Pericarditis symptoms and treatment with folk remedies. Pericarditis: symptoms and treatment. Which doctors should you contact if you have pericarditis?

Pericarditis refers to inflammation in the pericardial sac. The disease is serious and quite severe. In this case, timely treatment is the key to a good prognosis. We will tell you about the treatment of pericarditis with medications and traditional medicine recipes in this article.

Compliance with the treatment regimen

As with myocarditis, bed rest is very important. Its duration must be at least one month. If there is fluid in the pericardial cavity, then bed rest should be strict.

Impact on the factor that led to inflammation

When all the causes that caused inflammation in the pericardium are eliminated, it often leads to a rapid recovery of the patient.

If the inflammation is bacterial in nature, antibiotics are prescribed intramuscularly.

Pericarditis is not treated with antiviral drugs, despite the fact that it is often a complication of a viral infection. It is believed that their effectiveness in pericarditis has not been proven.

In case of pericarditis, which has developed against the background of systemic diseases, this disease is treated first of all, for example, rheumatoid arthritis.

In recent years, cases of pericarditis due to tuberculosis have become more frequent. For tuberculous pericarditis, anti-tuberculosis drugs are used and are prescribed for a very long period of up to 6 months.

In acute myocardial infarction complicated by inflammation of the pericardium, as a rule, no special treatment is required; treatment of the underlying disease is sufficient.

Sometimes it is even necessary to inject antibacterial drugs directly into the pericardial cavity; this procedure is performed for purulent pericarditis.

Use of non-steroidal anti-inflammatory drugs (NSAIDs)

Doctors have been using this group of drugs in the treatment of pericarditis for quite a long time. They eliminate inflammation and relieve pain. Mainly used: indomethacin and voltaren. Doses of these drugs are selected only by a doctor..

NSAIDs often cause erosive lesions of the gastrointestinal tract, so they are prescribed only if the stomach is healthy and in combination with drugs that protect the stomach (for example, omeprazole).

Glucocorticoid drugs

Autoimmune and allergic mechanisms play an important role in the development of pericarditis. These mechanisms are more pronounced in systemic and allergic pericarditis, but can also develop in others. Glucocorticosteroids eliminate allergic reactions in the body and also have pronounced anti-inflammatory properties.

Prednisolone is the main representative of this group. It is prescribed in tablets and the dosage is selected individually, depending on the severity of the process.

Glucocorticosteroid drugs are not used for purulent pericarditis, as well as for pericarditis caused by a tumor.

Drugs for the treatment of pericarditis

Puncture of the pericardial cavity

There are strict indications for puncture of the pericardial cavity.

1. Rapid accumulation of exudate in the pericardial cavity, combined with cardiac tamponade. In this case, puncture of the pericardial cavity is urgent and is a vital measure.
2. Presence of purulent pericarditis.
3. To clarify the diagnosis in case of exudative pericarditis.

Puncture of the pericardial cavity is always performed under electrocardiographic control. When carrying out this manipulation, doctors often insert a catheter into the pericardial cavity, through which medications are subsequently supplied to the heart, such as antibiotics, hydrocortisone and prednisolone.

With developing cardiac tamponade, evacuation of fluid from the pericardial cavity can save a person’s life.

It is important for every person to know signs of tamponade, which require urgent hospitalization in intensive care:

• Shortness of breath at rest, which is very pronounced.
• The patient “feels fear.”
• The patient is covered in cold sweat.
• Lips, nose and ears become bluish.
• The face and neck swell.
• Blood pressure is low or not detectable at all.
• The pulse is irregular and difficult to palpate.
• There is a rapid (over several hours) accumulation of fluid in the abdomen (ascites).

In case of rapid accumulation of fluid in the heart cavity in a hospital, cardiologists usually prescribe fluid restriction to 500 ml per day, a diet with limited salt and diuretics. Two diuretics come out on top: furosemide and veroshpiron.

In case of severe edematous-ascitic syndrome, Lasix is ​​administered intravenously.

Surgical treatment of pericarditis

Constrictive pericarditis is difficult to treat with conventional medications and is usually treated with surgery.

The preoperative period includes the administration of antibacterial and anti-inflammatory drugs. Next, an operation called pericardectomy.

The purpose of the operation is to destroy the calcified capsule in the area of ​​the ventricles, which promotes normal expansion of the heart during diastole.

After surgery, it is necessary to remain in bed for a long time.

Traditional methods of treating pericarditis

Inflammation of the pericardial sac is a fairly serious disease, so the use of traditional methods of treatment is possible only after the severity of the process has subsided and, of course, with the permission of the attending physician. The old postulate: “Do no harm” is very appropriate here.

Causes and symptoms of pericarditis. How to treat pericarditis folk remedies. Treatment of heart and artery diseases with improvised means at home: medicinal herbs for pericarditis.

Heart and artery diseases

Causes and treatment of pericarditis. Folk remedies: what herbs to use for pericarditis and products made from these herbs.

Pericarditis

Folk remedies

Pericarditis is inflammation of the pericardium, the membrane sac surrounding the heart. The disease can be caused by infection, diseases such as systemic lupus erythematosus, rheumatism, or chest trauma.

Symptoms of pericarditis: Chest pain, which intensifies with breathing and changing body position, as well as difficulty breathing, are often observed.

Folk remedies, treatment of pericarditis

Treatment of pericarditis with pine needles, folk remedy

Grind 5 tablespoons of young pine needles (spruce, pine, fir, juniper), pour 0.5 liters of boiling water, put on fire and bring to a boil. Cook over low heat for 10 minutes, leave for 6-8 hours in a warm place, strain. For pericarditis, drink 0.5 cups 4-5 times a day.

Treatment of pericarditis with herbal infusion, folk remedy

Take equal parts of hawthorn flowers, calendula flowers, dill fruits, oat straw, linden flowers. Pour 5 g of powdered collection into 250 ml of boiling water, leave in a warm place (in a thermos) for 3 hours, strain. Take 50 ml warm 3-4 times a day 30 minutes before meals for pericarditis.

Folk remedy: treatment of pericarditis with tincture of birch brunettes

Fill a glass jar 2/3 full with staminate (larger in size) birch catkins, fill them to the top with vodka, close and leave for 14 days. Do not strain. Take from 20 drops to 1 teaspoon 3 times a day 30 minutes before meals. When using this tincture, pain in the heart subsides, shortness of breath disappears, and vigor appears.

Treatment of pericarditis with herbal collection, folk remedy

Take 3 parts of motherwort herb, cudweed herb, hawthorn flowers and 1 part of chamomile flowers. Pour 1 tablespoon of the mixture into 1 glass of boiling water, leave for 8 hours, strain. Take 0.5 cups 3 times a day, 1 hour after meals.

Treatment of pericarditis with infusion of medicinal herbs, folk remedy

Take 2 parts of anise fruit, 1 part of rhizome with roots of valerian officinalis, yarrow herb and lemon balm leaf. Pour 1 tablespoon of the mixture into 1 glass of boiling water, leave for 30 minutes, strain. Take during the day in 2-3 doses.

Treatment of pericarditis by collecting medicinal plants, folk remedy

3 parts each: green cudweed, motherwort greens, hawthorn flowers and 1 part chamomile flowers. Brew 1 tablespoon of the mixture with 1 cup of boiling water, leave for 8 hours, filter. Take 0.5 cups 3 times a day 1 hour after meals for pericarditis.

Heart medications must be strictly followed by all instructions of the treating cardiologist. You cannot choose medications and determine the dosage on your own. After all, therapy for this disease involves the use of different groups of drugs that have different therapeutic effects.

What drugs can be used: their mechanism of action and features of use

Basic treatment of cardiac pericarditis is based on eliminating symptoms. Additionally, medications are prescribed to neutralize the cause of the disease. Let's review the drugs for the basic treatment regimen.

Anti-inflammatory analgesics: Aspirin, Ibuprofen, Indomethacin, Diclofenac. This group belongs to non-selective inhibitors of cyclooxygenase 1 and 2. Cyclooxygenase is an enzyme that is involved in reducing inflammatory processes. The drugs in question help thin the blood, eliminate the inflammatory process, relieve pain and increase effusion. Admission rules:

1. Acetylsalicylic acid should be taken up to 8 times a day, 500 mg. The duration of the course is 14-21 days.
2. Diclofenac is taken three times a day, 50 mg maximum. The course of treatment is 21 days.
3. Ibuprofen is prescribed 400 mg four times a day.
4. Indomethacin – 4 times a day, 50 mg.

These medications should be taken immediately after meals, as they have a negative effect on the stomach, developing gastritis and ulcers.

Non-steroidal anti-inflammatory drugs. Selective cyclooxygenase 2 inhibitors include Lornoxicam, Meloxicam, Celecoxib. The drugs have anti-inflammatory properties. Unlike the previous group, the effectiveness is slightly lower, but the drugs do not have a negative effect on the gastrointestinal tract. Therefore, they are prescribed even for ulcerative manifestations. Rules of application:

1. Lornoxicam is produced in tablet and injection form. Tablets are taken twice a day, 8 mg. An injection solution is also used. The duration of the course is 21 days.
2. Meloxicam should be taken twice a day, 7.5 mg.
3. Celecoxib – 200 mg maximum once a day.

Morphine is considered the most highly effective and fastest acting. If dosages are artificially increased, addiction may develop. Negatively affects the respiratory system. Therefore, strictly adhere to the prescribed doses.

The drug is available in an injection solution that can be administered either intramuscularly or intravenously. The lower the intensity of the pain threshold, the lower the dosage required. The minimum dose is 2 mg, the maximum is 15. The injection solution can be used up to 2 times a day.

Pentazocine is administered intramuscularly or taken orally up to 8 times a day. The maximum dose of solution is 60 mg, tablets – 100. Use orally after eating.

Tramadol is used for intramuscular administration and oral administration. The duration of treatment is 14 days. Take 50 mg tablets twice a day. If the pain threshold is very strong, the dose may be increased to 200 mg. Injections are also administered 2 times a day, but 100 mg maximum.

This group of medications can be addictive, so exceeding the dosage on your own is strictly prohibited.

Many basic therapy drugs have a negative effect on the gastrointestinal tract, so appropriate medications are additionally prescribed. And the main therapy is prescribed depending on the cause of cardiac pericarditis.

Features of treatment with drugs for various types of pericarditis

What to do when there is no cardiac tamponade? If there is no cardiac tamponade and the effusion is moderate, the doctor will prescribe diuretics that will quickly remove excess fluid from the body. The most commonly used is regular Furosemide. The duration of the course of treatment is 6-8 days. The dosage is gradually reduced towards the end of therapy.

Additionally, hormonal glucocorticosteroids are prescribed. They neutralize the inflammatory process. The most commonly used drugs: Prednisolone, products based on prednol, decortin and metipred. The greatest effect can be achieved by injecting the drug into the pericardial area.

What to do with cardiac tamponade? If cardiac tamponade is present, a puncture from the pericardium is performed, after which glucocorticosteroid solutions are administered directly into the pericardium.

Treatment of infectious types of cardiac pericarditis. In case of infectious lesions of the cardiac pericardium, therapy is carried out in a hospital under the strict supervision of medical staff. The prescribed drugs are administered by injection - inside a vein.

The following antibiotics are used:

1. Benzylpenicillin is used for streptococcal infections. It is administered intravenously up to 6 times a day. The duration of treatment is 21 days maximum.
2. Vancomycin is used for staphylococcal bacteria. The drug is administered twice a day.
3. Amoxiclav (a mixture of clavulanic acid and amoxicillin). The minimum duration of therapy is 14 days. Administered intravenously up to 4 times a day.

Therapy of tuberculous pericarditis. For tuberculous lesions of the cardiac pericardium, the treatment method is selected based on the type of disease and the severity of the underlying pathology. Therapy is carried out in an isolated facility. The duration of treatment is long. Medicines:

1. Pyrazinamide is taken orally three times a day.
2. Isoniazid is also available in tablets, but you need to take it a maximum of twice a day.
3. Rifampicin is administered exclusively intravenously twice daily.

If a stable reaction to the prescribed drugs is detected, they are replaced with alternative ones. In each specific case, an individual dosage is selected.

Treatment of fungal pericarditis. In case of fungal infection, intravenous administration of drugs is carried out. The duration of the course of treatment is at least one and a half months. The most commonly used are Flucytosine and Amphotericin B. The former is administered by drip over 6 hours. Another drug is also used as a dropper. Feature - in some cases, specific treatment is not required at all, because the disease recedes on its own.

What to do with viral pericarditis? For viral heart disease, basic treatment is used and antiviral drugs are not used. Additionally, for some types of virus, the following treatment is carried out.

For cytomegalovirus, hyperimmunoglobulin is used, which is administered intravenously. The therapy regimen is specific: the drug is used on the first, fourth, eighth day of treatment. Then, after another 4 days, a half-reduced dosage is administered.

For parvovirus B19 and adenovirus, an immunoglobulin solution is injected dropwise over 8 hours. Two procedures are enough: on the first day of general therapy and on the third.

For Coxsackie virus, a puncture of interferon beta or alpha is performed. The drug is injected into the organ cavity.

Therapy of autoimmune pericarditis. If pericarditis occurs against the background of autoimmune disorders, hormonal anti-inflammatory drugs are used. Cytostatics are also prescribed. They are needed to slow down the growth and process of cell division. Colchicine may also be used.

The therapy is quite complex, so it is extremely rare to completely get rid of the pathology. This is influenced by factors such as the amount of effusion, the ability of it to be absorbed, the presence of heart murmurs and the level of white blood cells in the blood.

Treatment of pericarditis with medications during pregnancy and lactation

It is known that during pregnancy and subsequent breastfeeding, many medications are strictly prohibited for a woman, as they can harm the fetus and child. But what to do if pericarditis is detected? After all, this disease is considered serious.

So, pericarditis can be treated only in the 3rd trimester, since there are great risks at other stages of pregnancy. For the same reason, if pericarditis is detected in the 1st and 2nd trimester, it is more advisable for a woman to have an artificial termination (abortion).

Therapy for a pregnant or lactating woman is aimed at neutralizing the causative agent of the disease, relieving symptoms and preventing the development of complications. Treatment is carried out in a hospital setting. Primary requirements:

• compliance with bed rest;
• exclusion of intense physical activity;
• avoiding overwork;
• proper nutrition, rich in magnesium and potassium;
• exclusion of stressful situations and any anxiety in general;
• strict compliance with all instructions of the treating specialist.

If infectious pericarditis of the heart is detected, antibacterial treatment is prescribed. Antibiotics are selected taking into account the pathogen and the absence of contraindications for use during pregnancy and lactation. Anti-inflammatory drugs, painkillers and immunomodulators are required.

If strong antibiotics are prescribed, breastfeeding should be discontinued. If secondary cardiac pericarditis is detected, it is necessary to achieve resorption of the effusion, therefore corticosteroids are prescribed. If there is a rapid accumulation of exudate or significant compression of the heart muscles, then surgical intervention is performed.

In the treatment of cardiac pericarditis, early detection of the disease and timely treatment play a huge role. The earlier treatment for pericarditis is started, the better the prognosis. Therefore, carefully study how the pathology manifests itself, and if you have such symptoms, go to a specialist who will prescribe you medication.

Since the pericardium is most often a secondary disease, its treatment should begin with the treatment of the root cause, while not forgetting the pericardium itself. Depending on the form of the disease, treatment of pericarditis can be conservative or surgical.

Drug treatment

The main drugs used in the treatment of pericarditis are antibiotics and non-steroidal anti-inflammatory drugs. Prescribe diclofenac sodium, mesulide, movalis. At high body temperature in combination with pain, glucocorticoids, for example, prednisolone, are prescribed.

Purulent and coccal pericarditis treated with non-selective antibiotics, for example, penicillin, as well as a combination of streptomycin with PAS and ftivazide, which is used in the fight against tuberculosis. Sometimes antibiotics are injected directly into the pericardial cavity using a puncture needle.

At rheumatic pericarditis Antirheumatic drugs come to the fore: the salicylic group (butadione, pyramidone) and steroid hormones. The course of treatment is quite long - up to six months, sometimes it is supplemented with cardiac medications.

Digitalis drugs are rarely effective in the treatment of pericarditis, since there is no main symptom for which they would be useful - myocardial hypertrophy. Other drugs in this group are also ineffective. Instead, camphor or regular doses of caffeine are used. For pain, painkillers and even drugs (promedol, morphine, omnopon) are indicated.

To suppress the exudative inflammatory reaction, it is useful to use prednisolone (cortisone), not only in the case of rheumatic and tuberculosis variants, but also when during treatment dry pericarditis of unknown origin.

Since this disease is usually long-term, causing disturbances in the well-being and nutrition of patients, it is important to make the latter easily digestible, enrich it with vitamins P, C and group B, and when treating exudative pericarditis, it is necessary to limit the intake of fluid and salt.

Treatment of acute pericarditis must be carried out with bed rest, and in the exudative form, mandatory hospitalization is required. Even after the cessation of the active stage and effusion, the patient must remain under medical supervision for a long time, as relapses often occur. The ability to work of such a patient is restored rather slowly, so he and the doctor must be patient.

Patients with the constrictive form of pericarditis retain their ability to work for some time, but over time they lose it, and if surgical intervention does not have an effect, then their ability to work is completely lost.

Surgery

If there is a threat of cardiac tamponade, increasing effusion and purulent pericarditis, it is carried out pericardial puncture. Most often, fluid is pumped out with a special needle from the pericardial sac.

1. A long (minimum 10 cm) and thick (1.2 mm) needle is inserted into the area of ​​the xiphoid process, formed between it and the seventh costal cartilage located on the left. The needle passes up the back of the sternum. The end of the needle is connected to the chest electrode of the electrocardiograph.
2. When the needle meets the heart, the doctor feels its beating.
3. Everything that happens is regulated by an ECG. If the doctor notices ST segment elevation, the needle is pulled back slightly until the elevation stops.
4. Using a thin plastic catheter, the pericardial contents are aspirated. The catheter is inserted with a guide into the pericardial cavity.
5. The last step is to administer antibiotics, cytostatics and glucocorticoids through the catheter.

Pericardial puncture does not guarantee complete cure of the disease, since relapses often occur. If after several punctures the exudate still accumulates, pericardiectomy (removal of the pericardium) is performed.

With purulent pericarditis often the pericardium is opened(sometimes with its partial resection). The operation is performed through the left pleural cavity with removal of pus through drainage.

How to cure constrictive and extensive pericarditis? They usually require surgical intervention. During the operation, resection of the ribs near the heart is performed, followed by removal of part of the thickened pericardium and release of the parts of the heart that have been compressed by it (the apex of the heart, ventricles, orifices of the vena cava).

With a “shell heart” you have to perform a particularly significant resection(removal of part of an organ) to eliminate ossified tissue.

After operation cardiolysis(elimination of the fusion of the pericardium with the outer shell of the heart) the heart, freed from shackles, can work more freely, the hepatic and vena cava better deliver blood to it, which relieves its stagnation in the liver and venous system. Sometimes even the patient can return to heavy physical activity.

Traditional methods of treating pericarditis

Treatment of pericarditis with folk remedies should not be an alternative to medication or, especially, surgery, but as an additional treatment that gives a greater chance of success, it is quite suitable.

Needles

From young shoots of coniferous species (pine, spruce, juniper and fir) quite effective decoctions are obtained that help treat pericarditis. To prepare the decoction, 5 tablespoons of pine needles are steamed in 0.5 liters of boiling water, placed on low heat and boiled for 10 minutes. Then the vessel with the hot broth is wrapped and infused for 8 hours or more.

The liquid is filtered and drunk up to 5 times a day, half a glass.

Birch buds

An excellent remedy is tincture of birch catkins. For large buds, you need to fill a liter jar two-thirds full, fill them with vodka, close the lid and leave for 2 weeks. It is not necessary to strain the tincture before use.

It is taken three times a day, half an hour before meals, 20 drops. This remedy helps with shortness of breath, weakness, and heart pain.

Medicinal mixtures and fees

If you have pericarditis, treatment with folk remedies very often resorts to herbal collections:

• You need to mix 3 parts each of hawthorn flowers, cudweed and motherwort, and 1 part chamomile. A tablespoon of the resulting mixture is added to a glass of boiling water and left for 8 hours, then filtered through cotton wool. The infusion is taken three times a day, 100 ml, 1 hour after meals.
• 2 parts of anise seeds are mixed with the roots of valerian and the same anise, as well as with yarrow and lemon balm (1 part of each component). A tablespoon of the resulting mixture is poured with a glass of boiling water and left for half an hour. The tincture is filtered and drunk in 2-3 doses.
• The seeds are removed from the lemon, after which it is ground in a meat grinder along with the zest, and apricot kernels crushed into powder are added to it. Then 0.5 liters of honey and geranium slurry is added there. Use 1 tablespoon before each meal.
• A good help in the fight against rheumatic pericarditis is a tincture of cornflower flowers. To prepare it, pour a tablespoon of the plant’s flowers with 70% alcohol (100 ml) and leave for about two weeks. The tincture is taken three times a day before meals. The course continues depending on the patient's condition.
• Dry pericarditis, which occurs as a complication after suffering from the flu, can be treated with honey and rose hips. First, a rosehip tincture is made: a teaspoon of its crushed fruits is placed in a thermos and 0.5 liters of boiling water is poured in, where it is infused for up to 10 hours. A tablespoon of honey is added to the infusion, after which the liquid is filtered. The resulting healthy and tasty tea is drunk half a glass three times a day.

The most important thing is that for a sick heart you need proper nutrition, which must include: greens, fish, nuts, juices, dried and fresh fruits, a variety of berries, and seafood. It is also a good idea to periodically take fish oil, royal jelly and bee pollen.

What medications and methods of treating pericarditis do you know? Tell us about this or your experience in treating this disease in the comments - help others overcome this disease!

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Inflammation of the serous membrane of the heart (its visceral layer) is called pericarditis. This disease is caused by mechanical, toxic, immune (autoimmune and exoallergic), as well as infectious factors. They cause primary damage to the serous cardiac membrane.

Pathogenesis and main forms of the disease

The mechanism of occurrence and development of pericarditis includes the following points:

Infection enters the pericardial cavity in two ways:

1. Lymphogenous, various infections of the subdiaphragmatic space, lung and pleura, and mediastinum most often spread through it;
2. Hematogenous, it causes damage to a viral infection or septic diseases.

With the development of diseases such as purulent pleurisy, abscesses and tumors of the mediastinum and lung, the inflammatory process spreads directly to the pericardium. The following forms of pericarditis develop:

• Fibrinous, which is characterized by the hairy appearance of the visceral layers due to the deposits of fibrinous threads on them, as well as a slight formation of fluid.
• Serous-fibrinous, in which a small amount of relatively dense protein exudate is added to the fibrinous threads.
• Serous, with the formation of serous exudate of high-density protein origin, which has the ability to be completely absorbed. Pericarditis of this type is characterized by the proliferation of granulations during the resorption of exudate and the formation of scar tissue. As a result, the visceral layers are soldered; in some cases, the pericardial cavities are completely overgrown. An impenetrable membrane forms around the heart. This pathology is called “shell heart”. Sometimes adhesions also form on the outside, when the pericardium fuses with the diaphragm, mediastinum, or pleura.
• With hemorrhagic diathesis, tuberculosis, inflammatory processes that occur as a result of various injuries in the chest area (for example, postoperative), it develops hemorrhagic pericarditis, accompanied by a sharp increase in the number of red blood cells.
• Serous-hemorrhagic, with the formation of serous purulent contents and an increase in the number of red blood cells in the blood.
• Purulent, accompanied by a cloudy effusion containing an increased amount of fibrin and neutrophils.
• Putrefactive, developing as a result of an anaerobic infection.

Causes of pericarditis

There are also metabolic causes of pericarditis. These are thyrotoxicosis, myxedema, gout, chronic renal failure. It can lead to pericarditis, although in recent years cases of rheumatic pericarditis have been reported very rarely. But inflammation of the visceral layer, caused by collagenosis or systemic lupus erythematosus, began to be diagnosed more often. Often, pericarditis occurs as a consequence of drug allergies. It occurs as a result of an allergic lesion of the pericardial sac.

Clinical manifestations

The symptoms of pericarditis are especially pronounced in the acute form of the disease. Very strong, acute pain occurs in the area of ​​the cardiac apex or lower part of the sternum, similar to the pain syndrome of pleurisy or myocardial infarction. It may radiate to the epigastric region, left arm, neck or left shoulder. This is a manifestation of dry pericarditis.

With exudative (effusion) pericarditis, aching pain occurs or a feeling of heaviness appears in the chest. When effusion appears, severe shortness of breath occurs during walking or in a static upright position, which intensifies as the amount of exudate increases. When a person sits down or leans forward slightly, shortness of breath decreases. This is due to the fact that purulent exudate descends to the lower parts of the pericardium, clearing the way for blood flow. Therefore, the patient instinctively tries to take the position in which it is easier for him to breathe. The fluid produced in the pericardium puts pressure on the upper respiratory tract, causing a dry cough. Because of this, the phrenic nerve is excited and vomiting may occur.

An increase in the amount of purulent contents accumulating in the pericardial sacs causes, accompanied by difficulty filling the left ventricle with blood when it relaxes. And this, in turn, becomes the cause of circulatory failure in the systemic circle. This is manifested by the appearance of edema, enlargement of the cervical veins (without pulsation), ascites (edema of the abdomen) and enlargement of the liver. Exudative pericarditis develops against the background of subfebrile (37°-37.5°C) temperature, a shift in the leukocyte formula to the left. A paradoxical pulse occurs (decreased on inspiration). Blood pressure also decreases.

The chronic form of the disease is characterized by two types of clinical development: adhesive and constrictive.

1. With adhesive pericarditis, the patient experiences aching pain in the heart, he develops a dry cough, which intensifies during physical activity.
2. With the constrictive type, the patient’s face becomes puffy, with signs of cyanosis, veins enlarge in the neck, and trophic disorders may appear on the skin of the legs, turning into ulcers. Beck's triad is also observed: increased venous pressure, ascites and a decrease in the size of the ventricles of the heart.

The course of particular types of pericarditis

Classification of pericarditis is carried out:

• According to clinical manifestation: for fibrinous pericarditis (dry) and exudative (exudative);
• According to the nature of the course: acute and chronic.

Acute fibrinous pericarditis

Acute fibrinous pericarditis (if it is an independent disease) has a benign course. Its treatment does not cause difficulties and ends after one or two months with a favorable outcome (not the slightest trace remains of the disease). It has a viral etiology and occurs due to hypothermia of the body against the background of acute respiratory diseases. Young people are more susceptible to the disease. It is characterized by the sudden onset of pain in the heart area (behind the breastbone), accompanied by a slight increase in temperature.

Acute infectious pericarditis

Acute pericarditis that occurs against the background of infectious diseases (for example, pneumonia) occurs without pronounced symptoms. This often makes it difficult to diagnose, which leads to the development of adhesive chronic pericarditis with the formation of a “shell heart” and adhesions. This form of the disease is dangerous because a complication may develop in the form of purulent pericarditis, which can only be treated with surgical methods.

Exudative pericarditis

Effusion pericarditis (exudative) most often occurs in a subacute or chronic form, with relapses and accumulation of a large amount of fluid in the pericardial cavity. Clinically, it manifests itself in the form of adhesive (adhesive) and compressive (constrictive) pericarditis:

1. Adhesive pericarditis is characterized by rough extrapericardial fusion or deposition of lime in scar tissue with the formation of an armored heart. In this case, the amplitude of heart contractions has no restrictions; sinus tachycardia and a sharp muffling of heart sounds are often observed. In some cases, the disease may be asymptomatic.
2. Constrictive (compressive) pericarditis is more often detected in males. With the development of this form of the disease, compression of the heart occurs, which causes a decrease in blood filling in cardiac diastole. The vena cava is also compressed, resulting in decreased blood flow to the heart. Developing. The danger of constrictive pericarditis is that the inflammatory process can spread to the liver capsule and lead to its thickening. This causes compression of the hepatic veins. Pick's pseudocirrhosis occurs. In some cases, large volumes of effusion compress the left lung, leading to bronchial breathing in the area of ​​the angle of the left scapula.

Exudative purulent pericarditis

Exudative purulent pericarditis is caused by coccal pyogenic microflora, which enters the pericardial cavity hematogenously. Most often it occurs in an acute, severe form, accompanied by intoxication of the body and elevated temperature, symptoms of cardiac tamponade in acute and subacute forms. A purulent course often accompanies traumatic pericarditis. In this case, fluid accumulates in large quantities in the pericardial cavity. Only timely diagnosis and surgery can save the life of a patient diagnosed with purulent pericarditis. The highest mortality rate is observed with purulent pericarditis, which develops very quickly. Drug therapy for this form of the disease is not effective.

Hemorrhagic pericarditis

Pericarditis can also develop against the background of cancer. Cancerous tumors metastasize to the visceral layers of the cardiac membrane. This causes hemorrhagic pericarditis. It is distinguished from other species by the presence of bloody exudate. It often develops against the background of renal failure.

Tuberculous pericarditis

When the tuberculosis bacillus penetrates the pericardial cavity by lymphogenous route or by direct transfer from the affected areas of the pleura, lungs and bronchi, tuberculous pericarditis develops. It is characterized by a slow course, accompanied by acute pain in the initial period. As fluid accumulates, the pain subsides, but returns again with a significant accumulation of purulent contents. Shortness of breath is added to the dull, pressing pain. Treatment uses glucocorticoid steroids, protease inhibitors, and penicillin drugs to inhibit collagen synthesis.

Pericarditis in children

Pericarditis in children usually develops against the background of septic diseases and pneumonia, due to the penetration of coccal infection through the bloodstream into the pericardial cavity. Clinical manifestations are practically no different from the symptoms of the disease in adults. Acute forms of the disease cause severe pain in the child's heart, uneven heartbeat, and pale skin. The pain may radiate to the left arm and epigastric region. The child coughs and vomits. It is difficult for him to find a comfortable position, so he becomes restless and sleeps poorly. The diagnosis is established on the basis of differential diagnosis, X-ray kymographic examination, etc. It is recommended to treat pericarditis in children only with medication. No puncture is performed.

Pericarditis in animals

Pericarditis is very often diagnosed in animals. It develops when they swallow various small sharp objects. They penetrate the heart from the stomach, esophagus and wall. The disease is traumatic in nature. Its treatment is ineffective. The animal usually dies itself (cats, dogs) or is subject to slaughter. Meat can be eaten.

Diagnosis of pericarditis

When examining the patient, the following is revealed:

1. Dry pericarditis is accompanied by slightly muffled or unchanged sounds, with a pericardial friction rub (due to a small effusion). In this case, friction noise is heard in the form of a scratching sound, the frequency of which is higher than the others. It is better heard on inspiration. Heart sounds with exudative pericarditis are muffled, friction noise is practically absent.
2. The x-ray clearly shows a change in the configuration of the shadows of the heart: the ascending aorta has practically no shadow, and the left contour of the heart is straightened. With an increase in the amount of accumulated fluid, the cardiac contour becomes more round with a shortening of the shadow of the bundle of blood vessels. With an increase in the amount of exudate, there is a noticeable expansion of the boundaries of the heart and a decrease in the pulsation of the shadow of the cardiac contour. Chronic pericarditis causes the heart to appear bottle-shaped or triangle-shaped on an x-ray. On X-ray kymographic recording, the amplitudes of the waves of the left ventricle are reduced.
3. The ECG can trace changes caused by damage to the superficial layers of the myocardium during dry pericarditis. This is indicated by the elevation above the isoline of the segment ST in all leads. Gradually, with the development of the disease, its position returns to normal, but the tooth T can take a negative value. Unlike the electrocardiogram for myocardial infarction, the ECG for pericarditis has a complex QRS and prong Q not changed, but in the segment ST there are no discordant displacements (below the isoline). With exudative pericarditis, the voltage of all teeth is reduced.

The symptoms of acute exudative pericarditis are similar to the symptoms of myocarditis, cardialgia, dry pleurisy and myocardial infarction. The main difference from these diseases are the following signs of pericarditis:

• The presence of a connection between the pain syndrome and the body position of the sick person: increased in the “standing” position and when moving; weakening in the sitting position.
• Clearly audible loud, diffuse pericardial friction noise.
• Heart failure is caused by impaired blood flow in the systemic circle.
• The ECG shows an elevated segment in all leads ST, absence of discordance, prong T negative.
• Blood enzyme activity remains unchanged.
• The x-ray shows an expansion of the borders of the heart and a weakening of the pulsation.

structure of the heart membrane

The most difficult thing to distinguish between pericarditis and, since both diseases are accompanied by heart failure and. Therefore, a differential diagnosis of pericarditis is carried out, which includes listening and percussing heart sounds, examining blood tests (general, biochemical and immunological), echocardiographic, radioisotope, etc. The formation of an effusion is indicated by the following:

• 1. The presence of an echo-free space between the pericardium and epicardium, around the heart or behind the wall of the left ventricle;
  2. Epicardium and endocardium of the heart walls with increased excursion;
  3. The amplitude of pericardial movement is reduced;
  4. The image of the right ventricle (its anterior wall) is at a greater depth.

Therapy

Treatment of pericarditis consists of symptomatic, pathogenetic and etiotropic therapy.

Video: puncture for pericarditis (eng)

Forecast

The prognosis of pericarditis is made on the basis of its clinical picture, which depends on the phase of the inflammatory process, the degree of sensitization of the tissues of the serous cardiac membrane, the general reactivity of the body and the nature of the inflammatory process.

The most favorable prognosis is given if cardiac pericarditis is diagnosed as a symptom of the underlying disease and during its course there is no tendency to transform into adhesive pericarditis.

The highest percentage of deaths is observed with the development of purulent, hemorrhagic and putrefactive pericarditis. Fears for the patient’s life often arise with constrictive pericarditis, with progressive heart failure. But modern surgical treatment techniques make it possible in many cases to save the lives of patients even with very severe forms of the disease. Patients diagnosed with acute dry (fibrinous) pericarditis usually lose their ability to work for 2 months or more. But after completing the treatment course, she fully recovers.

Video: TV program about pericarditis and its treatment