Pericarditis

Pericarditis - inflammation okoloserdecna bags. The most frequent cause of pericarditis is rheumatism or tuberculosis, but it can occur with scarlet fever, influenza, measles and other Cause of pericarditis can be and transition inflammation with neighbouring authorities in pleurisy, pneumonia, acute myocardial infarction. Sometimes pericarditis develops with uremia, beriberi and haemorrhagic diathesis. There are dry and vpotnye, or exudative, pericarditis. At a dry pericarditis the main symptom is a pericardial friction noise (like the crunch of snow. Occurs it due to deposition of fibrin on the inner surface of both the pericardial sheets. Often it is heard only on the limited part of the cardiac area and usually synchronous with the contractions of the heart. At a dry pericarditis body temperature is moderately increased. There have severe pain in the heart area with dedication in the epigastric region, sometimes in the back. Pain worse with coughing, deep breath and change of position.
Pericardial effusion is serous and purulent and hemorrhagic. Patients complain of shortness of breath and pain in the right hypochondrium arising from the enlargement of the liver due to heart failure.


Fig. 1. Typical posture of the patient suffering from chronic pericarditis.

Fig. 2. Area percussion stupidity in exudative pericarditis. Place apex beat is marked by a cross.

When effusion in the pericardium cavity, pain in the heart decrease. When large amounts of exudate patients prefer to sit with tilted forward the torso and toned chest knees (Fig. 1).
A characteristic appearance of the patient: and face pitch in, pale with a cyanotic shade, veins of the neck swollen, sometimes there is a protrusion in the heart, especially in young patients. The work of the heart when a large effusion is difficult because it is due to the increase in pressure in the pericardial cavity of the heart during diastole been unable to expand and fill with blood. In addition, the effusion squeezes cava, so the blood stagnates in the veins and liver, the sooner you receive ascites. The pulse becomes small and frequent. If percussion determined a significant increase in cardiac dullness in all directions, and it takes the form of a triangle (Fig. 2). The apical jerk is not palpated. The heart sounds are heard faintly. When chest x-ray revealed an increase in cardiac shadow; ripple the edges of the shadow is missing. The body temperature is raised. At purulent pericarditis always observed leukocytosis.
Sometimes as a result of pericarditis comes fusion of the pericardial sheets, resulting hampered the work of the heart and is developing heart failure. Appear cyanosis, hypostases, ascites. The liver is enlarged, dense. When viewed significantly systolic retraction of the intercostal space in the apex of the heart, characteristic nesmeshivaemost heart at change the position of the patient. Noise over an area of the heart no. Determined paradoxical pulse (decrease of its content, and sometimes disappearance to breath). Heart drugs, as a rule, do not improve blood circulation, as a violation of his dependent on mechanical reasons.
Forecast when pericarditis depends on the underlying disease course and the nature and amount of exudate. Purulent pericarditis extremely dangerous to life and requires urgent treatment measures.
Treatment. Bed rest. In exudative pericarditis is particularly important to take care of the convenient position of the patient in bed. Drug treatment depends on the cause of pericarditis. So, when pericarditis rheumatic etiology apply the same tools and rheumatism, and other Antibiotics used in purulent pericarditis. Treatment of heart failure when pericarditis - see the blood Circulation, circulatory insufficiency. When large amounts of exudate, leading to circulatory failure, make a puncture of the pericardial and release the fluid. Puncture of the pericardial makes only specialist. At purulent pericarditis perform surgical treatment.
Effusion in children is most often a manifestation of rheumatism; may be dry or exudative (serous or sero-fibrinous). Usually starts as acute disease, much less pericarditis joins the already existing extensive lesion of the heart. Among the clinical symptoms are most pronounced pain in the heart, characteristic poluciaetsea the position of the patient, lethargy, apathy, hurt or frightened face, pale, tachycardia, shortness of breath. Often, pain in the abdomen, nausea, sometimes repeated vomiting. Temperatures can be high, low or normal. Detects a sudden increase cardiac dullness, listening to the noise of friction pericardium (rough or soft) along the left side of the sternum or over the whole surface of the heart in a short time, sometimes several hours, rarely 5-6 days. Blood pressure is reduced, the pulse frequent, small filling.
In the study of the blood by the accelerated ROHE, small leukocytosis, and neutrophilia shift leukocyte left.
Under favorable for effusion is usually absorbed, in some cases formed spikes. With extensive adhesive process can develop right ventricular heart failure.
Treatment - see above.