, first due to absolute and then relative dullness. Heart sounds may initially be even more sonorous (above the apex of the heart that is shifted forward and upward), and then become significantly weakened, coming as if from afar. Blood pressure decreases (by approximately 10-20 mm Hg), paradoxical pulse appears (decreased pulse filling during inspiration). The liver enlarges and becomes painful, ascites appears, and edema is possible.

Cardiac compression syndrome develops. In infants, this syndrome has nonspecific manifestations. An increase in pressure in the superior vena cava causes an increase in intracranial pressure, which is accompanied by meningism (vomiting, bulging of the greater fontanel, stiff neck). The veins of the hand, neck and ulnar veins, usually invisible at this age, become clearly visible and palpable.

An increase in the volume of fluid in the pericardial cavity can cause cardiac tamponade. At the same time, the child’s condition sharply worsens, he becomes very restless, feels fear, shortness of breath increases, acrocyanosis and cold sweat appear. In the absence of emergency assistance (pericardial puncture), syncope and sudden death are possible.

Chronic pericarditis can be exudative (usually of tuberculous etiology), adhesive (constrictive) and mixed; with or without compression of the cavities of the heart. Both a primary chronic course and the development of acute pericarditis of any etiology are possible.

With chronic exudative pericarditis, children are worried about increased fatigue, shortness of breath, discomfort in the heart area, especially with excessive physical exertion. With long-term current, with early childhood, exudative pericarditis can form a “heart hump”. Significant cardiomegaly, muffled heart sounds, and hepatomegaly occur.

Adhesive pericarditis without compression of the heart is asymptomatic. The only things noteworthy are the preservation of the size of absolute cardiac dullness during inspiration and the late systolic flapping pleuropericardial tone or click.

Constrictive pericarditis is manifested by the following symptoms: general weakness, a feeling of heaviness in the right hypochondrium. Upon examination, attention is drawn to the puffiness of the face, swelling and pulsation of the neck veins, cyanosis that increases in a horizontal position, and ascites. Leg swelling is rare. The heartbeat is weakened or not detected, sometimes it can be negative. The borders of the heart are unchanged or slightly expanded. Tachycardia is noted, accent of the second tone is over pulmonary artery with a general moderate muting of tones. Often amplified pathological III tone (“pericardial knock”, “click”), sometimes - pericardial friction noise.

Complications. In acute exudative pericarditis, cardiac tamponade is possible; in constrictive pericarditis, circulatory failure is possible.

Causes of pericarditis in children

The population incidence of pericarditis is unknown. They are diagnosed in approximately 1% of children, and are detected at autopsy in 4-5% of cases.

In children over 3 to 4 years of age, dry or serous pericarditis is a symptom of tuberculosis. IN last years Pericarditis caused by the Coxsackie virus has become common.

The causative factors are:

• influenza A and B viruses, mumps, chickenpox, hepatitis, measles, cytomegaly, adenoviruses, etc.;
• bacteria – staphylococci, pneumococci, meningococci, streptococci, etc.;
• mushrooms and other infections.

Causes of pericarditis in children

Pericarditis in children can be infectious and aseptic, accompanied by allergic reactions, systemic or metabolic diseases. Sometimes their cause cannot be determined. These are so-called idiopathic pericarditis. It is believed that a role plays in their occurrence viral infection. Pathogens infectious process in the pericardium there may be viruses (Coxsackie B, Epstein-Barr, influenza, adenovirus) and rickettsia, bacteria (strepto, staphylo, meningococci, mycoplasmas, tuberculosis bacillus, actinomycetes), protozoa (amoeba, malarial plasmodium, toxoplasma) and helminths (echinococcus) , fungi (histoplasma, candida). In addition, pericarditis can accompany infections such as typhus, cholera, brucellosis, and syphilis. Aseptic pericarditis occurs with allergic reactions to the administration of vaccines, serums, and antibiotics. They may be a manifestation of polyserositis, which develops during acute rheumatic fever, diffuse diseases connective tissue, JRA, sarcoidosis, periodic disease, hematological and oncological diseases, as well as trauma, heart surgery, hypoparathyroidism, uremia.

Pathogenesis of pericarditis in children

With infectious pericarditis, the pathogen can penetrate into the pericardial cavity by hematogenous, lymphogenous routes, as well as by direct spread from adjacent organs (Koch's bacillus - from the pleura, coccal flora - when a myocardial abscess ruptures, lungs).

Aseptic inflammatory reactions in the pericardium can occur with increased permeability vascular wall under the influence of protein breakdown products, toxic substances (uremia, gout), radiation (for example, in the treatment of tumors), as well as due to a systemic immunopathological process.

In the initial phase of the development of pericarditis, the exudation of fluid in the choroid plexus of the visceral layer of the pericardium in the area of ​​the great vessels at the base of the heart increases. The effusion spreads along the posterior surface of the heart from top to bottom. With a small effusion, it is quickly reabsorbed, and fibrin deposits may remain on the surface of the epicardium (dry pericarditis). With more widespread and intense involvement of the visceral and parietal layers in the process, a more massive effusion is formed. The ability to reabsorb it decreases, fluid accumulates in the pericardial cavity, first in the lower part, pushing the heart forward and upward. IN further effusion occupies the entire space between the layers of the pericardium (effusion pericarditis).

It should be noted that this process can stop (spontaneously or under the influence of treatment) at any stage and end with the patient’s recovery, which, apparently, is observed in most cases of this disease (benign pericarditis).

Classification of pericardial diseases

The classification of pericardial diseases is based on the clinical and morphological principle (Table)

The inflammatory process in the pericardial sac is called pericarditis. Manifestations of the disease can be subtle (if chronic) or develop acutely, causing tamponade with subsequent cardiac arrest. Occurs against the background of infectious, autoimmune and tumor diseases, after trauma to the chest, including after operations on the heart and blood vessels.

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Causes of pericarditis in children

The most common reason of this disease in childhood- These are infections. Among them, the leading position is occupied by influenza viruses, entero- and adenoviruses, as well as infection by staphylococci and streptococci.

Less common etiological factors are: rickettsia, pathogens of tuberculosis, mycoplasmosis, amoebiasis, malaria, cholera and syphilis, helminthic, fungal infections. The microorganism can penetrate both from the blood or lymph, and from the lungs, pleura, and heart muscle.

Pericarditis of non-infectious origin develops with the following pathologies:

• allergic reaction to serum, vaccine, medications,
• rheumatism,
• autoimmune diseases,
• blood diseases,
• tumors
• damage to the chest due to injury or surgery,
• renal failure.

In addition, there is pericarditis, which cannot be associated with any known cause. It is called idiopathic.

And here is more information about exudative pericarditis.

Classification of pathology

Depending on condition immune system child and the intensity of the damaging factor, pericarditis can have an acute and chronic course, accompanied by effusion in pleural cavity or fusion of the leaves of the cardiac sac with each other, can be limited or widespread.

Therefore, to formulate a diagnosis and select treatment, varieties of this pathology are identified.

Acute and chronic

If the disease begins suddenly and lasts up to 6 months, then a diagnosis of acute pericarditis is made. Initially, an effusion appears in the pericardial cavity, it can resolve on its own, then the process enters the dry (fibrinous) stage or continues to progress, moving the heart and making it difficult to work. A large accumulation of fluid fills the entire space between the pericardial layers and can cause contractions to stop.

A chronic process can be the outcome of an acute one or occur primarily. According to the mechanism of development, exudative (with the accumulation of fluid) and adhesive (with the adhesion of the membranes of the heart sac), as well as mixed, are distinguished. Over a long period of time, connective tissue forms at the site of the inflammatory process, the cavity can become overgrown, and calcium is deposited on the surface of the leaves. This leads to the formation of a “shell heart”.

Dry and exudative

With dry pericarditis, the pericardial sac contains deposits of fibrin filaments in the form of villi and a small volume of fluid. This form of the disease was called “hairy” heart.

Exudative pericarditis is characterized by the accumulation of liquid contents between the inner and outer layers of the pericardial sac. According to the nature of the effusion, it can be:

• serous or fibrinous (fluid and fibrin),
• purulent (infectious origin),
• bloody (during injuries or operations).

The effusion variant of the disease is most severe, especially when fluid quickly enters the pericardial sac, while the dry and adhesive variants can be asymptomatic.

Symptoms of disease development

Clinical manifestations in children differ depending on the form of pericarditis. Their occurrence is associated with stretching of the cavity of the pericardial sac, compression of the heart, as well as symptoms of the underlying disease that led to pericarditis.

Spicy dry

It begins with an increase in temperature, increased heart rate and constant pain. Small children become restless, often cry and scream. Pressing on the navel area causes pain. At an older age, the child may complain of chest pain or pain in the chest area, which becomes stronger when inhaling, moving, and radiates to the left shoulder.

When listening in a sitting position, a pericardial friction noise from gentle to rough, reminiscent of the crunch of snow, is heard along the left edge of the sternum.

Acute exudative

The disease is usually severe, it becomes difficult for the child to breathe, the pulse quickens, and dullness appears. It's a dull pain in the region of the heart, cough. Due to irritation of the diaphragmatic nerve plexus, hiccups, nausea and vomiting occur.

Children take a semi-sitting position with their head bowed to relieve the condition.

During the examination, it is possible to detect expansion of the borders of the heart, weakened sounds, low pressure and an increase in the pulse wave during inspiration. The liver is enlarged, fluid accumulates in abdominal cavity, there is swelling on the legs.

When the heart is compressed by effusion in infants, the following symptom complex occurs:

• the veins in the arms and neck become congested,
• the fontanelle bulges,
• vomiting appears
• pressing your head to your neck becomes painful,
• fingers on extremities turn blue.

Chronic

Children become weakened, during physical activity they experience pain in the heart, difficulty breathing, the heart increases in size, and a “heart hump” may occur. Due to the enlargement of the liver, heaviness appears in the hypochondrium on the right, loss of appetite, and nausea. Puffiness of the face is noted, and swelling on the legs occurs in rare cases. Heart sounds are weakened, the pulse is frequent, and a pericardial friction rub may be detected on auscultation.

Watch the video about pericarditis and its treatment:

Diagnostic methods

To identify pericarditis, they are guided by the patient’s complaints and examination data, and research data are used to confirm the diagnosis:

• There are signs of inflammation in the blood - increased content leukocytes, high ESR, shift of the leukocyte formula to the left.
• ECG - the amplitude of the ventricular complex is reduced, the P and T waves can change polarity. In the acute stage, ST rises, then decreases to normal.
• PCG – murmur throughout the entire cardiac cycle, periodic clicks. Accent of 2 tones over the pulmonary artery.
• X-ray – the heart is in the form of a ball with exudative pericarditis; with the adhesive process, the superior vena cava is wide, the contour of the cardiac shadow is unclear, there are adhesions with the pleura.
• EchoCG is the main method for determining the amount of fluid in the cavity of the pericardial sac, disturbances in ventricular contraction, adhesions between the layers of the pericardium and with the pleura, thickening outer shell hearts.
• CT and MRI detect changes in the thickness of the pericardial layers.

Treatment of pericarditis

For therapy, they focus on the form of inflammation and the severity of the child’s condition. In case of an acute process, strict bed rest is prescribed; for children with a chronic course of the disease, it is limited physical activity. It is recommended to eat a diet rich in vitamins and easily digestible proteins, and reduce fatty and salty foods in the diet.

Medication

Dry pericarditis in acute stage treated with non-steroidal anti-inflammatory drugs (Nemesulide, Nurofen), painkillers and vitamin supplements, potassium salts, Riboxin, Mildronate are prescribed.

When fluid accumulates due to infectious diseases, the use of antibiotics is indicated. If a pericardial puncture was performed, then the exudate is examined for microflora and its sensitivity to antibacterial drugs. In case of a purulent process, the administration of drugs can be used combined method– intramuscularly and through drainage.

Pericarditis of rheumatic and autoimmune origin is treated with the use of corticosteroid hormones. Most often, Prednisolone is recommended for children to eliminate the inflammatory process and resolve the effusion.

Surgery

If fluid accumulates quickly in the cavity of the pericardial sac, then there is a threat of tamponade and cardiac arrest. Therefore, in such cases, an emergency puncture is performed to remove the effusion. It can also be recommended for long-term resorption of exudate (over 15 - 20 days), as well as for analyzing its cellular and biochemical composition.

If, as a result of pericarditis, its membranes are compacted and there are calcium deposits on the surfaces, which interferes with stretching in the diastole phase, then part of the scar tissue is removed using resection. Adhesive adhesions between the pleura and pericardium are excised during subtotal pericardiectomy.

Puncture for pericarditis

Folk recipes

After medication or surgical treatment, in the stage of stable remission of pericarditis, children are recommended to undergo a course of treatment with herbal preparations in the absence of allergic reactions to plant materials.

Before preparing the infusion, the herbs must be crushed and poured dessert spoon composition with a cup of boiling water in a thermos overnight. Give the child a third of a glass warm 30 minutes before meals. For this you can use the following herbs:

• motherwort, cudweed and hawthorn in equal parts, add one spoon of chamomile flowers to 3 tablespoons of the mixture;
• valerian, yarrow and lemon balm leaves in equal proportions;
• For one part of anise fruit, take two parts of St. John's wort and mint leaves.

For small child It’s better to grind everything thoroughly. The proportions can be arbitrary; usually equal parts of the ingredients are taken. You need to take no more than a tablespoon of this delicious medicine in the morning with water.

Prognosis for the disease

Recovery is possible with early diagnosis and a complete, correct course of treatment. The purulent process is dangerous for weakened children, as it can be complicated by sepsis; a rapid increase in the volume of fluid in the pericardium causes tamponade with cardiac arrest. Adhesion of the pericardial sheets, even after surgery, may be accompanied by persistent residual changes.

Preventive actions

At severe infections, autoimmune reactions must be overcome full course treatment with laboratory and instrumental confirmation of recovery. To prevent relapse of pericarditis and its complications, observation by a cardiologist, preventive courses of therapy to strengthen the immune system and metabolic processes in heart.

Pericarditis in children is quite rare, but it can cause severe consequences, which means you need to be prepared to recognize the disease in a timely manner.

The risk of developing pathology exists even in newborns, and for this reason there are various reasons. Preventive measures can prevent the occurrence of this dangerous pathology, and the task of parents is to provide them.

Pericarditis is inflammatory lesion outer heart membrane, which leads to pathological disorders. is associated with 2 mechanisms - the accumulation of a significant amount of exudative fluid in the pericardial cavity and a change in the structure of the membrane tissue (thickening or fusion of leaves).

Excessive pressure appears on the heart, and the possibility of its expansion during contraction is limited. As a result, there appear serious violations in the circulatory system.

Most often, the inflammatory process has an infectious etiology. In childhood, the most common pathogens are viruses (influenza, adenoviruses, Coxsackie), but bacteria (staphylococci, streptococci, meningococci, tubercle bacilli) and fungi (candida, actinomycetes, toxoplasma) are also isolated.

The etiology of childhood pericarditis may also be aseptic in nature.. In this case, the following causes are identified: allergic reactions, juvenile-type rheumatoid arthritis, birth defects heart disease, renal pathologies and uremia, blood diseases, autoimmune disorders, chest injuries, taking certain medications (antibiotics, vaccines, serums), systemic diseases, diabetes, polyserositis, toxic or radiation exposure.

Common forms of the disease

The nature of the inflammatory process in children differs as follows:

1. . It usually develops as a result of an infectious lesion, and therefore accounts for more than 80 percent of childhood pericarditis.

   A characteristic feature of the pathology is the gradual accumulation of exudate in the cavity.

   This variety is very dangerous for a child, because... leads to compression of the organ and disruption of blood flow. Failure to take action may result in death.

2. . In contrast to the previous option, the pericardium dries out excessively, and fibrin (a thread-like protein) accumulates on the surface of the membrane in the form of villi. As a result, the shock-absorbing capabilities of the shell deteriorate and, accordingly, obstacles arise for normal heart contractions.
3. Adhesive or adhesive type. It manifests itself in the form of thickening of the pericardial layers and their fusion with each other. The result is compression of the heart and organ dysfunction. A dangerous variety is considered when thickened leaves compress the atria and ventricles, impairing blood circulation.
4. Purulent pericarditis. This is a dangerous infectious species caused by pathogenic bacteria. Purulent exudate accumulates in the cavity, which complicates the course of the disease.
5. Tuberculosis type. It is excited by the tuberculosis bacillus and is typical for children with tuberculosis. However, it can also be detected in children whose tuberculosis tests are negative. This form Pericarditis is very dangerous and requires effective measures.

Based on the nature of the disease and the manifestation of symptoms, the following options are distinguished:

• spicy has a characteristic sharp manifestation with pronounced symptoms for up to 7 days;
• subacute– develops within 3 months;
• chronic diagnosed when the disease lasts more than 6 months.

Medical statistics indicate some features of childhood pericarditis. Until the age of 6, pathology is detected only in an acute form, and a purulent manifestation is often recorded.

Newborns are most often infected in the first days of life, in the maternity hospital. In infants, up to 90% of the pathologies under consideration are provoked by staphylococci and streptococci. Next, priority goes to viral pathogens.

After 6-7 years of age, the course of pericarditis in children is practically no different from adults.. In etiology, acute respiratory viral infections and acute respiratory infections are especially distinguished. According to statistics, 15-22% of adolescents with pericarditis have the rheumatoid variety. In general, pericarditis occurs in 1 to 1.5 percent of children under 16 years of age.

Symptoms and signs

The manifestation of pericarditis in children depends on the type of pathology, its etiology and stage of development. Quite often the disease is asymptomatic, which makes diagnosis difficult. The most pronounced symptoms of the disease are in the acute form.

Symptoms common to all types can be identified:: painful sensations V chest area, frequent malaise and weakness, shortness of breath, non-productive (dry) cough, swelling lower limbs, increase in the size of the jugular vein, arterial hypotension, blue discoloration on the lips and ears, increased body temperature.

It is necessary to highlight some specific signs:

1. Dry pericarditis in acute form. The onset is marked by pain and fever. The pain in children is concentrated in the navel area, and in adolescents - in the heart area with irradiation to the left shoulder. They intensify with deep inspiration. Parents may notice a reaction in babies such as crying and fussing.
2. Exudative pericarditis in acute form. arise constant pain stupid character, because of which the child tries to take a “half-sitting” position with his head tilted forward. Characteristic additional symptoms- hiccups, wheezing, vomiting, pain in the liver area. The progression of the disease causes an increase in intracranial pressure in children with swelling of the large fontanelle.
3. Constrictive pericarditis. Particularly noticeable is the swelling and pulsation of the neck veins. There is an unpleasant sensation in the hypochondrium on the right, the face swells. The development of the process leads to an enlargement of the liver.

In adolescents, it is characterized by constant unpleasant sensations (periodically turning into pain) in the heart area. They intensify with physical activity. Quite often, slight cyanosis of the nail plates and ears appears.

Course of the pathology

The onset of the disease is associated with infection in the pericardial cavity. Next, a toxic effect on tissue cells develops or an immune-mediated effect occurs. It is possible to combine these mechanisms.

Pathogenesis may be caused by inflammation contact method, i.e. spread of the process from nearby organs. The aseptic reaction is caused by the action of toxicants.

The disease in children usually begins acutely. When the cardiac cavities are compressed, hypodiastole develops, which leads to stagnation of blood in the vena cava, hepatomegaly and edema.

Pain syndrome appears almost from the very beginning, and in children under 4-5 years old it is felt in the navel area and is accompanied by active gas formation in the intestines.

The intensity of symptoms is largely determined by the accumulation of fluid (effusion) in the cavity. ABOUT this phenomenon indicates an increase in the area of ​​cardiac dullness. Compression of the heart chambers disrupts their diastolic filling. With adhesive pericarditis in a child, the acute phase can be smoothed out, and severe symptoms appear only at the hypodiastole stage.

In infants (up to 1 year) it increases significantly intracranial pressure with the manifestation of signs of neuralgia similar to meningitis.

At what age is it most common and how is it diagnosed?

Pericarditis can affect a child at any age. If up to 6-7 years only an acute form is possible, then after this age the disease can acquire chronic forms. The doctor makes a preliminary diagnosis after examination, palpation, percussion and auscultation of the child..

Upon examination, smoothness of the intercostal zone is revealed. In infants, the chest may protrude on the left side. Absent active phase respiratory movement in the epigastric zone. An abnormal pulse with weak filling during inspiration, dullness of heart sounds, and expansion of the boundaries of the organ are detected.

The diagnosis is confirmed by conducting the following studies:

1. General and biochemical analysis blood to confirm the presence of an inflammatory process and determine its nature.
2. ECG. The change in the amplitude and width of the teeth and the ST segment is established.
3. Echocardiography reveals fluid accumulation and the appearance of fibrin.
4. Radiography clarifies changes in organ size and reveals atelectatic foci.
5. MRI and CT scan provides complete information about the pathology.

In some cases it becomes necessary to use invasive methods diagnostics Pericardial puncture (pericardiocentesis) is performed when high risk severe complications and planning surgical intervention. We talked in more detail in another article.

To unify approaches to the diagnosis and treatment of childhood pericardium, the Ministry of Health of the Russian Federation has developed Federal clinical recommendations for the provision of medical care children with pericarditis. They were approved by the Congress of Pediatricians on 02/14/15. Priorities therapeutic measures are based on grades of recommendations and levels of evidence based on decisions of the European Society of Cardiology.

Treatment and prognosis

The main difference in treatment for children from treatment for adults is mandatory hospitalization, the use of invasive methods only in extreme, particularly severe cases, the prescription of drugs taking into account age restrictions and strict monitoring of the treatment process and the development of the disease.

Conservative methods include the establishment of a special regime and diet, etiotropic, anti-inflammatory and symptomatic therapy.

Basic therapy is aimed at eliminating the inflammatory response. The drugs prescribed are Ibuprofen, Aspirin, Diclofenac, Indomethacin. At the same time, the root cause of the disease is affected. Most often, antibiotics are prescribed (Penicillin, Ampicillin, Amoxicillin).

For rheumatoid pericarditis, glucocorticoids (Prednisolone) are used. If a pathology of the tuberculosis type is detected, then an injection of Streptomycytin is performed.

Long-term active therapy requires gastroprotection, for which antacids and proton pump inhibitors are prescribed. Colchicine is used to eliminate the risk of relapse.

The prognosis for the recovery of children with timely initiation of treatment is favorable. The greatest concern is advanced adhesive or constrictive pericarditis and especially the complication of cardiac tamponade.

At mild flow Symptoms of the disease can persist for 14-16 days, and the effusion is removed in 9-12 days without complications.

Purulent processes are especially dangerous for infants. In this case there is a risk fatal outcome, and the probability of chronicity of the process is estimated at 15-18%.

Possible consequences

Pericarditis in children is dangerous due to its complications. The progression of exudative type pathology with excessive accumulation of effusion can cause cardiac tamponade. Severe cardiac dysfunction appears, venous and intracranial pressure increases.

Tamponade is characterized by swelling of the face and neck, acrocyanosis, cold sweating, and severe shortness of breath. If the fluid is not removed immediately, it can be fatal.

In the case of adhesive type pericarditis, the development of the process inevitably leads to heart failure, which is a clear threat to life. Liver damage should be considered as a late complication. There are signs of false cirrhosis.

In some cases, the disease is asymptomatic and therefore cannot be detected in a timely manner. Despite the absence external manifestations, structural changes occur that are irreversible. The pathology gradually becomes chronic.

With age, under the influence of a number of factors, this process can significantly worsen the quality of life. A person cannot be exposed to significant physical activity and may partially lose working capacity. This leads to disability of the patient.

Primary and secondary prevention

Primary prevention of pericarditis in a child should begin during pregnancy. It is necessary to ensure the prevention of fetal infection and periodic examination of pregnant women. After birth, anti-tuberculosis vaccinations, prevention of colds, acute respiratory viral infections and influenza, as well as hemophilus influenza infections play an important role.

If foci of infection are detected in a child (for example, tonsillitis), their timely sanitation is necessary. Immunological rehabilitation is indicated for frequently ill children. All children are recommended to exercise and exercise.

Secondary prevention is necessary after the child has been cured of the disease in question.. First of all, it is necessary to ensure constant control and clinical observation.

For such children, it is important to conduct regular. Physical exercise must be dosed. Special exercise therapy can play a beneficial role, but the legs must be developed with the participation of a specialist.

Optimal nutrition involves a gentle diet, and the diet should be agreed upon with a nutritionist.

Pediatric pericarditis can occur at any age, starting from birth. Parents need to be vigilant and observant, and when the first signs appear, show the child to the doctor. With timely initiation of treatment, the prognosis for curing pericarditis is quite favorable. You can't miss the moment.