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Perikardit – an inflammation of pericardial bag (an external cover of heart - a pericardium) more often than infectious, rheumatic or postinfarction character. It is shown by the weakness, constant pains behind a breast amplifying at a breath, cough (dry perikardit). Can proceed with sweating of liquid between pericardium leaves (ekssudativny perikardit) and to be followed by severe short wind. Vypotna perikardit it is dangerous by suppuration and development of a tamponada of heart (a sdavleniye of heart and vessels the collected liquid) and can demand the emergency surgical intervention.

Perikardit

Perikardit – an inflammation of pericardial bag (an external cover of heart - a pericardium) more often than infectious, rheumatic or postinfarction character. It is shown by the weakness, constant pains behind a breast amplifying at a breath, cough (dry perikardit). Can proceed with sweating of liquid between pericardium leaves (ekssudativny perikardit) and to be followed by severe short wind. Vypotna perikardit it is dangerous by suppuration and development of a tamponada of heart (a sdavleniye of heart and vessels the collected liquid) and can demand the emergency surgical intervention.

Perikardit it can be shown as a symptom of any disease (system, infectious or kardialny), to be a complication at various pathologies of internals or injuries. Sometimes in a clinical picture of a disease perikardit gains paramount value while other displays of a disease pass into the background. Perikardit not always it is diagnosed during lifetime of the patient, approximately in 3 – 6% of cases signs of earlier postponed perikardit are defined only on autopsies. Perikardita are observed at any age, but meet among the adult and elderly population more often, and incidence perikardity at women is higher, than at men.

At a perikardita inflammatory process affects a serous fabric cover of heart – a serous pericardium (a parietal, visceral plate and a pericardiac cavity). Changes of a pericardium are characterized by increase in permeability and expansion of blood vessels, infiltration of leukocytes, fibrin adjournment, adhesive process and formation of hems, a kaltsifikation of pericardiac leaves and a sdavleniye of heart.

Reasons of development of a perikardit

The inflammation in a pericardium can be infectious and noninfectious (aseptic). As the most common causes of a perikardit serve rheumatism and tuberculosis. At rheumatism perikardit usually is followed by defeat of other layers of heart: endokard and myocardium. Perikardita rheumatic and in most cases a tubercular etiology are manifestation of infectious and allergic process. Sometimes tubercular defeat of a pericardium comes at migration of an infection on lymphatic channels from the centers in lungs, lymph nodes.

The risk of development of a perikardit increases the following states:

Classification of perikardit

Primary and secondary (as a complication distinguish perikardita at diseases of a myocardium, lungs and other internals). Perikardit can be limited (at the heart basis), partial or to take all serous cover (the general poured).

Depending on clinical features sharp and chronic allocate perikardita.

Sharp perikardita

Sharp perikardita develop quickly, no more than 6 months proceed and include:

1. Dry or fibrinozny - result of the increased krovenapolneniye of a serous cover of heart with sweating in a pericardiac cavity of fibrin; liquid exudate is present at small quantity.

2. Vypotna or ekssudativny - allocation and accumulation of liquid or semi-fluid exudate in a cavity between parietal and visceral leaves of a pericardium. Vypotna exudate can be various character:

  • serous (mix of liquid and plastic exudate, in small amounts can resolve completely)
  • hemorrhagic (bloody exudate) at a tubercular and tsingotny inflammation of a pericardium.
    1. with tamponady hearts - accumulation in a cavity of a pericardium of surplus of liquid can cause increase in pressure in a pericardiac crack and violation of normal functioning of heart
    2. without heart tamponada

Uniform elements of blood (leukocytes, lymphocytes, erythrocytes, etc.) in different quantities surely are present at exudate in each case of a perikardit.

Chronic perikardita

Chronic perikardita develop slowly, more than 6 months and share on:

1. Vypotna or ekssudativny

2. Adhesive (slipchivy) - represents the residual phenomena of perikardit of various etiology. Upon transition of inflammatory process of an ekssudativny stage in productive in a cavity of a pericardium there is a formation granulyatsionny, and then cicatricial fabric, leaves of a pericardium stick together with formation of solderings among themselves, or with the next fabrics (a diaphragm, a pleura, a breast):

  • asymptomatic (without permanent violations of blood circulation)
  • with functional violations of warm activity
  • with adjournment in the changed pericardium of salts of calcium ("armor-clad" heart")
  • with ekstrakardialny unions (pericardiac and plevrokardialny)
  • konstriktivny - with germination of pericardiac leaves fibrous fabric and their kaltsifikation. As a result of consolidation of a pericardium limitation of filling of cameras of heart blood appears during a diastola and venous stagnation develops.
  • with a dissemination on a pericardium of inflammatory granulomas ("zhemchuzhniyets"), for example, at a tubercular perikardit

3. Ekssudativno-adgezivny.

Also not inflammatory perikardita meet:

  1. Hydropericardium - a congestion of serous liquid in a pericardium cavity at diseases which were complicated by chronic heart failure.
  2. Haemo pericardium - a blood congestion in pericardiac space as a result of a rupture of aneurism, heart wound.
  3. Hiloperikard - a congestion of a hilezny lymph in a pericardium cavity.
  4. Pneumopericardium - availability of gases or air in a pericardiac cavity at wound of a thorax and a pericardium.
  5. Exudate at a miksedema, uraemia, gout.

In a pericardium there can be various new growths:

  • Primary tumors: good-quality – fibromas, teratoma, angioma and malignant – sarcomas, mesotheliomas.
  • Secondary – defeat of a pericardium as a result of distribution of metastasises of a malignant tumor from other bodies (lungs, a mammary gland, a gullet, etc.).
  • Paraneoplastic syndrome – the defeat of a pericardium arising at impact of a malignant tumor on an organism in general.

Cysts (pericardiac, tselomichesky) are rare pathology of a pericardium. Their wall is presented by fibrous fabric and similar to a pericardium is covered mezoteliy. Cysts of a pericardium can be congenital and acquired (a consequence of a perikardit). Pericardiac cysts happen constant on volume and progressing.

Symptoms of a perikardit

Manifestations of a perikardit depend on its form, a stage of inflammatory process, character of exudate and speed of its accumulation in a cavity of a pericardium, expressiveness of adhesive process. At an acute inflammation of a pericardium it is usually noted fibrinozny (dry) perikardit which manifestations change in the course of allocation and accumulation of exudate.

Dry perikardit

It is shown by pain in heart and noise of friction of a pericardium. Thorax pain – stupid and pressing, sometimes giving to a left shoulder-blade, a neck, both shoulders. There are moderate pains more often, but there are severe and painful, reminding an attack stenocardias. Unlike a heartache at stenocardia its gradual increase, duration from several hours to several days, lack of reaction at nitroglycerine reception, a temporary zatikhaniye from reception of narcotic analgetics is characteristic of a perikardit. Patients can feel at the same time short wind, heartbeat, a general malaise, dry cough, a fever that pulls together disease symptomatology with displays of dry pleurisy. A characteristic symptom of pain at a perikardita is its strengthening at deep breath, swallowing, cough, change of position of a body (reduction in a sitting position and strengthening in a prone position on a back), breath superficial and frequent.

Noise of friction of a pericardium comes to light when listening heart and the patient's lungs. Dry perikardit can end with treatment in 2 — 3 weeks or pass in ekssudativny or adhesive.

Ekssudativny perikardit

Ekssudativny (vypotny) perikardit develops as a result of a dry perikardit or independently at violently beginning allergic, tubercular or tumoral perikardita.

There are complaints to pains in heart, feeling of constraint in a thorax. At accumulation of exudate there is a violation of blood circulation on hollow, hepatic and vorotny veins, short wind develops, the gullet (passing of food - a dysphagy is broken), a diafragmalny nerve is squeezed (the hiccups appears). Almost at all patients fever is noted. The edematous person, a neck, the forward surface of a thorax, swelling of veins of a neck ("Stokes's collar"), skin, pale with cyanosis, is characteristic of appearance of patients. At survey smoothing of intercostal intervals is noted.

Complications of a perikardit

In case of an ekssudativny perikardit development of a sharp tamponada of heart, in case of a konstriktivny perikardit – emergence of insufficiency of blood circulation is possible: a sdavleniye exudate of hollow and hepatic veins, the right auricle that complicates a diastola of ventricles; development of false cirrhosis.

Perikardit causes inflammatory and degenerate changes in layers of a myocardium, adjacent to an exudate, (mioperikardit). Due to development of cicatricial fabric the myocardium union with nearby bodies, a thorax is observed and with a backbone (mediastino-perikardit).

Diagnostics of a perikardit

It is timely it is very important to diagnose a pericardium inflammation as it can pose a threat for the patient's life. Treat such cases squeezing perikardit, ekssudativny perikardit with sharp tamponady hearts, purulent and tumoral perikardit. It is necessary to carry out differentiation of the diagnosis with other diseases, mainly, with a sharp myocardial infarction and sharp myocarditis, to establish the reason of a perikardit.

Diagnostics of a perikardit includes collecting the anamnesis, survey of the patient (listening and percussion of heart), carrying out laboratory researches. The general, immunological and biochemical (the general protein, fractions of protein, sialovy acids, a kreatinkinaz, fibrinogen, , SRB, urea, LE cages) blood tests carry out for specification of the reason and character of a perikardit.

The ECG is of great importance in diagnostics of a sharp dry perikardit, initial stage of an ekssudativny perikardit and adhesive perikardit (when squeezing cavities of heart). In case of an ekssudativny and chronic inflammation of a pericardium decrease in electric activity of a myocardium is observed. FKG (phonocardiography) notes the systolic and diastolic noise which are not connected with a functional warm cycle, and periodically arising high-frequency fluctuations.

The X-ray analysis of lungs is informative for diagnostics of an ekssudativny perikardit (increase in the size and change of a silhouette of heart is observed: the spherical shadow – is characteristic of sharp process, triangular – for chronic). At accumulation in a pericardium cavity to 250 ml of exudate the sizes of a shadow of heart do not change. The weakened heart shadow contour pulsation is noted. The shadow of heart is badly distinguishable behind a shadow of the pericardiac bag filled with exudate. At a konstriktivny perikardit indistinct contours of heart because of plevroperikardialny unions are visible. A large number of solderings can cause the "motionless" heart which is not changing a form and situation at breath and change of position of a body. At "armor-clad" heart limy deposits in a pericardium are noted.

KT of a thorax, MPT and MCKT of heart diagnoses thickenings and a kaltsifikation of a pericardium.

Echocardiography - the main method of diagnostics of a perikardit allowing to reveal existence even of small amount of liquid exudate (~ 15 ml) in a pericardiac cavity, change of movements of heart, existence of unions, thickenings of leaves of a pericardium.

The diagnostic puncture of a pericardium and biopsy in case of a vypotny perikardit allows to conduct an exudate research (cytologic, biochemical, bacteriological, immunological). Existence of signs of an inflammation, pus, blood, a tumor helps to establish the correct diagnosis.

Treatment of a perikardit

The method of treatment of a perikardit is chosen the doctor depending on a kliniko-morphological form and a cause of illness. The bed rest before subsiding of activity of process is shown to the patient with a sharp perikardit. In case of a chronic perikardit the mode is defined by a condition of the patient (restriction of physical activity, dietary food: full, fractional, with salt consumption restriction).

At sharp fibrinozny (dry) perikardita mainly symptomatic treatment is appointed: nonsteroid anti-inflammatory medicines (acetilsalicylic acid, indometacin, an ibuprofen, etc.), analgetics for removal of the expressed pain syndrome, the medicines normalizing exchange processes in a cardiac muscle, potassium medicines.

Treatment of sharp ekssudativny perikardit without heart sdavleniye signs, generally similar to that at dry perikardita. At the same time regular strict control of the main indicators of haemo dynamics (AD, TsVD, ChSS, warm and shock indexes, etc.), the volume of an exudate and signs of development of a sharp tamponada of heart is obligatory.

If ekssudativny perikardit developed against the background of a bacterial infection, or in cases of a purulent perikardit apply antibiotics (paranteralno and locally - through a catheter after drainage of a cavity of a pericardium). Antibiotics are appointed taking into account sensitivity of the revealed activator. At tubercular genesis of a perikardit apply 2 – 3 antitubercular medicines within 6-8 months. Drainage is used also for introduction to a pericardiac cavity of cytostatic means at tumoral defeat of a pericardium; for aspiration of blood and introduction of fibrinolytic medicines at a haemo pericardium.

Treatment of secondary perikardit. Application of glucocorticoids (Prednisolonum) promotes more bystry and full rassasyvaniye of an exudate, especially at perikardita of allergic genesis and developing against the background of system diseases of connecting fabric. joins in therapy of the main disease (system red a wolf cub, sharp rheumatic fever, juvenile rheumatoid arthritis).

At bystry increase of accumulation of exudate (threat of a tamponada of heart) carry out a pericardium puncture () for removal of an exudate. The puncture of a pericardium is applied also at a prolonged rassasyvaniye of an exudate (at treatment more than 2 weeks) to detection of its character and the nature (tumoral, tubercular, fungal, etc.).

To patients with a konstriktivny perikardit in case of chronic venous stagnation and a sdavleniye of heart perform operations on a pericardium: a resection of the cicatricial changed sites of a pericardium and solderings (a subtotal perikardektomiya).

Forecast and prevention of a perikardit

The forecast in most cases favorable, at the correct, begun in due time treatment working ability of patients is restored almost completely. In case of a purulent perikardit in the absence of urgent medical actions the disease can pose hazard to life. Slipchivy (adhesive) perikardit leaves permanent changes since surgical intervention is insufficiently effective.

Only secondary prevention of a perikardit which consists in dispensary observation at the cardiologist, the rheumatologist, regular control of an electrocardiography and echocardiography, sanitation of the centers of a chronic infection, a healthy lifestyle, moderate physical activity is possible.

Perikardit - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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