Pericarditis
Pericarditis
Pericarditis
A
Pericarditis is an infectious or non-
infectious (aseptic) inflammation of the
visceral and parietal pericardium.
Etiology
Infectious
Viral infection (Coxsackie viruses, ECHO, influenza, herpes, adenovirus, etc.)
Bacterial infection (pneumococci, staphylococci, meningococci, streptococci,
mycobacterium tuberculosis, chlamydia, salmonella, etc.)
Fungal infection
Rickettsia
Ionizing radiation, X-ray therapy
Malignant tumors (metastatic lesions, primary pericardial
tumors)
Hemoblastosis
Hemorrhagic diathesis
Non-infectious
Allergic diseases (serum sickness, drug allergy, etc.)
Diffuse connective tissue diseases (SLE, rheumatoid arthritis, systemic scleroderma,
rheumatism and etc.)
Myocardial infarction (episthenocarditis pericarditis and pericarditis in postinfarction
Dressler syndrome)
Chest trauma
Ionizing radiation, X-ray therapy
Malignant tumors (metastatic lesions, primary pericardial tumors)
Hemoblastosis
Hemorrhagic diathesis
Clinical and morphological classification
of pericarditis
Acute pericarditis (less than 6 weeks from onset):
1. Catarrhal
2. Dry, or fibrinous.
3. Effusion, or exudative (serous, serous-fibrinous, purulent,
hemorrhagic):
without cardiac tamponade;
with cardiac tamponade.
Subacute pericarditis (6 weeks to 6 months from onset):
1. Exudative.
2. Adhesive.
3. Compressive, or constrictive:
without cardiac tamponade;
with cardiac tamponade.
Chronic pericarditis (more than 6 months from the onset
of the disease):
1. Exudative.
2. Adhesive.
3. Compressive, or constrictive.
4. Compressive with calcification ("armored heart"):
without cardiac tamponade;
with cardiac tamponade.
Dry or fibrinous pericarditis
Limited fibrinous pericarditis, not accompanied by the
accumulation in the pericardial cavity of any noticeable
the amount of exudate,
This is the most common form of acute pericarditis.
In most cases, acute pericarditis begins with a limited catarrhal,
and then fibrinous inflammation, most often localized in the mouth
of large vessels. Formed with a small amount of inflammatory
effusion containing a large amount
fibrinogen, is reabsorbed. Liquid fractions of effusion effectively
are “sucked off” through the lymphatic vessels, and fibrin
filaments are deposited on the visceral and parietal sheets of the
pericardium,
Clinical sings
Pain in the chest - dull, monotonous, not too intense pain that is localized
behind the sternum or to the left of it and radiates to both arms, trapezius
muscles, the epigastric region. pain can last for hours and days. A
characteristic feature of pericardial pain is its intensification in the patient's
position. lying on your back, with a deep breath, coughing and swallowing.
Pain is often relieved by sitting and with shallow breathing. Nitroglycerin
does not relieve pain.
nonspecific manifestations of the inflammatory syndrome: small increased body
temperature, chills, malaise, pain and heaviness in skeletal muscles.
examination
orthopnea ( slightly reduces contact with each other inflamed pericardium)
Superficial , rapid breathing.
palpation and percussion of the heart no specific
signs
Auscultation
pericardial rubb superficial stretching sound produced by
movement of inflamed pericardium, localized to a small area
over the pericardium, best heard to the left of the lower
sternum, usually in systole but my be audible in diastole.
Friction is best heard when the patient learns forward,
diaphragm of stethoscope is pressed firmly upon the chest,
the patients breath being held for a time in inspiration and
than in expiration.
Arterial pulse and blood pressure with dry pericarditis
practically do not change
Laboratory data are non-specific. leukocytosis, shift of
the blood count to the left, an increase in ESR, an increase
in the content of seromucoid, C-reactive protein,
hypergammaglobulinemia
Electrocardiogram in acute pericarditis, elevation of the
RS-T segment is recorded in most standard, limb and in
several chest leads. ( with acute pericarditis, as a rule, there is a large lesion
area, affecting many areas of the heart muscle). C oncordant (unidirectional)
elevation of the RS-T segment,
treatment
depends on the clinical and morphological form of the disease
and its etiology.
Newly diagnosed acute pericarditis requires hospitalization of
the patient and restrictions physical activity.
regularly monitor the levels of arterial and venous pressure and
heart rate.
Repeated echocardiographic studies (timely diagnosis of the formation of
effusion in the pericardial cavity )