Pericarditis - features of the course, symptoms and treatment, complications

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Pericarditis - features of the course, symptoms and treatment, complications
Pericarditis - features of the course, symptoms and treatment, complications
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Pericarditis: what is it? Symptoms and treatment

Pericarditis is an inflammation of the serous membrane that covers the heart. The disease rarely develops on its own, most often other pathological processes lead to it, which can be infectious and non-infectious in nature.

With pericarditis, fluid begins to accumulate in the region of the heart, or adhesions form. This process takes place directly in the pericardial cavity, between its sheets.

Features of the development of pericarditis

Features of the development of pericarditis
Features of the development of pericarditis

The disease can develop rapidly, in a few hours, or slowly - in a few days. The faster this pathological process occurs, the higher the likelihood of heart failure and cardiac tamponade. The average time for the development of pericarditis from the moment of manifestation of the underlying disease is 7-14 days.

Pericarditis is more common in men than in women. The average age of patients varies between 20-50 years.

What happens in the heart during pericarditis?

The disease begins with the fact that inflammatory exudate begins to sweat into the pericardium. The shell of the heart cannot be strongly stretched, so the fluid accumulated in its cavity begins to put pressure on the organ itself. This causes the ventricular chambers to lose their ability to relax during diastole.

Because the heart's ventricles do not stretch properly, the pressure in the chambers of the heart increases, which increases the impact force of the ventricles. The more inflammatory exudate sweats into the pericardium, the higher the load on the heart muscle will be. If the liquid arrives very quickly, then this threatens the development of heart failure and even cardiac arrest.

When the inflammatory process begins to fade, the fluid will be absorbed by the sheets of the pericardial sac. This leads to a decrease in its volume in the cavity of the heart. However, the fibrin contained in the liquid does not disappear anywhere. It contributes to the fact that the pericardial sheets begin to stick together, later adhesions form between them.

What's going on in the heart
What's going on in the heart

Hemodynamics in pericarditis

The atria in pericarditis experience less stress than the ventricles, since they do not contract with such impact force. While in the ventricles it increases significantly, but the original minute volume remains the same.

At an early stage of the development of pericarditis, the patient's blood pressure rises, and then it goes down. This leads to the formation of congestion in the systemic circulation, which further leads to the development of heart failure.

Causes of pericarditis

Causes of pericarditis
Causes of pericarditis

It is not always possible to isolate the exact cause of pericarditis. In this case, they talk about the idiopathic nature of inflammation. Although sometimes the factors leading to the disease are obvious.

These include:

  • Infections caused by bacterial flora, such as tuberculosis.
  • Inflammatory diseases: rheumatoid arthritis, SLE, scleroderma.
  • Diseases associated with metabolic disorders: hypothyroidism, kidney failure, high blood cholesterol.
  • Heart and vascular disease: myocardial infarction, aortic dissection, Dressler's syndrome.
  • Other causes: HIV, drug use, cancer, trauma, heart surgery.
  • Taking certain medications: immunosuppressants, Isoniazid, Difenin, etc.

Sometimes, pericarditis develops in infants. In this case, the most likely cause is a streptococcal or staphylococcal infection. In older children, viral infections or other pathologies accompanied by an acute inflammatory reaction in the body lead to damage to the heart membrane.

Classification

Classification
Classification

About 60% of all pericarditis are infectious.

In this regard, the following types of inflammation of the lining of the heart are distinguished:

  • 20% of people develop viral pericarditis.
  • In 16.1% of cases, pericarditis is bacterial.
  • Rheumatic pericarditis occurs in less than 10% of cases.
  • Septic pericarditis can develop in 2.9% of cases.
  • Fungal pericarditis - 2% of cases, same as tuberculous pericarditis.
  • Protozoal pericarditis is diagnosed in 5% of patients.
  • Syphilitic pericarditis develops less frequently than others, in about 1-2% of cases.

In 40% of cases, pericarditis is non-infectious.

At the same time, the following types of it are distinguished:

  • Post-infarction (10.1% of cases).
  • Postoperative pericarditis (7% of cases). With the same frequency, people develop pericarditis against the background of connective tissue diseases.
  • Traumatic pericarditis (7-10% of cases).
  • Allergic pericarditis (3-4% of cases).
  • Radiation pericarditis (less than 1% of cases).
  • Pericarditis due to blood diseases develops in 2% of cases.
  • Medicated pericarditis accounts for 1.4% of cases.
  • Idiopathic pericarditis is diagnosed in 1-2% of cases.

In children, the disease occurs in 5% of cases. At the same time, 10% of pericarditis occur in an exudative form, and the remaining 80% of pericarditis - in a dry form.

Newborns are most often diagnosed with viral pericarditis, which develops in 60-70% of cases. Bacterial pericarditis is found in 22% of cases. In childhood, the frequency of occurrence of different types of pericarditis is as follows:

  • 55-60% is due to viral pericarditis.
  • 12% of cases are due to rheumatic pericarditis.
  • 5, 5-7% of cases are postoperative pericarditis.
  • 5% of cases are due to bacterial pericarditis.

In adults, the incidence of the disease is somewhat different:

  • Viral pericarditis is diagnosed in 18-23% of cases.
  • In 15% of cases, pericarditis develops after a heart attack.
  • Rheumatic pericarditis occurs in 10% of cases.
  • Connective tissue diseases lead to the development of pericarditis in 7-10%.

Pericarditis symptoms

Symptoms of pericarditis
Symptoms of pericarditis

When pericarditis develops acutely, the patient experiences intense pain in the region of the heart. They are concentrated behind the sternum on the left side. The pain is piercing, although some patients complain of a dull ache.

Painful sensations radiate to the back and neck. They become more intense during coughing, when trying to take a deep breath, while lying down. If the person sits or leans forward, the pain subsides.

Another symptom of pericarditis is a cough. It's dry and hard to get rid of. These symptoms can develop not only with pericarditis, but also with myocardial infarction. This fact complicates the process of making a correct diagnosis.

Chronic pericarditis is characterized by persistent inflammation in which fluid begins to accumulate in the pericardium.

In addition to pain in the chest, a person will complain of other symptoms:

  • Shortness of breath that worsens when leaning forward.
  • Frequent pulse.
  • Increase in body temperature up to 37.5 °C, but not higher. The temperature remains at this level for a long time.
  • Cough.
  • Bloating.
  • Swelling of the lower extremities.
  • Increased sweating at night.
  • Weight loss.

If a patient develops dry pericarditis, his symptoms will be as follows:

  • Increased weakness, increased body temperature, muscle aches.
  • Increased sweating.
  • Heart pains.
  • Disturbances in the work of the heart, which a person feels well.
  • Increased heart rate on inspiration, with a decrease in systolic pressure. This phenomenon is called the paradoxical pulse.
  • Pressure rise followed by pressure drop.

When a person develops pericardial effusion, they will experience symptoms such as:

  • Shortness of breath.
  • Subfebrile body temperature.
  • Fall in blood pressure.
  • Loss of consciousness. Fainting is frequent, but not long lasting.
  • Deterioration of sleep quality.
  • Pain when swallowing food.
  • Pain in the epigastric region.
  • Hiccups that last a long time. It is impossible to cope with it by conventional means.
  • Dry cough that may produce blood.
  • Vomiting and nausea.
  • Swelling of the lower extremities.
  • Enlargement of the veins closest to the skin.

Pericarditis pain

Pain in pericarditis
Pain in pericarditis

The pain that occurs with pericarditis has some characteristics:

  • The nature of the pain varies. It can be burning, aching, pressing or stabbing.
  • At first, the pain is not too intense, but as the disease progresses, it gets worse. Pain can peak within hours.
  • If a person does not get help from a doctor, then the pain can become unbearable.
  • Pain focus area: left side of chest. Pain can radiate to the back, neck and hip.
  • If a person coughs, he will feel the pain increase. Sneezing, swallowing, sharp turns of the body can provoke an increase in its intensity.
  • Relieve intense pain by bending the torso forward, or pulling the knees to the chest.
  • Pain disappears as exudate accumulates.
  • Analgesics, drugs from the NSAID group can relieve a pain attack. Nitrates cannot stop a pain attack.

Pericarditis cough

Cough always accompanies pericarditis. It is dry, torments a person with seizures. At an early stage in the development of inflammation, cough occurs due to the fact that the pericardium increases in size and begins to put pressure on the lungs. In the future, the cough will be due to heart failure. Sometimes during coughing, sputum begins to separate. It may contain streaks of blood. Often the sputum looks like foam.

When a person lies down, the pressure on the bronchi and trachea increases. This causes the cough to sound like a barking dog.

When should I see a doctor?

When to contact
When to contact

Symptoms that develop with pericarditis may indicate other diseases of the lungs or the cardiovascular system. Therefore, when the first pains appear in the region of the heart, it is necessary to consult a doctor and receive treatment.

If a person does not have a medical education, then he will not be able to independently distinguish pericarditis from other cardiac or pulmonary pathologies. Inflammation of the pericardium can be mistaken for myocardial infarction or pulmonary thrombosis. All of them pose a direct threat to the life of the patient and require immediate assistance.

In order not to forget all the symptoms that bother a person, it is best to write them down on a piece of paper and list them to the doctor. It is important to remember how long ago they appeared, how intense they are. The doctor will need information about the diseases of the cardiovascular system, which suffered from close blood relatives of the patient. If a person is receiving any treatment, they should inform the doctor. Including, this applies to dietary supplements.

Pericarditis during pregnancy

During pregnancy, pericarditis most often develops in the 3rd trimester. About 40% of women suffer from the disease. The disorder develops due to the fact that in the body of the expectant mother, the volume of circulating blood increases. At the same time, pregnant women do not present any complaints.

Pericarditis, which was caused by another pathology in the body, requires treatment. He is selected taking into account the position of a woman.

If a woman suffers from chronic pericarditis, which often recurs, then pregnancy can only be planned after achieving a stable remission.

Complications of pericarditis

Complications that can develop with severe pericarditis:

  • Pericardial effusion. The doctor can suspect this pathology due to the symptom of Huert. The sound during percussion of the left subscapular region will be dulled. A similar sound occurs during percussion at the level of 2-5 thoracic vertebrae. If the effusion is minor, it may go away on its own. When a lot of fluid accumulates and the patient has pathological symptoms (shortness of breath, drop in blood pressure, change in heart tone, etc.), then the likelihood of developing tamponade increases.
  • Cardiac tamponade. It develops when blood accumulates very quickly in the heart sac, and it does not have time to stretch to the desired volume. At the same time, the heart begins to suffer from pressure, which affects its work. Tamponade can develop with effusions from 100 ml, and sometimes more blood is required for its manifestation, for example, 1 liter. A person's blood pressure decreases, jugular veins begin to swell, heart sounds become muffled. To detect tamponade, an ultrasound of the heart and its ECG are required.
Complications of pericarditis
Complications of pericarditis

Calcification of the pericardium. This complication develops against the background of a prolonged inflammatory process, when damaged pericardial lobes begin to fuse with each other with adhesions. The pericardium becomes thick, its ability to stretch worsens. The heart muscle stops doing its job normally, the patient develops heart failure. In this case, a diagnosis of constrictive pericarditis is made, which is observed in approximately 9% of cases (in those patients who have had acute pericarditis). The disease progresses, which leads to the deposition of calcium s alts in the pericardium. When there are a lot of them, it hardens. Doctors call this condition "shell heart."

Diagnosis of pericarditis

If the doctor suspects pericarditis, it is necessary to perform auscultation of the chest. For this purpose, a stethoscope is used. During the examination, the person should lie flat on his back, or lean on his elbows. If the doctor hears a noise that resembles the rustling of paper, he will refer the patient for further instrumental examination. The fact is that such noise is made by the petals of the pericardium, which are in an inflamed state.

Procedures that can be shown to the patient to clarify the diagnosis:

  • ECG. Examination helps distinguish pericarditis from myocardial infarction.
  • Chest x-ray. This procedure makes it possible to assess the size and shape of the heart. When large volumes of fluid accumulate in the pericardium (more than 250 ml), an enlarged heart can be seen in the picture.
  • Ultrasound. This study allows you to examine the heart in detail and evaluate its functions.
  • CT. To obtain maximum information about cardiac structures, a patient may be assigned a computed tomography. This procedure will distinguish pericarditis from pulmonary thrombosis, from aortic dissection, etc. CT provides information on the degree of thickening of the pericardium.
  • MRI. This method allows you to get a layered image of the heart. The study is one of the most informative.
Diagnosis of pericarditis
Diagnosis of pericarditis

In addition to instrumental methods of examination, the patient is prescribed laboratory diagnostics. Blood is taken for a general analysis with the obligatory determination of ESR, urea nitrogen and creatinine, AST, lactate dehydrogenase.

To identify the causative agent of inflammation of the heart membrane, additional examinations may be needed.

Pericarditis is most often confused with myocardial infarction. To conduct a differential diagnosis, you need to focus on the differences that are listed in the table.

Symptom

Pericarditis

Myocardial infarction

Features of pain Pain gets worse when coughing or breathing deeply. The pain is sharp, concentrated behind the chest on the left side. The pain is pressing. The man points to a feeling of heaviness in his chest.
Spreading pain Pain radiates to the back, or does not radiate to any organs at all. Pain radiates to the jaw or to the left arm. Sometimes there is no pain at all.
Voltage Does not affect the nature of the pain. Pain worsens with exertion.
Body position When a person lies on his back, the pain becomes more intense. Intensity of pain does not depend on body position.
When pain occurs and how long does it last Pain manifests itself sharply. A person can tolerate it and not seek medical help for several days. Pain develops unexpectedly for a person. He seeks medical help within a few hours. Sometimes the pain goes away on its own.

Treatment and prognosis

Treatment and prognosis
Treatment and prognosis

Taking medications can reduce swelling, relieve inflammation. If there is a suspicion of developing cardiac tamponade, it is necessary to hospitalize the patient. When the diagnosis is confirmed, surgery is required. The help of a surgeon is needed for patients with hardening of the pericardium.

Therapy largely depends on the severity of the inflammation. Mild pericarditis may resolve on its own. In other cases, treatment is required. It can last from 14 days to several months.

The likelihood that inflammation recurs varies between 15-30%. Developing heart failure, high body temperature and fluid accumulation in the pericardial area worsen the prognosis. In general, it depends on what exactly caused the development of pericarditis. More than 88% of patients with idiopathic pericarditis live for 7 years or more. For people with postoperative pericarditis, this figure drops to 66%. Poor prognosis for patients with radiation pericarditis. No more than 27% of patients pass the survival threshold at 7 years.

Prevention of pericarditis

Prevention of pericarditis
Prevention of pericarditis

To prevent the development of inflammation, the following recommendations must be observed:

  • Treat infectious diseases in a timely manner.
  • Take antibiotics if bacterial disease develops.
  • Streptococcal infection requires bicillin prophylaxis.
  • Treat caries, tonsillitis and influenza in time.

If pericarditis has already developed and managed to stop it, you need to focus on preventing the recurrence of inflammation.

Measures to be taken:

  • Do sports.
  • Eat right.
  • Minimize stressful situations.
  • Prevent hypothermia.
  • Treat the underlying disease.

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