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 of an infectious and non-infectious nature.

With pericarditis, fluid begins to accumulate in the area of ​​uXNUMXbuXNUMXbthe heart, or adhesions form. This process occurs directly in the pericardial cavity, between its sheets.

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.

What happens in the heart with 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. Because of this, the ventricular chambers lose their ability to relax during diastole.

Since the ventricles of the heart do not stretch as they should, 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, in the future, adhesions form between them.

Hemodynamics in pericarditis

The atria with 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 initial minute volume remains the same.

At an early stage in 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

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 impaired metabolic processes: hypothyroidism, renal failure, high blood cholesterol.

• Diseases of the heart and blood vessels: myocardial infarction, aortic dissection, Dressler’s syndrome.

• Other causes: HIV, drug use, cancer, trauma, heart surgery.

• Taking certain medications: immunosuppressants, Isoniazid, Difenin, etc.

Classification

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

• In 20% of cases, people develop viral pericarditis.

• In 16,1% of cases, pericarditis is bacterial.

• Rheumatic pericarditis is observed no more often than in 10% of cases.

• Septic pericarditis can develop in 2,9% of cases.

• Fungal pericarditis – in 2% of cases, as well as tuberculous pericarditis.

• In 5% of cases, patients are diagnosed with protozoal pericarditis.

• Syphilitic pericarditis develops less frequently than others, in about 1-2% of cases.

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

In this case, the following types are distinguished:

• Postinfarction (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 against the background of blood diseases develops in 2% of cases.

• Drug-induced 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.

In newborns, viral pericarditis is most often diagnosed, 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:

• In 18-23% of cases, viral pericarditis is diagnosed.

• In 15% of cases, pericarditis develops after a heart attack.

• Rheumatic pericarditis develops in 10% of cases.

• Connective tissue diseases lead to the development of pericarditis in 7-10%.

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 dull pain.

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 down or leans the torso forward, the pain subsides.

Another symptom of pericarditis is coughing. 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, which is aggravated by bending forward.

• Rapid pulse.

• An 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, then his symptoms will be as follows:

• Increased weakness, increased body temperature, muscle aches.

• Increased sweating.

• Heart pain.

• Violations in the work of the heart, which a person feels well.

• Increased inspiratory heart rate, with a decrease in systolic pressure. This phenomenon is called the paradoxical pulse.

• An increase in pressure followed by a fall.

When a person develops exudative pericarditis, they will experience symptoms such as:

• Dyspnea.

• Subfebrile body temperature.

• Drop in blood pressure.

• Loss of consciousness. Fainting occurs frequently, but they are not long lasting.

• Deterioration in the quality of sleep.

• Pain while swallowing food.

• Pain in the epigastric region.

• Hiccups that last a long time. It is not possible to cope with it by conventional means.

• Dry cough, during which blood may come out.

• Vomiting and nausea.

• Swelling of the lower extremities.

• Enlargement of the veins that are closest to the skin.

Pain in pericarditis

The pain that occurs with pericarditis has some features:

• 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 becomes stronger. Pain can reach peak values ​​in just a few hours.

• If a person does not receive help from a doctor, then the pain can become unbearable.

• Area of ​​focus of pain: left side of the chest. Pain can radiate to the back, neck and thigh.

• If a person coughs, he will feel the pain intensify. Sneezing, swallowing, sharp turns of the body can provoke an increase in its intensity.

• To relieve intense pain, bend the torso forward, or pull the knees to the chest.

• The pain disappears as the exudate accumulates.

• Analgesics, drugs from the group of NSAIDs allow you to relieve a painful attack. Nitrates can not stop the pain attack.

Cough with pericarditis

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 leads to the fact that the cough begins to resemble the barking of a dog.

When is it necessary to see a doctor?

Symptoms that develop with pericarditis may indicate other diseases of the lungs or the cardiovascular system. Therefore, when the first pains in the heart area appear, 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 carry a direct threat to the life of the patient and require immediate assistance.

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 the 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, a drop in blood pressure, a change in heart tone, etc.), then the likelihood of developing tamponade increases.

• Cardiac tamponade. It develops when blood accumulates very quickly in the heart bag, 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.

• Calcification of the pericardium. This complication develops against the background of a long-term inflammatory process, when the damaged petals of the pericardium 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 salts 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, then 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 emitted 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. The study allows you to distinguish pericarditis from myocardial infarction.

• Chest X-ray. This procedure makes it possible to assess the size of the heart and its shape. 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 get the maximum information about the cardiac structures, the 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.

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.

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.

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 the 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 7% of patients pass the survival threshold at 27 years.

Prevention of pericarditis

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

• Timely treat infectious diseases.

• Take antibiotics if a bacterial disease develops.

• Streptococcal infection requires prophylaxis with bicillins.

• Treat caries, tonsillitis and flu in time.

If pericarditis has already developed and managed to stop it, efforts should be made to prevent the recurrence of inflammation.

Measures to be taken:

• Do sport.

• Eat right.

• Minimize stressful situations.

• Avoid hypothermia.

• Engage in therapy for the underlying disease.