Pericarditis is an acute or chronic inflammation of the pericardium (external serous membrane of the heart). The myocardium is often involved in the inflammatory process. Mostly men suffer from this ailment. Pericarditis is possible in children and adolescents.
As a rule, pericarditis is a secondary disease that complicates the course of various diseases. The causes of its development can be acute infections, autoimmune (rheumatism and other collagenoses), metabolic diseases, myocardial infarction, chest injuries, aortic aneurysm, condition after surgery on the heart.
With the course, acute pericarditis and chronic are distinguished. Clinically, pericarditis can be dry, also called fibrinous, and exudative - effusion.
Pericarditis: symptoms of the disease during a clinical examination
In acute pericarditis, chest pain is radiating, radiating to the left side of the chest and left arm. This pain is quite intense, prolonged, aggravated at the height of inspiration, during coughing, while lying on your back. To reduce pain, patients often take a forced position of the body: they sit, leaning forward. This is called the Praying Bedouin posture. The intensity of pain increases depending on the position of the body, and when performing movements. In some cases of pericarditis, the pain can be dull, aching.
Symptoms of intoxication accompany any pericarditis - fever, pain in joints and muscles, general malaise, palpitations, headache. The accumulation of effusion exudate in the cavity of the heart bag lined with pericardium is accompanied by the appearance of dyspnea, which decreases in a sitting position. With shortness of breath, there may be a dry unproductive cough.
The accumulation of a large volume of fluid in the cavity of the heart bag leads to the development of cardiac tamponade syndrome , which is manifested by symptoms of venous stasis. During the examination, the patient can determine neck vein overflow, liver enlargement, edema and ascites (free fluid in the abdominal cavity).
If dry pericarditis has developed, there are no symptoms of a change in the borders of the heart. If the volume of exudate exceeds 500 ml, it is possible to determine the shift of the borders of cardiac dullness in both directions. With dry pericarditis, cardiac sounds are not auscultated. With the development of exudative pericarditis, the volume of heart sounds decreases sharply, and tachycardia is determined.
A specific sign of dry pericarditis, determined during auscultation, is the pericardial friction noise. This noise can be heard in a limited area of the chest, to the left at the edge of the sternum. The noise can be amplified by pressing the phonendoscope on the chest wall. He listens during systole and diastole, quickly disappears.
Dry and exudative pericarditis - symptoms in additional studies
To diagnose the disease, a general blood test, ECG, echocardioscopy, chest x-ray are prescribed . In a general blood test, signs of inflammation are determined. On the ECG with exudative pericarditis, a decrease in the height of the teeth is detected, the appearance of rhythm disturbances is possible, with dry pericarditis, a change in the position of the ST segment above the contour is determined. Changes in the radiograph are determined with the accumulation of 200 or more ml of exudate. With echocardioscopy, the localization of the process and the amount of exudate are determined. For diagnostic purposes, a pericardial cavity is punctured, followed by examination of the resulting fluid.
Acute dry pericarditis has a benign course. Exudative pericarditis often occurs subacute or becomes chronic.
In the treatment of pericarditis, non-steroidal anti-inflammatory drugs, corticosteroids are used. With exudative pericarditis, diuretics are prescribed, puncture of the pericardial cavity for therapeutic purposes. The purpose of antibacterial therapy, a diet with a restriction of salt and liquid, is shown.