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43. Pericarditis
Pericarditis in the clinic of rheumatism is rare.
Dry pericarditis clinically manifested by constant pain in the region of the heart and a pericardial friction rub, which is more often heard along the left edge of the sternum.
The intensity of the noise during auscultation is different, often it is determined in both phases of the cardiac cycle. The ECG shows an upward shift of the ST interval in all leads at the very beginning of the disease. With further development, these intervals return to the isoelectric line, and biphasic or negative T waves are also formed simultaneously. Dry pericarditis itself is not capable of causing an increase in the heart.
Exudative pericarditis is a further stage in the development of dry pericarditis. The main first clinical sign of the appearance of effusion is the disappearance of pain due to the separation of the inflammatory layers of the pericardium, accumulating exudate.
Clinical manifestations in the form of shortness of breath, which increases when the patient lies down. The region of the heart with a large amount of exudate swells, the intercostal spaces are smoothed, the apex beat is not palpable. The heart is greatly enlarged and takes the form of a trapezium or round graphite. The pulsation of the contours during fluoroscopy is small. On auscultation, the tones and noises are deaf (as there is an effusion). Pulse is frequent, small filling; arterial pressure is lowered. Venous pressure is always increased, swelling of the cervical and peripheral veins appears.
The electrocardiogram is the same as in dry pericarditis, an additional symptom may be a marked decrease in the voltage of the QRS complex. Of particular diagnostic importance is echocardiography, which determines the presence of fluid in the heart sac. When the skin is damaged, annular erythema is practically characteristic, which is pink ring-shaped elements that never itch and are located mainly on the skin of the inner surface of the arms and legs, as well as the abdomen, neck, torso. It is found only in 1-2% of patients. The "rheumatic nodules" described in the old manuals are now practically non-existent. Nodular erythema, hemorrhages, urticaria are also not characteristic. With kidney damage, mild proteinuria and hematuria are detected (due to generalized vasculitis and damage to the renal glomeruli and tubules).
Damage to the nervous system and sensory organs. Chorea minor, the most typical "nervous form" of rheumatism, occurs predominantly in children, especially girls. Chorea minor is characterized by a combination of emotional lability with muscular hypotension and violent movements of the trunk, mimic muscles and limbs.
Chorea minor occurs with relapses, but by the age of 17-18 it almost always ends. A feature of this form may be a relatively small lesion of the heart, as well as slightly pronounced laboratory indicators of the activity of rheumatism.
Author: Pavlova N.V.
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