Internal illnesses. Pericarditis (most important)

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Internal illnesses. Pericarditis (most important)

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8. PERICARDITIS

Pericarditis is an inflammatory disease of the pericardium, which is more often a local manifestation of a certain disease (tuberculosis, rheumatism, diffuse connective tissue diseases) or a concomitant disease of the myocardium and endocardium.

Etiology. They are caused by bacteria, viruses, fungi, rickettsiae, mycobacteria, typhoid and dysentery bacillus.

Aseptic pericarditis with allergies, systemic lesions of the connective tissue, traumatic injuries, autoimmune processes.

There is a group of idiopathic pericarditis.

Pathogenesis. The infection penetrates into the pericardial cavity by the hematogenous or lymphogenous route. Exudative processes intensify.

The accumulation of a large amount of exudate in the pericardial cavity is manifested by the syndrome of cardiac tamponade.

Clinic. With dry (fibrinous) pericarditis: pain in the region of the heart of varying strength, a pericardial friction rub is heard, more often it is determined on the sternum and to the left of the parasternal line, it is heard in any phase of the cardiac cycle. It has a scratchy tint, can last for several hours or months.

With effusion (exudative) pericarditis: shortness of breath, cough (usually dry), vomiting is possible. The body temperature rises, the boundaries of the heart increase in all directions, the apex beat decreases or disappears, the cervical veins swell.

With a large effusion, the pulse decreases, blood pressure decreases.

With cardiac tamponade: severe chest pain, collapse, tachycardia, paradoxical pulse. With compression of the superior vena cava, the formation of a "consular" head, Stokes collar. With compression of the inferior vena cava: hepatomegaly, premature ascites, Breitman's position, periodic disturbance of consciousness.

With adhesive (adhesive) pericarditis: pain in the region of the heart, dry cough, retraction of the apex beat (symptom of Sali-Chudnovsky). On auscultation, the three-term nature of the rhythm, the appearance of systolic non-conductive noise over the anterior surface of the heart.

With constrictive (compressive) pericarditis: in the early stages of shortness of breath, slight cyanosis of the lips and tip of the nose. In the advanced stage, Beck's triad: high venous pressure, ascites, "small quiet heart."

Neck veins swell, face puffiness, cyanosis. The position of the patient in orthopnea. trophic disorders. The apex beat disappears. Atrial fibrillation, arterial pressure is reduced, venous pressure is increased. Possible low systolic murmur, marked anasarca, hydrothorax, ascites.

Diagnostic research. Complete blood count, (leukocytosis with a shift of the formula to the left, an increase in ESR), ECG studies, EchoCG studies.

Treatment. In the acute period, bed rest, diet. Etiotropic therapy. NSAIDs (not indicated for secondary pericarditis, myocardial infarction), glucocorticoids for 1-1,5 months (not prescribed for tumors), antihistamines, vitamin C.

With squeezing pericarditis, surgical treatment.

Flow. Acute (passes within 1-2 months), long-term, progressive.

Forecast. In acute forms it is often favorable, in chronic forms it is serious.

Author: Myshkina A.K.

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