The pericardium is the external connective membrane of the heart. It is very thin and looks like a bag where the organ is placed. Its main purpose is to protect the heart muscle from infections and injuries, to protect the organ chambers from excessive expansion. The inflammatory process in this membrane is called pericarditis. This pathology is more prone to men aged 20 to 50 years.
Pathology Description
Inflammation of the pericardium is always acute. If there is a large accumulation of fluid, then the leaves of the membrane can even restrict the movement of the heart.
Pericarditis is divided into exudative, dry and fibrinous, chronic and acute, and others.
Clinic
Most often, at the initial stage, the inflammatory process proceeds against the background of a slight increase in body temperature. The patient has general weakness and malaise, myalgia.
The symptom complex proceeds against the background of pain behind the sternum. Pain is most often observed in the left chest, but can be given to the trapezius muscle. In some patients, the pains are pleural in nature with amplification during a deep breath. In most people in a sitting position, pain is reduced, especially if the body is tilted forward slightly. Many people hold their breasts, constantly try to attach something to it, for example, a pillow or other object.
In addition, the presence of fluid in the heart is accompanied by:
- dry cough;
- pallor of the skin;
- shortness of breath in a horizontal position;
- anxiety.
In severe cases with constrictive pericarditis, many patients have swelling on their legs. This is due to the fact that the heart muscle does not cope with the incoming blood volume. If there is no treatment, then there is a huge risk that pulmonary edema will begin.
Causes
What does the fluid in the heart mean, what is the danger? In the normal state, the two-layer shell of the organ should contain no more than 30 milliliters of liquid. If the amount of this fluid increases, then swelling appears. Pericarditis can appear not only against the background of an increased amount of fluid, but also due to the appearance of adhesions and other inflammatory processes.
Most often, the pathology appears against the background of a viral disease, more precisely, viral pericarditis, or after the flu. Quite often, pathology occurs in HIV-infected individuals. There is a chance of developing the disease against a background of parasitic, fungal or bacterial infection.
Fibrinous pericarditis most often occurs against the background of the presence of Staphylococcus aureus in the body. This form of pathology, on the contrary, is characterized by the fact that the fluid leaves, therefore this type is also called dry pericarditis. Fibrin is deposited on the petals, they become dull, can be covered with villi.
Most often, in the absence of proper treatment, fibrinous pericarditis passes into exudative or constrictive form, and these types of pathology already threaten the patient's life.
Rare causes of the development of pathology
Rarely, but still, a number of diseases can provoke the appearance of fluid in the heart muscle:
- tumors;
- Dressler syndrome, after a heart attack or surgery;
- Mediterranean fever
- blood diseases;
- renal failure;
- long-term treatment with certain drugs;
- thyroid problems;
- chest injuries.
And in some patients, it is generally not possible to establish the cause of the development of the pathology.
Fluid in the heart in children appears for the same reason as in adults.
Diagnostic measures
Due to the high risk of death, it is very important to make a diagnosis on time and correctly. Especially when it comes to exudative, compressive, purulent form. It is very important to differentiate, distinguish pericarditis from other diseases.
Initially, the doctor collects an anamnesis, examines and listens to the heart rhythm. Laboratory tests are also carried out:
- blood chemistry;
- immunological test.
A blood test will clarify the nature and causes of the disease.
Of great importance is the ECG. With the help of FCG, it is possible to check diastolic and systolic murmurs.
Radiography of the lungs allows you to determine the increase in the size and silhouette of the heart muscle. Thickening and calcification can be determined on an MRI, chest CT scan, and cardiac CT scan. Echocardiography allows you to determine the presence of excess fluid even if the volume of excess is about 15 milliliters.
Pericarditis: symptoms and treatment in adults
Depending on the cause of the appearance of the pathology, therapeutic measures are also prescribed.
In the acute stage of the disease, non-steroidal anti-inflammatory drugs are used, in particular Ibuprofen. Initially, every 6-8 hours is prescribed from 300 to 800 milligrams of the drug. Treatment with this drug continues until the pericardial effusion disappears.
The effectiveness of NSAIDs can only be assessed after 2 weeks. Conclusions about the need to replace the used drug with a new one can be done only after this period.
At the end of the course of treatment, the drug is not immediately canceled, it should be taken for another 1 week, gradually reducing the dose.
Elimination of symptoms and treatment of pericarditis in adults can be supplemented with "Colchicine." It is consumed in 0.5 mg twice a day. The drug gives a positive effect even in the acute stage, has much less side effects when compared with NSAIDs.
Depending on the cause of the fluid in the heart, treatment may occur using corticosteroid drugs. Drugs of this type are prescribed in cases if the disease appeared against a background of pathology of the connective tissue, with uremia or in the presence of autoimmune processes.
Also, diuretics are prescribed to remove excess fluid from the body. They also allow you to reduce the load on the heart muscle, thereby improving the overall well-being of the patient. It can be Furosemide or Veroshpiron. Patients are also advised to limit the amount of salt consumed, it is not recommended to consume more than 2 grams per day. Along with salt, it is better to reduce the amount of water consumed.
Narcotic analgesics can be prescribed for severe pain in the heart. But such drugs are prescribed quite rarely, as they can cause the development of drug addiction.
If the pathology has an infectious nature of origin, then treatment is carried out with the help of antibacterial drugs. If tuberculosis became the cause of the development of the pathology, then treatment of this pathology is carried out first.
If fluid continues to accumulate
In most cases, if it was possible to find out the cause of the fluid in the heart, conservative treatment is effective. But in some patients, even after therapy, fluid continues to accumulate. In this case, pericardiocentesis may be recommended. The procedure involves the introduction of a needle into the pericardial cavity under local anesthesia and the removal of excess fluid from there. In most cases, the procedure is performed under the supervision of echocardiography.
It is possible that the condition of the patient will require the creation of a so-called pericardial window. This is a small operation in which the surgeon makes an incision in the pericardial region, inserts a shunt there, which is displayed in the abdominal cavity. As a result, the accumulating excess fluid flows into the stomach.
Surgical intervention
If it is not possible to eliminate the causes of fluid in the heart, treatment does not give proper results, then such patients are subject to surgery. Today, two types of operations are possible:
- wide excision of the changed leaf;
- limited resection.
Mandatory surgery is subject to patients with compressive pericarditis. The main goal of the procedure is the most complete release of the heart muscle from the altered pericardium.
Possible complications
The most severe consequence is constrictive pericarditis. This is the hardest form of the disease, in which the leaves of the pericardium are scarred and calcified. As a result, the heart is compressed, unable to fulfill the functions assigned to it. Patients with this form of the disease suffer from edema, they have heart failure, severe shortness of breath and rhythm disturbances in the organ. Fluid can build up and stagnate in the lungs, abdomen.
Another serious complication requiring immediate surgical intervention is cardiac tamponade. The condition is characterized by an abundant amount of fluid that squeezes the organ, it can not be reduced. As a result, if urgent measures are not taken, then everything can be fatal.
Pericarditis: clinical recommendations
The latest recommendations were published in 2015 by the European Society of Cardiology. The document analyzed and summarized all the evidence available at the time of making the recommendations. Despite the rather high percentage of morbidity, there is little epidemiological data. But nevertheless, it was clearly established that men are 2.2 times more likely to suffer from this pathology.
The main classification is based on the separation of types of pathology into two types:
- non-infectious nature of origin;
- infectious.
Basic treatment is based on the use of NSAIDs and Aspirin. Colchicine is still the main drug in anti-inflammatory therapy.
Life after pericarditis and preventive measures
As a rule, the disease recedes after 3 months. Complications are quite rare, therefore, already during the rehabilitation period, the patient may return to the usual rhythm of life. In very rare cases, relapse occurs, then you will need to undergo a full course of treatment again.
When the causes of fluid in the heart are known, treatment is more effective, but it is recommended not to forget about preventive measures. It is mandatory not to treat viral and catarrhal infections. It is impossible to suppose that even an ordinary cold was carried on legs.
Without fail, any foci of inflammation in the body should be eliminated, for example, to treat caries, other more serious diseases: systemic lupus, renal failure.
If the patient has chronic diseases, in particular heart disease or rheumatoid arthritis, then he needs to undergo regular examinations, as these diseases can cause the appearance of excess fluid in the heart.
Give up bad habits, do not smoke or abuse alcohol.