Pericarditis in children: exudative, purulent, fibrous. Get treatment in Korea, Israel, Germany, USA. Non-inflammatory lesions of the pericardium

Pericarditis in children is most often associated with septic diseases or pneumonia, against which it develops. The coccal infection penetrates through the bloodstream into the pericardial cavity and there it begins destructive work for the pericardium.

The symptoms of pericarditis in children are similar to the symptoms of the disease in adults. The child also feels pain in the heart area, however, the younger the age, the more difficult it is to obtain an adequate assessment of the condition from him. However, a child’s cough along with gagging should alert parents. It is worth paying attention to the situation of the child’s search for a comfortable position in which pain sensations decrease.

Statistics on pericarditis in children still indicate that in most cases the disease affects children over 6 years of age. Care should be taken when treating influenza, possibly tuberculosis and similar infectious diseases, after which pericarditis may occur. Often, inflammation of the pericardium in children goes away on its own. However, if you have prolonged complaints of shortness of breath and fatigue, you should consult a doctor.

Pericarditis in children is a process of inflammation of the pericardium of the heart (most often its inner layer). Usually, this pathology in childhood it does not often act as a symptom of another disease; most often it is a complication of some pathological process. In addition, it is very rarely diagnosed in children.

Depending on the child’s immunity and the strength of the influencing pathogenic factor, the inflammatory process in the pericardium can be acute or protracted course, accompanied by the accumulation of exudate in the pericardial sac or fusion of the pericardial layers with each other, have a limited or widespread localization.

For reference. Acute pericarditis in children is characterized by a sudden onset, the duration of the inflammatory process does not exceed six months.

In this condition, exudate accumulates, which can either resolve on its own, which will lead to the development of fibrinous pericarditis, or, on the contrary, accumulate in excess, which poses a threat to the life of the child.

Chronic pericarditis in children can occur either primarily or be a consequence of an acute inflammatory process in the pericardium. This disease may be:

• constrictive (adhesive),
• mixed.

For reference. With a significantly longer period of chronic pericarditis, connective tissue develops in the area of ​​inflammation, which can result in fusion of the pericardial cavity. At the same time, calcium is deposited on the pericardial layers. All this causes the development of a pathology called “shell heart”.

Classification of pericarditis in children

Based on the symptoms of the disease, the following types of pericarditis in children are distinguished:

• Dry, or;
• Potty.

This division is conditional, since both types of disease develop according to the same mechanism. Pericarditis is classified according to its symptoms. Effusion pericarditis in the clinic is also divided into purulent and serous.

At fibrous inflammation of the pericardium, deposits of fibrin threads and a small amount of effusion are noted in the pericardial cavity. This condition The clinic calls it a “hairy heart.”

With pericardial effusion, a significant amount of fluid accumulates in the pericardial sac. It can be serous, fibrinous, purulent or bloody in nature.

For reference. After suffering from inflammation of the pericardium, adhesive pericarditis develops - a set of symptoms caused by the fusion of the pericardial layers with each other.

Most severe course The exudative form of inflammation of the pericardium is different, especially with a rapid rate of exudate accumulation. Fibrous and adhesive pericarditis often occurs without symptoms.

Causes of pericarditis in children

The inflammatory process in the serosa of the heart in children usually occurs for the following reasons:

• The presence of an infectious disease (most often caused by streptococci, staphylococci, influenza viruses, adeno- or enteroviruses;
• Cardiac surgery;
• Tuberculosis;
• HIV infection;
• Rheumatic diseases;
• Traumatic chest injuries;
• Taking certain potent drugs medicines During a long time;
• Insufficient kidney function;
• Malignant neoplasms;
• Metabolic diseases - gout, thyrotoxicosis, Dressler's syndrome.

Pathogenesis of pericarditis in children

Attention. Most cases of pericardial inflammation are caused by a malfunction immune system child, that is, the presence of rheumatic or viral diseases.

Pericarditis during the course of purulent pathological processes is considered as metastatic, occurring due to the reflux of blood into the serosa of the heart or the penetration of purulent contents into the pericardial sac from the muscular layer of the heart.

Uremic inflammatory process in the pericardium develops with insufficient functioning of the kidneys, and is caused by poisoning of the body with circulating substances. Various examination methods can detect deposits of fibrin threads and exudate. The nature of the exudate depends on the leading disease that caused inflammation of the serous cardiac membrane.

Symptoms of pericarditis in children

The disease begins acutely. Most distinctive features pericarditis:

• Symptoms of accumulation of effusion or fibrinoid deposits, which is manifested during examinations in the pericardial friction noise, pain, as well as increased heart size.
• Insufficient filling of the heart with blood at the moment of relaxation, which signals compression of the heart chambers by accumulating exudate. This condition provokes stagnation of blood in the vena cava system, as well as an enlargement of the spleen and liver, and tissue swelling.

Attention! Most a clear sign Pericarditis is the presence of pain that constantly bothers the child. In young patients before school age they are often detected in the abdominal area, and are accompanied by flatulence.

On palpation, the pain intensifies, especially in the epigastric zone. In addition, the pain syndrome is often felt more strongly when the child changes position or more. deep breath. School-age children usually feel pain in the chest area, radiating to the neck and left shoulder.

In approximately half of young patients, especially at the very beginning of the disease, special symptom– friction noise serous membrane hearts. This sound may have the character of weak extratones, or may be more coarse and resemble the crunch of snow under the soles.

The strength of the pericardial friction noise does not depend on the volume and nature of the exudate - this sign appears when there are overlaps of fibrin threads on the outer lining of the heart, as well as when the pericardial layers touch each other.

The symptoms of effusion pericarditis depend on the volume and rate of flow of exudate. The little patient’s health suddenly deteriorates and dyspnea appears.

For reference. The child begins to be bothered dull pain V chest, due to which he is in a semi-sitting position. If there is a significant amount of exudate, the baby may experience hoarseness and hiccups.

Patients of preschool age often experience an enlargement of the chest on the left side, due to its increased resistance.

In addition, with pericarditis, a disturbance in the blood supply to the heart occurs during diastole, due to pressure on the cardiac chambers. Symptoms are especially pronounced in patients under 1 year of age. It is manifested by an increase in central venous pressure in the superior vena cava system.

Attention. This condition in babies under one year of age provokes an increase in intracranial pressure, which is manifested by increased resistance of the muscles of the occipital region, vomiting, swelling of the fontanelle, etc. After these signs, blueness often occurs skin in the area of ​​the roots of the nails, ears.

In addition, enlargement of the liver and spleen develops; most often, palpation of the liver causes pain. Also in children, swelling of the face is detected, which over time spreads to the neck area.

Adhesive pericarditis in children occurs as a complication of inflammatory processes in the pericardium due to rheumatism, tuberculosis or sepsis. In some situations, the acute phase of this disease they don’t have time to detect. The disease is diagnosed when there is a failure in the blood flow system that occurs as a result of the fusion of the layers of the serous membrane of the heart with each other.

First of all, insufficient blood supply to the heart occurs during the relaxation phase. The child is bothered by sensations of pressure under the right ribs and deterioration in health.

In this case, a bluish discoloration of the skin is also observed, which intensifies when taking a lying position. Venous system neck is clearly visible, swelling and pulsating. The baby is also found to have fluid accumulation in abdominal cavity.

Diagnosis of pericarditis in children

First of all, the child should be examined by a therapist or cardiologist and undergo a thorough visual inspection. In this moment
The heart is auscultated and its boundaries are determined.

After this, as a rule, the following are prescribed:

• Echocardiographic examination,
• radiography,
• laboratory examinations.

Differential diagnosis is required to distinguish pericarditis from other similar pathologies or complications.

Effusion pericarditis

With a significant volume of exudate, a decrease in the amplitude of the waves is recorded on the electrocardiogram, often a lowering of the T waves and movement of the ST segment. X-ray examination reveals an increase in cardiac shadows, and their shape most often becomes triangular or spherical.

Most reliable method The examination of pericarditis is an echocardiographic study. This examination helps to identify the presence and volume of exudate, detect fibrin deposits on the layers of the serous membrane of the heart.

For reference. Confirmation of the diagnosis occurs after puncture of the pericardium. In this case, the pumped out liquid is examined using a biochemical method.

Adhesive pericarditis

This pathology is diagnosed by recording an electrocardiogram. It reveals a slight decrease in the amplitude of the waves and a unidirectional displacement of the ST segment. The T wave may also point downward. In some cases, a pericardial early diastolic murmur is recorded on the phonocardiogram.

An X-ray examination is also performed. It allows you to detect a shift in cardiac boundaries and a decrease in pulsation.

Important. The difficulty of diagnosing pericarditis in children lies in the difficulty of identifying the pathogenesis of the disease.

Treatment of pericarditis in children

Therapy is aimed at eliminating the pathological process that caused the development of pericarditis. In this case, doctors focus on the type of inflammatory process and the level of severity of the little patient’s condition.

Attention. During acute period course of the disease, strict bed rest If the form of the disease is protracted, a restriction on physical activity is established for the child.

Appointed dietary food, including a vitamin complex and rich in easily digestible proteins. At the same time, the amount of fatty and salty foods is limited.

Drug therapy

During the acute period of dry pericarditis, anti-inflammatory drugs (“Nemesulide”, “Nurofen”), as well as analgesics and a complex of vitamins are prescribed. Doctors also prescribe potassium salts, Riboxin and Mildronate.

If exudate accumulates due to the presence of infectious processes, the child is prescribed antibiotic treatment.

For reference. If a puncture of the serous membrane of the heart has been made, a laboratory test of the effusion is carried out to identify microorganisms and their sensitivity to antibiotic medications.

With purulent pathological process Combination administration is often used medicines– by intramuscular injections and drainage.

Inflammation of the serosa of the heart caused by rheumatic or autoimmune diseases is treated with hormonal corticosteroid drugs. Most often in childhood, Prednisolone is prescribed to relieve inflammation and resolve exudate.

Surgical intervention

With the rapid accumulation of exudate in the pericardial sac, there is a risk of development for the child, which can lead to asystole and death of the disease.

In view of this, in these situations, an urgent puncture of the serous membrane of the heart is performed, followed by removal of the exudate. Also, this surgical intervention can be performed when the effusion takes a long time to resolve (more than two to three weeks) or for laboratory testing of its composition.

For reference. If the pericardial layers have hardened and calcium deposits have been found on them, which prevents the heart from expanding during relaxation, the area of ​​scar tissue is removed using resection. Adhesions in the form of adhesions between the pleura and pericardium are dissected by almost complete removal pericardial sac.

Prevention of pericarditis in children

If a child has severe infectious or autoimmune diseases, it is imperative to undergo a sufficient course of therapy, after which it is imperative to undergo repeated laboratory and instrumental diagnostics in order to confirm recovery.

To prevent recurrence of pericarditis or the development of severe consequences, the child should be registered with a cardiologist and take preventive courses to boost immunity and improve metabolic processes in the heart.

Attention. At least twice a year, you should undergo a full medical examination, with the mandatory inclusion of echocardiography, electrocardiography and blood tests in the diagnostic list.

Which doctors should you contact if you have pericarditis in children?

• Cardiologist;
• Pediatrician.

During pregnancy female body is undergoing enormous restructuring and change. Therefore, in this risk group the possibility of developing pericarditis is quite high. The disease in the expectant mother may be asymptomatic. Complicated forms occur rarely. Pericarditis in a pregnant woman can last 2-3 weeks and go away without special treatment.

The development of pericarditis during pregnancy may be associated with physiological changes and metabolic processes.

The most common causes of the development of this pathology in adults are rheumatism and tuberculosis. Inflammation of the cardiac membrane can be infectious or aseptic in nature. Diseases of rheumatic and tuberculous origin are an infectious-allergic process.

Risk factors influencing the development of pericarditis are:

• viral or bacterial infections;
• allergic reactions;
• systemic diseases (lupus erythematosus);
• heart injury or surgery;
• malignant tumor processes;
• radiation sickness;
• pathologies of pericardial development;
• swelling;
• hemodynamic disorders.

Complicated pericarditis detected in the first trimester of pregnancy may serve as an indication for its termination.

Symptoms

Clinical signs The diseases depend on the severity of the degree of inflammation, the presence of exudate and the speed of its formation, and the presence of adhesions.

The acute form is accompanied by the following clinical manifestations:

• long-term pressing pain in the sternum area,
• heart murmurs
• shortness of breath,
• heartbeat disturbance,
• general weakness body,
• unproductive "barking" cough,
• chills.

Often these signs can be confused with symptoms of dry pleurisy.

During acute pericarditis pain intensifies when inhaling, swallowing, or changing body position. Pain syndromes can increase gradually. Breathing becomes rapid and shallow, as if shortness of breath.

Two to three weeks after the dry form, exudative pericarditis may develop, characterized by the following symptoms:

• pain in the heart,
• feeling of tightness in the chest,
• rapid breathing,
• a feeling of constriction in the esophagus,
• hiccups,
• fever,
• swelling of the face,
• anterior chest,
• bulging neck veins,
• pallor of the skin.

During the examination of the patient, you can notice smoothing of the intercostal spaces.

Exudative pericarditis develops either independently or is a consequence of tuberculous, allergic, or tumor forms of the disease.

Diagnosis of pericarditis in pregnant women

With pericarditis, early diagnosis of the disease is extremely important, since its development poses a great threat to the health and life of the patient. It is imperative to carry out a differential diagnosis, excluding pathologies with similar symptoms. To make a diagnosis, the cardiologist collects the patient's medical history and examines him by listening and beating the heart. Along with this, laboratory tests are carried out, including general, biochemical analysis blood, immunological studies which are necessary to identify the cause and nature of the disease.

To make a diagnosis, the following diagnostic measures are also carried out:

• electrocardiography,
• X-ray examination of the lungs and heart,
• computer and magnetic resonance therapy,
• echocardiography.

For pericarditis with effusion, exudate is examined. For this purpose, a diagnostic puncture and biopsy of the pericardium is taken.

Complications

Complicated pericarditis can cause death. At adequate treatment the disease has a favorable prognosis.

Treatment

What can you do

At the first signs of malfunctions of cardio-vascular system you need to consult a doctor. Ignoring symptoms can lead to undesirable consequences, including complications of pregnancy, delayed fetal development, congenital pathologies The child has.

If a pregnant woman is diagnosed with pericarditis, she should remain in bed. The expectant mother must be protected from overwork, intense physical activity, stress and anxiety.

What does a doctor do

The treatment tactics for pericarditis are selected after identifying clinical manifestations, determining the form of the disease and pathogenesis.

In acute cases, treatment is carried out aimed at relieving symptoms. The patient is prescribed anti-inflammatory drugs, analgesics, potassium-based drugs and medications whose action is aimed at normalizing metabolic processes.

For exudative pericarditis of a bacterial nature, antibiotic therapy is performed. For tuberculosis, therapy lasts more than six months.

Treatment of secondary pericarditis is carried out by prescribing corticosteroids to promote complete resorption of the effusion. This therapy is highly effective for allergic pericarditis that has developed against the background systemic diseases, for example, with lupus erythematosus.

In some cases, for example, with the rapid accumulation of exudate, with compression of the heart muscle, surgical intervention is prescribed.

At early diagnosis and if treatment is started on time, the prognosis of the disease is favorable.

Prevention

Prevention of the development of pericarditis during pregnancy comes down to general recommendations, among which:

• healthy lifestyle,
• proper nutrition,
• refusal bad habits- alcohol and smoking,
• moderate physical activity.

The expectant mother should avoid overwork, frequent stress and anxiety, follow a sleep and rest schedule. Before conception and during pregnancy, it is necessary to undergo examinations by specialists, in particular a cardiologist.

In the article you will read everything about methods of treating a disease such as pericarditis during pregnancy. Find out what effective first aid should be. How to treat: choose medications or traditional methods?

You will also learn how it can be dangerous not to timely treatment the disease pericarditis during pregnancy, and why it is so important to avoid the consequences. All about how to prevent pericarditis during pregnancy and prevent complications. Be healthy!

Acute or chronic inflammation epi and pericardial layers - this is pericarditis. In children, 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 to diagnose and treat pericarditis in a child.

Causes of pericarditis in children

The population incidence of pericarditis is unknown. Pericarditis is approximately diagnosed in 1% of children, and is 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.

Etiology of pericarditis

Pericarditis in a child can be infectious and aseptic, accompanied by allergic reactions, systemic or metabolic diseases.

1. Sometimes their cause cannot be determined. These are the so-called idiopathic pericarditis. It is believed that a role plays in their occurrence viral infection. The causative agents of the infectious process in the pericardium can 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 in a child can accompany infections such as typhus, cholera, brucellosis, and syphilis.
2. Aseptic pericarditis arise when allergic reactions for the administration of vaccines, serums, antibiotics. They can be a manifestation of polyserositis, developing in acute rheumatic fever, diffuse connective tissue diseases, JRA, sarcoidosis, periodic illness, hematological and oncological diseases, as well as in trauma, heart surgery, hypoparathyroidism, uremia.

Pathogenesis of pericarditis

With infectious pericarditis, the pathogen can penetrate into the pericardial cavity by hematogenous, lymphogenous route, 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 increases in the area great vessels at the base of the heart. 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).

Symptoms of pericarditis in children

Pericarditis in a child 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

1. Pain syndrome: pain is constant; in young children symptoms such as abdominal pain, flatulence, increased pain upon palpation of the abdomen appear; in older boys and girls, 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.
2. Pericardial friction rub is heard at the base of the heart along the left edge of the sternum with the patient sitting.
3. 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.
4. 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 detected 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 and signs of pericarditis

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

Table. Some clinical features of acute pericarditis associated with their etiology

Classification of pericardial diseases

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

Pericarditis:

Non-inflammatory lesions of the pericardium:

• Hydropericardium,
• Hemopericardium,
• Chylopericardium,
• Pneumopericardium,
• Effusion due to myxedema, uremia, gout.

Pericardial neoplasms:

• Primary,
• Disseminated, complicated by pericarditis.

Cysts:

• Constant in volume,
• Progressive.

Acute dry pericarditis in children

It 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 the epigastric region. Older children complain of the following symptoms of pericarditis: 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 systolic-diastolic murmur - “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. Treatment of pericarditis should be started immediately.

Acute effusion pericarditis in children

Especially with a rapid increase in the volume of exudate, it 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

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. With absence emergency care(pericardial puncture) syncope and sudden death are possible.

Exudative pericarditis in children

With exudative pericarditis, the general state sick. Angina attacks appear and are accompanied by a feeling of fear, which is associated with the formation of ischemic areas of the myocardium as a result of compression by effusion coronary vessels. With exudative pericarditis, symptoms of heart failure are also observed in the form of shortness of breath, cyanosis and liver enlargement.

Most early symptom Pericarditis is a pericardial friction noise that is heard at the base of the heart along the edges of the sternum, as well as in the area of ​​large vessels. At first, the pericardial friction noise is intermittent, then becomes rougher, resembling the “crunch of snow.” It is heard during systole and diastole, in contrast to heart murmurs, which are heard in one phase. This noise can be transient, heard for 1-2 days, and sometimes even several hours, and disappears with the appearance of exudate, which promotes the expansion of the pericardial layers, and therefore their friction stops. Hearing a friction rub of the pericardium at least once gives the right to diagnose pericarditis.

Rheumatic pericarditis in children

L.D. Steinberg was right when he noted that the frequency of clinical recognition of rheumatic pericarditis is directly proportional to the persistence and regularity with which the doctor examines the patient [Gornitskaya E.A., 1964]. With rheumatic pericarditis, the exudate is not particularly abundant, it is rich in fibrin and often resolves completely. With pronounced exudates, diagnosing the pericardium does not present any particular difficulties. With dry (adhesive) pericarditis, the main clinical symptoms are pain in the heart and a pericardial friction rub along the left edge of the sternum. Echocardiography data and radiography clarify the diagnosis.

Chronic pericarditis in children

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

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

Adhesive pericarditis in young children without compression of the heart occurs without symptoms. 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, the following symptoms attract attention: puffiness of the face, swelling and pulsation of the neck veins, cyanosis increasing in horizontal position, 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, accent of the second tone over the pulmonary artery with a general moderate muffling of tones are noted. An increased pathological third sound ("pericardial knock", "click") is often heard, and sometimes a pericardial friction noise is heard.

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

Diagnosis of pericarditis in children

Diagnosing pericarditis in young children is often difficult due to its mild severity clinical symptoms and often a complete examination of the patient is not enough.

1. Changes in peripheral blood are nonspecific and indicate only a current inflammatory or purulent process.
2. Biochemical, immunological and bacteriological studies are usually carried out to clarify the etiology and form of pericarditis.
3. An ECG over time is informative in acute fibrinous pericarditis, in the initial stage of effusion pericarditis, as well as in the adhesive process (compression syndrome of the cardiac cavities). With exudative and chronic pericarditis, a decrease in the electrical activity of the myocardium is detected.
4. FCG records systolic-diastolic murmur not related to the cardiac cycle and periodic high-frequency oscillations (“clicks”).
5. Radiography is of great importance in the diagnosis of the exudative process, in which the size and configuration of the cardiac shadow changes (it takes on a spherical, trapezoidal shape); Atelectasis of the lower lobe of the left lung is also possible due to compression of the bronchus. With constrictive pericarditis, radiographs reveal an enlarged shadow of the superior vena cava, and blurred contour of the heart due to pleuropericardial adhesions is noted. When performing x-ray kymography, a decrease in the amplitude of pulsation along the contours of the heart is detected. Puncture and biopsy of the pericardium can clarify the etiology of pericarditis in severe and unclear cases.
6. The main method used to diagnose pericarditis in children is echocardiography, which allows one to judge the presence and amount of fluid in the pericardial cavity, changes in cardiac kinetics, the presence of intrapericardial and pleuropericardial adhesions, and residual effects of the process in the form of thickening of the epicardial and pericardial layers.

Echocardiography of pericarditis in children

Echocardiography can even detect a small amount of fluid in the pericardial cavity.

Fibrinous and adhesive pericarditis are determined by echocardiography by an increase in the density and thickness of the pericardial sheets, the appearance of layering, heterogeneity of their structure, and divergence of the pericardial sheets due to the fluid present between them.

At rapid education exudate, intrapericardial pressure increases significantly, and diastolic filling of the ventricles of the heart is disrupted. A number of patients experience prolapse syndrome mitral valve, which disappears when fluid is removed from the pericardial cavity.

Among infectious pericarditis, there is an increase in the frequency of forms of diseases caused by a virus. The most cardiotropic are enteroviruses Coxsackie B 3.

Diagnosis of pericarditis by ultrasound

Ultrasound diagnostics is especially valuable for diagnosing the effusion process in the cavity of the pericardial sac in girls and boys of infancy. Even a small amount of effusions in the pericardial cavity causes separation of echo signals from the epicardium and the parietal layer of the pericardium with registration of the echo-negative space between them.

Based on the width of the echo-negative zone, it is possible to judge the amount of effusion.

The fibroplastic process is characterized by the presence of layered chaotic echo-positive signals on the epicardium or separated pericardial layer, and also manifests itself in the form of an organized second compressive membrane located in the echo-negative space between the pericardial layers.

Equal-amplitude concordant movement of the separated parietal layer of the pericardium with back wall left ventricle indicates the presence of adhesions between the layers of the pericardium.

Clinical and laboratory and instrumental diagnostic criteria for pericarditis are presented in the table.

Table. Diagnostic criteria various forms pericarditis

Differential diagnosis of pericarditis

At acute development Both dry and effusion pericarditis are differentiated primarily from myocarditis. At rheumatic diseases The membranes of the heart are usually affected simultaneously, so myopericarditis is most often diagnosed. Certain diagnostic value has an ECG that allows you to identify rhythm disturbances, intra-atrial and intraventricular conduction, characteristic of myocarditis.

Chronically current, especially asymptomatic effusion pericarditis is differentiated from non-rheumatic carditis and cardiomyopathies. Unlike the latter, the children’s well-being, despite severe cardiomegaly, is not impaired, there is no “heart hump”, heart sounds are distinct, although weakened. The ECG shows no signs of overload of the heart chambers, arrhythmias, or blockades, but a decrease in the electrical activity of the myocardium persists for a long time. Final diagnosis pericarditis is diagnosed after echocardiography.

With constrictive pericarditis, differential diagnosis is carried out with portal hypertension, liver cirrhosis, chronic carditis, glycogenosis type 1a (von Gierke's disease). Take into account appearance patients, the presence of dilated veins of the esophagus, signs of hypersplenism according to peripheral blood tests, glucose phosphatase levels, splenoportography data. In difficult cases, a puncture biopsy of the liver and pericardium is performed. In most cases, diagnosis is based on echocardiography data.

Treatment of pericarditis in children

Treatment of the underlying disease - antimicrobial and antihistamines, chemotherapy, dialysis, etc. Puncture and drainage of the heart cavity (if purulent pericarditis) on the background antibacterial therapy. Surgery(with adhesive pericarditis).

How to treat pericarditis in a child?

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.

Medicines for the treatment of pericarditis in children

1. Antibiotics for bacterial pericarditis are prescribed for the treatment of pericarditis according to the same principles as for infective endocarditis, taking into account the sensitivity of the pathogen.
2. For pericardial tuberculosis, two (or three) drugs (isoniazid, rifampicin, pyrazinamide) are prescribed for 6 to 8 months.
3. 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.
4. With purulent pericarditis, it is sometimes necessary to drain the pericardial cavity and inject antibiotics into it.
5. 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 young 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, drugs that improve metabolic processes in the myocardium [potassium and magnesium aspartate (for example , asparkam, panangin), inosine (for example, riboxin), etc.]

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, the prognosis that ends with acute pericarditis in a child 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.

Now you know the main causes and symptoms of pericarditis in children, as well as how to treat pericarditis in a child. Health to your children!

Pericarditis in children is a rare disease diagnosed in isolated cases, usually a complication of another disease. During illness, inflammation of the serous membrane of the heart (pericardium) occurs.

Traditionally, pericarditis is divided into dry (fibrous) and exudative (serous and purulent). Separate view considered adhesive, resulting from earlier pericarditis of another type.

Pericarditis in children in most cases is provoked viral diseases. Also the cause may be transferred, diffuse disease connective tissue (for example, lupus). The disease may be caused by uremia.

In addition, in children (up to six years old), pericarditis is provoked by septic processes (for example, staphylococcus). Very rarely, but pericarditis of tuberculous origin still occurs.

Symptoms

Pain. Typical sign. Painful sensations continuous.

1. Pain in the abdominal area. In children (up to five years old) it is observed together with, and becomes stronger with pressure. It can also intensify when changing body position or taking a strong breath.
2. Pain in the chest area. Children seven years old and older. They are also transmitted to the neck area, and then to the left shoulder.
3. A characteristic sound when listening to the heart (pericardial friction noise). Identified in every second child, the sounds differ in tone and pitch.
4. Compression of the cavities of the heart (hypodiastole). Stagnation in the vena cava system, swelling. Palpable swelling of the veins.
5. Deterioration of general condition. The patient feels noticeably worse; shortness of breath and dull pain in the heart area are observed. Characteristic sign– due to unpleasant sensations, the child often sits half-sitting.
6. Changes in heart size. Some increase due to accumulated fluid. Identified by increased cardiac dullness (audible borders of the heart inside the chest).
7. Hoarse voice and hiccups. Very rarely.
8. Swelling of the left side of the chest. Sometimes seen in children under 5 years of age.
9. Reducing upper pressure with normal (and even increased) lower.
10. Swelling. It appears first on the face, then on the neck.

Parents, be careful, don’t let this happen. This entails big health problems, just like too much sugar.

This is a common heart rhythm disorder that needs to be treated.

Pain in the heart area can also lead to. Monitor symptoms closely and contact your doctor.

In infants

The specificity is due to the characteristics of the manifestations of hypodiastole.

1. Increased pressure inside the skull. Caused by increased pressure in the superior vena cava system.
2. Neurological symptoms. A sharp increase in the tone (rigidity) of the muscles at the back of the head, vomiting, bulging of the fontanel.

Location of the heart in the chest cavity.

Features of adhesive form

Other names for this disease are adhesive, constrictive pericarditis. It is believed that this type is a consequence of another form of pericarditis (rheumatic, septic, etc.). The symptoms are not observed so acutely, therefore the adhesive form in a child is detected when hemodynamic (blood circulation) problems are identified.

1. Hypodiastole. It manifests itself through a feeling of squeezing in the right hypochondrium, weakness.
2. Cyanosis. The skin becomes bluish tint, especially when the child is in a horizontal position.
3. Puffiness. Swelling and pulsation of the neck veins, as well as ascites (fluid accumulation in the abdominal cavity) without swelling of the legs.
4. Weakened heartbeat. Detected using medical examinations cardiac activity.

Also a feature of this form of the disease in children is the usual or only slightly enlarged borders of the heart area.

Diagnostics

To make a diagnosis, ECG, radiographic instruments, and echocardiography are used. In case of exudative pericarditis, a puncture is taken to establish the exact nature of the disease.

Treatment

Since pericarditis in children is considered a secondary disease, its treatment is based on eliminating the underlying disease. Therefore, treatment may vary.

1. Dry (fibrinous) pericarditis may not require therapy.
2. Treatment of the exudative form of the disease depends on the nature of the accumulated fluid and its origin. For example, if the disease is of an allergic nature, appropriate medications are often prescribed, in particular corticosteroids. In most cases, diuretics (diuretics) are prescribed to remove excess fluid from the body, which is symptomatic treatment.
3. However, if there is a large volume of accumulated fluid in the area of ​​the heart, a puncture may be prescribed, and in case of purulent pericarditis, it is mandatory or even replaced by drainage of the pericardial cavity. In this case, after complete suction of the purulent fluid, the cavity is washed saline solution With necessary medications, after which antibiotics are administered.

In severe cases of the disease, signs of circulatory failure may appear, which is treated with medication.

Surgical treatment is necessary for adhesive forms of the disease, since other methods are ineffective.

Unfortunately, on this moment does not exist known methods prevention of pericarditis in children, so you should carefully monitor the manifestation of symptoms of the disease in the child.

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: the general condition and well-being worsens, reflex and mechanical hemodynamic disorders are observed, 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.

Causes

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-term use a number of powerful drugs.

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.

Symptoms

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:

• pain in the heart area can vary in nature: dull and aching - this is how exudative pericarditis begins to manifest itself, sharp and sharp are noted in the fibrinous form;
• dyspnea;
• frequent periods of physical weakness;
• constant feeling of fatigue;
• tachycardia;
• dry cough;
• quite high temperature;
• signs of acute heart failure: cyanosis (blue discoloration) of the lips, nose, ears;
• swelling localized on the legs;
• swollen veins in the neck;
• blood pressure decreases.

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.

Forms of the disease

Doctors distinguish several types of childhood pericarditis, each of which differs in the nature of the inflammatory process that occurs in the heart sac. This classification as follows.

• Exudative (exudative)

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 (dry)

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.”

• Adhesive

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 (infectious)

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

• Tuberculous

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.

• Fibrous

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.

Treatment

Cardiac pericarditis in children is serious illness, requiring inpatient 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, an operation is performed to dissect the chest wall to remove the affected areas of the pericardium.

IN in rare cases the disease occurs in soft form 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 is an acute or chronic inflammation of the epicardium and pericardium. 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: clinical observation in a cardio-rheumatology office, regular ECG and echocardiography, elimination of foci of chronic infection, recreational activities, dosed physical activity.

Treatment prognosis. In most cases of 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 with 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 in 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. The main clinical symptoms of pericarditis are associated with fibrin deposition or fluid accumulation in the pericardial cavity, as well as compression of the heart cavities with large effusion and impaired diastolic function of the heart.

Table. Some clinical features of acute pericarditis associated with their etiology

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 the 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 a sharp deterioration in 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 of the 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, are detected. 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

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 concerned about increased fatigue, shortness of breath, and discomfort in the heart area, especially with excessive physical exertion. With long-term exudative pericarditis, from early childhood, a “heart hump” can form. 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, accent of the second tone over the pulmonary artery with a general moderate muffling of tones are noted. An increased pathological third sound (“pericardial knock”, “click”) is often heard, and sometimes a pericardial friction noise is heard.

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 recent 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 viral infection plays a role in their occurrence. The causative agents of the infectious process in the pericardium can 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 can be a manifestation of polyserositis, developing in acute rheumatic fever, diffuse connective tissue diseases, JRA, sarcoidosis, periodic illness, hematological and oncological diseases, as well as in trauma, heart surgery, hypoparathyroidism, uremia.

Pathogenesis of pericarditis in children

With infectious pericarditis, the pathogen can penetrate into the pericardial cavity by hematogenous, lymphogenous route, 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 when the permeability of the vascular wall increases 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. Subsequently, the 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)

Pericarditis

Non-inflammatory lesions of the pericardium

• Hydropericardium,
• Hemopericardium,
• Chylopericardium,
• Pneumopericardium,
• Effusion due to myxedema, uremia, gout.

Pericardial neoplasms

• Primary,
• Disseminated, complicated by pericarditis.

Cysts

• Constant in volume,
• Progressive.

Diagnosis of pericarditis in children

Diagnosis of pericarditis often causes difficulties due to the mild severity of clinical symptoms and often insufficient complete examination of the patient.

Changes in peripheral blood are nonspecific and indicate only a current inflammatory or purulent process.

Biochemical, immunological and bacteriological studies are usually carried out to clarify the etiology and form of pericarditis.

An ECG over time is informative in acute fibrinous pericarditis, in the initial stage of effusion pericarditis, as well as in the adhesive process (compression syndrome of the cardiac cavities). With exudative and chronic pericarditis, a decrease in the electrical activity of the myocardium is detected.

FCG records systolic-diastolic murmur not related to the cardiac cycle and periodic high-frequency oscillations (“clicks”).

Radiography is of great importance in the diagnosis of the exudative process, in which the size and configuration of the cardiac shadow changes (it takes on a spherical, trapezoidal shape); Atelectasis of the lower lobe of the left lung is also possible due to compression of the bronchus. With constrictive pericarditis, radiographs reveal an enlarged shadow of the superior vena cava, and blurred contour of the heart due to pleuropericardial adhesions is noted. When performing x-ray kymography, a decrease in the amplitude of pulsation along the contours of the heart is detected. Puncture and biopsy of the pericardium can clarify the etiology of pericarditis in severe and unclear cases.

The main method for diagnosing pericarditis is echocardiography, which makes it possible to judge the presence and amount of fluid in the pericardial cavity, changes in cardiac kinetics, the presence of intrapericardial and pleuropericardial adhesions, residual effects of the process in the form of thickening of the epicardial and pericardial layers.

Clinical and laboratory and instrumental diagnostic criteria for pericarditis are presented in the table.

Table. Diagnostic criteria for various forms of pericarditis

Differential diagnosis of pericarditis

With the acute development of both dry and effusion pericarditis, it is differentiated primarily from myocarditis. In rheumatic diseases, the membranes of the heart are usually affected simultaneously, so myopericarditis is most often diagnosed. An ECG has a certain diagnostic value, making it possible to identify rhythm disturbances, intra-atrial and intraventricular conduction, characteristic of myocarditis.

Chronically current, especially asymptomatic effusion pericarditis is differentiated from non-rheumatic carditis and cardiomyopathies. Unlike the latter, the children’s well-being, despite severe cardiomegaly, is not impaired, there is no “heart hump”, heart sounds are distinct, although weakened. The ECG shows no signs of overload of the heart chambers, arrhythmias, or blockades, but a decrease in the electrical activity of the myocardium persists for a long time. The final diagnosis is made after echocardiography.

With constrictive pericarditis, differential diagnosis is carried out with portal hypertension, liver cirrhosis, chronic carditis, glycogenosis type 1a (von Gierke's disease). The appearance of the patients, the presence of dilated veins of the esophagus, signs of hypersplenism according to peripheral blood tests, the level of glucose 6 phosphatase, and splenoportography data are taken into account. In difficult cases, a puncture biopsy of the liver and pericardium is performed. In most cases, diagnosis is based on echocardiography data.