Pericarditis: what is it? Symptoms and Treatment
Pericarditis is an inflammation of the serous membrane that covers the heart. The disease rarely develops on its own, most often other pathological processes lead to it, which may be infectious and non-infectious in nature.
With pericarditis, fluid begins to accumulate in the region of the heart, or adhesions form. This process takes place directly in the pericardial cavity, between its leaves.
- Features of the development of pericarditis
- What happens in the heart with pericarditis?
- Hemodynamics for pericarditis
- Causes of pericarditis
- Pericarditis symptoms
- When should you see a doctor?
- Pericarditis during pregnancy
- Complications of pericarditis
- Diagnostics of the pericarditis
- Treatment and prognosis
- Prevention of pericarditis
Features of the development of pericarditis
The disease can develop rapidly, in a few hours, or slowly, in a few days. The faster this pathological process occurs, the higher the likelihood of heart failure and cardiac tamponade. The average time it takes for pericarditis to develop from the onset of the underlying disease is 7-14 days.
Pericarditis is more common in men than in women. The average age of the sick varies between 20-50 years.
What happens in the heart with pericarditis?
The disease begins with the fact that inflammatory exudate begins to sweat into the pericardium. The shell of the heart cannot stretch strongly, therefore, the fluid accumulated in its cavity begins to exert pressure on the organ itself. Because of this, the ventricular chambers lose the ability to relax during diastole.
Since the ventricles of the heart do not stretch as expected, pressure builds up in the chambers of the heart, which increases the striking force of the ventricles. The more inflammatory exudate sweats into the pericardium, the higher the load on the heart muscle will be. If the liquid arrives very quickly, then this threatens the development of heart failure and even cardiac arrest.
When the inflammatory process begins to fade away, the fluid will be absorbed by the leaves of the pericardium. This leads to a decrease in its volume in the heart cavity. However, the fibrin contained in the fluid does not disappear anywhere. It contributes to the fact that the pericardial sheets begin to stick together, later adhesions form between them.
Hemodynamics for pericarditis
The atria with pericarditis experience less stress than the ventricles, since they do not contract with such a shock force. While in the ventricles it increases significantly, the initial minute volume remains the same.
At an early stage of development of pericarditis, the patient's blood pressure rises, and then it decreases. This leads to the formation of stagnation in the systemic circulation, which further lead to the development of heart failure.
Causes of pericarditis
It is not always possible to isolate the exact cause of pericarditis. In this case, they talk about the idiopathic nature of inflammation. Although sometimes the factors leading to the disease are obvious.
- Infections caused by bacterial flora, such as tuberculosis.
- Diseases of an inflammatory nature: rheumatoid arthritis, SLE, scleroderma.
- Diseases associated with metabolic disorders: hypothyroidism, renal failure, high blood cholesterol levels.
- Diseases of the heart and blood vessels: myocardial infarction, aortic dissection, Dressler's syndrome.
- Other reasons: HIV, drug use, cancers, trauma, heart surgery.
- Taking some medications: immunosuppressants, Isoniazid, Diphenin, etc.
Sometimes pericarditis develops in infants. In this case, the most likely cause is streptococcal or staphylococcal infection. In older children, viral infections or other pathologies accompanied by an acute inflammatory reaction in the body lead to damage to the cardiac membrane.
About 60% of all pericarditis are infectious in nature.
In this regard, the following types of inflammation of the heart membrane are distinguished:
- In 20% of cases, people develop viral pericarditis.
- In 16.1% of cases, pericarditis is bacterial.
- Rheumatic pericarditis occurs no more than 10% of cases.
- Septic pericarditis can develop in 2.9% of cases.
- Fungal pericarditis - in 2% of cases, as well as tuberculous pericarditis.
- In 5% of cases, patients are diagnosed with protozoal pericarditis.
- Syphilitic pericarditis develops less often than others, in about 1-2% of cases.
In 40% of cases, pericarditis is of a non-infectious nature.
At the same time, the following types are distinguished:
- Postinfarction (10.1% of cases).
- Postoperative pericarditis (7% of cases). With the same frequency, people develop pericarditis against the background of connective tissue diseases.
- Traumatic pericarditis (7-10% of cases).
- Allergic pericarditis (3-4% of cases).
- Radiation pericarditis (less than 1% of cases).
- Pericarditis against the background of blood diseases develops in 2% of cases.
The share of medicinal pericarditis accounts for 1.4% of cases.
- Idiopathic pericarditis is diagnosed in 1-2% of cases.
In children, the disease occurs in 5% of cases. At the same time, 10% of pericarditis occurs in exudative form, and the remaining 80% of pericarditis is in dry form.
Newborn children are most often diagnosed with viral pericarditis, which develops in 60-70% of cases. Bacterial pericarditis is found in 22% of cases. In childhood, the incidence of different types of pericarditis is as follows:
- 55-60% is due to viral pericarditis.
- 12% of cases are due to rheumatic pericarditis.
- 5.5-7% of cases are due to postoperative pericarditis.
- 5% of cases are due to bacterial pericarditis.
In adults, the incidence of the disease is somewhat different:
- In 18-23% of cases, viral pericarditis is diagnosed.
- In 15% of cases, pericarditis develops after a heart attack.
- Rheumatic pericarditis develops in 10% of cases.
- Connective tissue diseases lead to the development of pericarditis in 7-10%.
When pericarditis develops acutely, the patient experiences intense pain in the region of the heart. They are concentrated behind the sternum on the left side. The pain is piercing, although some patients complain of dull pain.
Painful sensations radiate to the back and neck. They become more intense when coughing, when trying to take a deep breath, while lying down. If the person sits down or tilts the torso forward, the pain subsides.
Another symptom of pericarditis is coughing. It is dry and difficult to get rid of. The listed symptoms can develop not only with pericarditis, but also with myocardial infarction. This fact complicates the process of making the correct diagnosis.
Chronic pericarditis is characterized by persistent inflammation, in which fluid begins to accumulate in the pericardium.
In addition to painful sensations in the chest, a person will complain of other symptoms:
- Shortness of breath, which is worse when bending the trunk forward.
- Rapid pulse.
- Increase in body temperature to 37.5 ° C, but not higher. The temperature remains at this level for a long time.
Swelling of the lower extremities.
- Increased sweating at night.
- Weight loss.
If the patient develops dry pericarditis, then his symptoms will be as follows:
- Increased weakness, increased body temperature, muscle aches.
- Increased sweating.
- Heart pains.
- Disturbances in the work of the heart, which a person feels well.
- Increased pulse rate on inspiration, with a decrease in systolic pressure. This phenomenon is called paradoxical pulse.
- Pressure rise followed by pressure drop.
When a person develops pericardial effusion, they will experience symptoms such as:
- Subfebrile body temperature.
- Drop in blood pressure.
- Loss of consciousness. Fainting is common, but it does not last long.
- Deterioration in sleep quality.
- Painful sensations when swallowing food.
- Pain in the epigastric region.
- Hiccups that last a long time. It is not possible to cope with it by conventional means.
- Dry cough, during which blood may flow.
- Vomiting and nausea.
- Swelling of the lower extremities.
- Enlargement of the veins that are closest to the skin.
The pain that occurs with pericarditis has some features:
- The nature of the pain varies. It can be burning, aching, pressing, or stabbing.
- The pain is not very intense at first, but it gets worse as the disease progresses. Pain can peak in just a few hours.
- If a person does not receive help from a doctor, then the pain can become unbearable.
- Pain focus area: left side of the chest. Painful sensations can be given to the back, neck and thigh.
- If a person coughs, then he will feel the pain intensify. Sneezing, swallowing, and sharp turns of the body can provoke an increase in its intensity.
- To relieve intense pain, bending the body forward, or pulling the knees up to the chest.
- The pain disappears as the exudate accumulates.
- To relieve a painful attack, analgesics, drugs from the NSAID group allow. Nitrates cannot stop a pain attack.
Cough always accompanies pericarditis. He is dry, torments the person with seizures. At an early stage of the development of inflammation, coughing occurs due to the fact that the pericardium increases in size and begins to press on the lungs. In the future, the cough will be due to heart failure. Sometimes phlegm starts to separate during coughing. It may contain streaks of blood. Often the phlegm looks like foam.
When a person lies down, the pressure on the bronchi and trachea increases. This leads to the fact that the cough begins to resemble the barking of a dog.
When should you see a doctor?
Symptoms that develop with pericarditis may indicate other lung or cardiovascular disease. Therefore, when the first pains in the heart area appear, it is necessary to consult a doctor and receive treatment.
If a person does not have a medical education, then he will not be able to independently distinguish pericarditis from other cardiac or pulmonary pathologies. Inflammation of the pericardium can be mistaken for myocardial infarction or pulmonary thrombosis. All of them pose a direct threat to the patient's life and require immediate assistance.
In order not to forget all the symptoms that bother a person, it is best to write them down on a piece of paper and list them to the doctor. It is important to remember how long ago they appeared, how intense they are. The doctor will need information about the diseases of the cardiovascular system, which suffered from close blood relatives of the patient. If a person receives any treatment, he must inform the doctor about it. In particular, this applies to dietary supplements.
Pericarditis during pregnancy
During pregnancy, pericarditis most often develops in the 3rd trimester. About 40% of women suffer from the disease. The violation develops due to the fact that the volume of circulating blood in the body of the expectant mother increases. At the same time, pregnant women do not present any complaints.
Pericarditis, which was caused by another pathology in the body, requires treatment. He is selected taking into account the position of the woman.
If a woman suffers from chronic pericarditis, which often recurs, then pregnancy can be planned only after a stable remission has been achieved.
Complications of pericarditis
Complications that can develop with severe pericarditis:
- Pericardial effusion. The doctor can suspect this pathology due to Ewert's symptom. Percussion sound of the left subscapularis will be dull. A similar sound occurs with percussion at the level of 2-5 thoracic vertebrae. If the effusion is minor, it may clear up on its own. When a lot of fluid accumulates and the patient has pathological symptoms (shortness of breath, a drop in blood pressure, a change in heart tone, etc.), the likelihood of tamponade development increases.
- Cardiac tamponade. It develops when blood accumulates in the heart bag very quickly, and it does not have time to stretch to the required volume. At the same time, the heart begins to suffer from pressure, which affects its work. Tamponade can develop with an effusion of 100 ml or more, and sometimes more blood is required for its manifestation, for example, 1 liter. A person's blood pressure decreases, the jugular veins begin to swell, and heart sounds become muffled. To identify tamponade, an ultrasound scan of the heart and its ECG are required.
- Calcification of the pericardium. This complication develops against the background of a prolonged inflammatory process, when the damaged pericardial petals begin to grow together with adhesions. The pericardium becomes thick, its ability to stretch worsens. The heart muscle ceases to do its job normally, the patient develops heart failure. In this case, constrictive pericarditis is diagnosed, which is observed in about 9% of cases (in those patients who have suffered acute pericarditis). The disease progresses, which leads to the deposition of calcium salts in the pericardium. When there are a lot of them, it hardens. Doctors call this condition the "armored heart".
Diagnostics of the pericarditis
If the doctor suspects pericarditis, chest listening is necessary. A stethoscope is used for this purpose. During the examination, the person should lie on his back straight, or lean on his elbows. If the doctor hears a noise that resembles the rustling of paper, then he will direct the patient for further instrumental examination. The fact is that such a noise is emitted by the pericardial petals, which are in an inflamed state.
Procedures that can be shown to the patient to clarify the diagnosis:
- ECG. The study allows you to distinguish pericarditis from myocardial infarction.
- Chest X-ray. This procedure makes it possible to assess the size of the heart and its shape. When large volumes of fluid (more than 250 ml) accumulate in the pericardium, an enlarged heart can be seen in the picture.
- Ultrasound. This study allows you to look in detail at the heart and assess its functions.
- CT. To obtain the maximum information about the cardiac structures, the patient may be assigned a computed tomography. This procedure will distinguish pericarditis from pulmonary thrombosis, aortic dissection, etc. CT scans provide information about the degree of pericardial thickening.
- MRI. This method produces a layered image of the heart. The study is one of the most informative.
In addition to instrumental examination methods, the patient is prescribed laboratory diagnostics. Blood is taken for a general analysis with the obligatory determination of ESR, urea nitrogen and creatinine, AST, lactate dehydrogenase.
Additional examinations may be needed to identify the causative agent of inflammation of the heart membrane.
Pericarditis is most often confused with myocardial infarction. To carry out differential diagnostics, you need to focus on the differences that are listed in the table.
Features of pain
The pain gets worse when you cough or breathe deeply. The pain is acute, concentrated behind the chest on the left side.
Pressing pain. The person indicates a feeling of heaviness in the chest.
The pain radiates to the back, or does not radiate to any organs at all.
The pain radiates to the jaw or to the left arm. Sometimes the pain does not occur at all.
Does not affect the nature of the pain.
The pain increases with tension.
When a person lies on their back, the pain becomes more intense.
The intensity of pain does not depend on body position.
When does pain occur and how long does it last
Pain manifests sharply. A person can tolerate it and not seek medical help for several days.
The pain develops unexpectedly for a person. He seeks medical help within hours. Sometimes the pain goes away on its own.
Treatment and prognosis
Taking medications allows you to reduce swelling, relieve inflammation. If there is a suspicion of developing cardiac tamponade, the patient must be hospitalized. When the diagnosis is confirmed, surgery is required. The help of a surgeon is needed for patients with pericardial hardening.
Therapy largely depends on the severity of the inflammation. Mild pericarditis may resolve on its own. In other cases, treatment is required. It can last from 14 days to several months.
The likelihood that inflammation will recur varies between 15-30%. Developing heart failure, high body temperature and fluid accumulation in the pericardial region worsen the prognosis. In general, it depends on what exactly caused the development of pericarditis. More than 88% of patients with idiopathic pericarditis live 7 years or more. For people with postoperative pericarditis, this figure drops to 66%. Poor prognosis for patients with radiation pericarditis. No more than 27% of patients cross the 7-year survival threshold.
Prevention of pericarditis
To prevent the development of inflammation, the following recommendations must be followed:
- Treat infectious diseases in a timely manner.
- Take antibiotics if a bacterial disease develops.
- Streptococcal infection requires prophylaxis with bicillins.
- Treat caries, tonsillitis and flu in time.
If pericarditis has already developed and managed to stop it, efforts should be made to prevent recurrence of inflammation.
Measures to be taken:
- Do sport.
- Eat properly.
- Minimize stressful situations.
- Prevent hypothermia of the body.
- Treat the underlying disease.
The author of the article: Molchanov Sergey Nikolaevich | Cardiologist
Education: Diploma in "Cardiology" received at the PMGMU. I. M. Sechenov (2015). Here I completed my postgraduate studies and received a diploma "Cardiologist".