What is Pericarditis Acute?The pericarditis is an acute inflammation or chronicle of the pericardium. The pericardium is the external layer of the heart, that forms a species of stock exchange (another name for the pericardium is the stock exchange of the heart), in which it finds the organ.
The pericardium composes of a conical fibrous sack that contains the heart and the roots of the big glasses parietal pericardium.
The stock exchange in continuity with a membrane serosa that covers all the myocardium of four cavities (visceral pericardium or epicardio).
It exists between these two layers a virtual cavity that contains of 20 to 50 ml of liquid.
In the pericarditis acute, brochures pericárdicos are the seat of the changes inflamatorios with influx of neutrophile and lymphocytes, associated with the deposition of fibrin and the secretion of liquid by the serosa.
The inflammation of the sack pericárdico (the external layer of the heart-pericardium) is with greater frequency infecciosa, reumática or postinfarto. Self-evident by weakness, constant pains behind the sternum, worse with inspiration, cough (pericarditis dry). It can flow with the liquid of the sweat between the plates pericárdicas (pericarditis exudativa) and accompanied of severe dyspnea. The excess of pericarditis is dangerous by supuración and development of taponamiento cardiac (compression of the heart and glasses with liquid accumulated) and can require surgical intervention of emergency.
That causes the Pericarditis Acute?The inflammation in the pericardium can be infecciosa and no infecciosa (aseptic).
The most common causes of pericarditis are rheumatism and tuberculosis .
With the rheumatism, the pericarditis is used to to go accompanied of the defeat of other layers of the heart: endocardio and myocardium.
The pericarditis reumática and in the majority of the cases of etiology tuberculosa is a demonstration of the allergic process infeccioso.
Sometimes, an injury tuberculosa of the pericardium produces when the infection happens through the lymphatic pipes of the foci in the lungs, the lymphatic ganglions.
Other causes of the pericarditis?They include injury in the breast, as after an accident of car (pericarditis traumatic), other problems of health such as the renal insufficiency (pericarditis urémica), tumors, genetic illnesses, like the familiar Mediterranean fever (FMF), or rare time, the medicines that suppress the immune system.
The risk of pericarditis is greater after an attack to the heart or after a surgery of heart (syndrome of Dressler), radiotherapy or treatment percutáneo, like the cateterismo cardiac or the ablation by radiofrecuencia (RFA).
In these cases, a lot of experts think that the pericarditis is the result of the body that produces an answer inflamatoria by error to the pericardium.
After the surgery of bypass, the symptoms of the pericarditis can not occurring until several weeks after the surgery.
In a lot of cases of pericarditis, the cause is unknown.
Pericarditis With an unknown cause designates like the pericarditis idiopática.
Pericarditis Small turns into recurrent after the initial episode and the attacks can last during a lot of years.
I predict and prevencion pericarditis?The prognosis in the majority of the cases is favourable, with the suitable and timely treatment, the capacity of work of the patients reestablishes almost completely. In the case of pericarditis purulenta in absence of urgent medical measures, the illness can represent a danger for the life. The pericarditis adhesive (adhesive) leaves persistent changes, tk. The surgical intervention is not the sufficiently effective.
Only it is possible pericarditis secondary prevention, that is in the dispensario of observation cardiologist , reumatólogo , electrocardiografia periodic follow-up and the ecocardiografia, readjustment of focus of chronic infection, a healthy lifestyle, a moderate effort.
Risk to develop pericarditis?The risk to develop pericarditis increases in the following states:
Distinguish between pericarditis?(Like a complication in illnesses of the myocardium, lungs and other internal organs). The pericarditis can be limited (in the base of the heart), partial or capture all the membrane serosa (spill common).
Segun The clinical characteristics, the pericarditis acute and pericarditis chronic.
The pericarditis acute develops quickly, no hard more than 6 months and includes
The exudate of the exudate can be of different types:
Seroso-fibrinoso (A mix of liquid exudate and plastic, in small quantities can dissolve completely)
Hemorrágico (Exudate sanguinolento) with inflammation tuberculosa and escorbuta of the pericardium.
The blood elements formed (leucocytes, lymphocytes, erythrocytes, etc.) in different quantities are necessarily present in the exudate in each case of pericarditis.
The pericarditis chronic develops slowly, more than 6 months and divides in:
1.- Asintomático (Without persistent circulatory disorders).
2.- With functional disorders of the cardiac activity.
3.- With deposition in the pericardium altered of salts of calcium ("armed heart").
4.- With fissures extracardiacas (pericárdico and pleurocardiaco).
5.- Constrictivo With the germination of plates pericárdicas with fibrous fabric and his calcification. Like result of the densificación of the pericardium, the filled of the cameras of the heart with blood produces during the diastole and develops venous congestion.
6.- With dissemination of granulomas inflamatorios pericárdicos ("perla"), for example, with pericarditis tuberculosa.
PERICARDITIS NO INFLAMATORIA
Neoplasias in the pericardium?In the pericardium, can arise several neoplasias:
Symptoms Pericarditis Acute?The pericarditis can manifest like a symptom of an illness (sistémica, infecciosa or cardiac), a complication in diverse pathologies of internal organs or trauma. Sometimes, in the clinical picture of the illness, is the pericarditis the one who purchases a fundamental importance, whereas other demonstrations of the illness happen to a flat second. The pericarditis no always diagnoses during the life of the patient, roughly the 3-6% of the cases of signs of a pericarditis previous determine only in the autopsy.
The pericarditis observes to any age, but is more common in the population adult and elderly, with the incidence of pericarditis in the women is higher that in the men can describe eat:
Acute and punzante (caused by the heart brush against the pericardium)
It can increase with the cough, deglución, deep breath or put to bed
It can be relieved by seated and bent to forward
Also it can feel the need to bend or sustain the breast to breathe with greater comfort.
With the inflammation pericárdica affects the membrane of the fabric seroso of the heart - pericardium seroso (parietal, visceral plate and cavity pericárdica). The changes in the pericardium characterise by a greater permeabilidad and expansion of the blood vessels, infiltration of leucocytes, tank of fibrin, adhesive process and training of scars, calcification of plates pericárdicas and compression of the heart.
Other symptoms include:?Pain in the back, the neck or the left shoulder Difficulty to breathe when acuesta A dry cough The anxiety or the fatigue.
In some people, the pericarditis can cause swell of the feet, the legs or the ankles.
This inflammation can be a symptom of pericarditis constrictiva, a grave type of the pericarditis.
In pericarditis constrictiva, pericardium of the patient toughens and / or dense, avoiding that the muscle of the heart of the expansion and that affect to the function of the heart.
The heart can be compressed by the process constrictivo, what can cause that the blood retreat to the lungs, the abdomen and the legs, as well as cause the swell.
If you has some symptom of pericarditis acute, is important that call to his doctor immediately.
If you feels that his symptoms are a medical emergency, do not expect to do an appointment.
It call immediately to the 911 and ask be transported to the nearest hospital.
As it manifests the Pericarditis?The demonstrations of the pericarditis depend on his form, the stage of the process inflamatorio, the nature of the exudate and the speed of his accumulation in the cavity pericárdica, the gravity of the process of adhesion. In the acute inflammation of the pericardium, generally observes pericarditis fibrinosa (dry), whose demonstrations change during the isolation and the accumulation of exudate.
Self-evident by pain in the region of the heart and noise of friction pericárdica. Pain in the breast: deaf and apremiante, that sometimes affects the omóplato left, the neck and both shoulders. With greater frequency occur moderate pains, but are strong and painful, asemejan to an attack of angina of breast .
Unlike the pain in the heart with angina of breast, his gradual increase, the length of several hours to several days, the absence of reaction when taking nitroglycerine, the desvanecimiento temporary to take analgesic narcotics is characteristic. The patients can feel simultaneously difficulty to breathe, palpitaciones, general unrest, dry cough, shivers, what brings the symptoms of the illness together with demonstrations of pleuresia dry .
A characteristic sign of pain in the pericarditis is his intensification with the deep breath, the deglución, the cough, the changes in the position of the body (decrease of the position seated and strengthening in position supina), the breath is superficial and frequent.
The noise of friction of the pericardium reveals when it listens the heart and the lungs. The pericarditis dry can give as resulted a cure in 2-3 weeks or go in in an exudativo or adhesive.
The pericarditis exudativa (effusive) develops like consequence of pericarditis dry or only with pericarditis allergic, tuberculosa or tumoral that begins quickly.
There are complaints of pain in the heart, a feeling of oppression in the breast. When the exudate accumulates , there is a rape of the blood circulation along the hollow veins, hepatic and portal, develops dyspnea, compresses the oesophagus (breaks the disfagia) and the diaphragmatic nerve (appear hipo).
Almost all the patients have fever . For the apparition of the patients characterises by swell of the face, the neck, the frontal surface of the breast, swell of the veins of the neck ("Stokes necklace"), pale with cianosis of the skin. In the examination, the spaces intercostales soften .
Treat Pericarditis Acute?
The treatment of the pericarditis acute (sudden apparition) can include medicines for the pain and the inflammation, such like drugs anti-inflammatories no esteroideos, including ibuprofen in big doses.
Depending on the cause of his pericarditis, the doctor can prescribe an antibiotic (for the pericarditis bacteriana) or a medicine antimicótico (by pericarditis fúngica).
If his symptoms last more than two weeks or more repeat the following months, the doctor can prescribe a drug anti-inflamatorio called colchicina in combination with the ibuprofen.
The colchicina is one more ancient and very established drug anti-inflamatorio that it can help to control the inflammation and warn the pericarditis repeat weeks or even months afterwards.
When they prescribe high dose of ibuprofen, the doctor can prescribe medicines to counter the symptoms gastrointestinales. If you is taking high doses of drugs anti-inflamatorios no esteroideos, has to him monitor with the visits of frequent follow-up to evaluate the changes in the renal or hepatic function.
A small number of patients will develop the pericarditis chronic, a condition that persists in spite of the treatment, or that returns (pericarditis recurrent).
These patients can need take medicines anti-inflamatorios no esteroideos or colchicina during several years, even when it feels well.
The previous treatment includes the use of steroids, like the prednisone; however, this has found in a lot of cases to cause dependency of the medication to warn a return of the symptoms.
Besides, the steroids can reactivate the infection viral initial.
Besides, some patients can arrive to be dependent of the narcotics for the control of the pain.
How control the symptoms?The treatment of the pericarditis produces (depending on the cause) with some medicines
The patients with pericarditis have to protect also.
If there is a spill pericárdico (spill pericárdico) or taponamiento cardiac, directed by the doctor, the liquid, already was with a long drainage of the succión with a fine needle from (prick).
In general, the pericarditis goes very well and has a favourable prognosis.
In general, the people have to protect physically.
This means that in the acute phase of the illness of rest in bed is recommended.
During this time, the treatment with drugs anti-inflamatorios is the but tested.
If the commonly used drugs anti-inflamatorio are not sufficient to contain the infection, known like steroids has to be used like such, like the prednisone.
If a treatable cause, such as an infection with the bacterium or the agent causante of the tuberculosis is present, treats of the cause in the first place. Although a fever reumática finds that it is the cause, has to be treated in the first place.
As it diagnoses pericarditis?The urgent diagnostic of the inflammation pericárdica is very important, since it can represent a threat for the life of the patient. Such cases include pericarditis acute by compression, pericarditis exudativa with taponamiento cardiac acute, pericarditis purulenta and tumoral.
It is necessary to differentiate the diagnostic of other illnesses, mainly with acute infarct of myocardium and miocarditis acute, to identify the cause of the pericarditis.
The diagnostic of pericarditis includes the compilation of anamnesis, the examination of the patient (listens and tapping of the heart), the realisation of proofs of laboratory. They realise analysis of general blood, immunological and biochemical ( total proteins , fractions of proteins , sour siálicos, creatine quinasa , fibrinógeno , seromucoide, CRP , urea , leucocytes) to clear the cause and the nature of the pericarditis.
When the cavity pericárdica accumulates until 250 ml of exudate, the size of the cardiac shadow does not change. It notices a feeble pulsación of the outline of the shadow of the heart. The shadow of the heart is not clearly discernible behind the shadow of the sack pericárdico full of exudate. With the pericarditis constrictiva, the blurred outlines of the heart are visible because of the fusion pleuropericárdica.
A big quantity of adherencias can cause a fixed "heart", that does not change the form and the position when breathing and when changing the position of the body. When the heart "carapacho" is marked with calcareous tanks in the pericardium.
Look for immediate help?In the case of the pericarditis exudativa, is possible the development of taponamiento cardiac acute, in the case of the pericarditis constrictiva, the apparition of circulatory insufficiency: exudation of the hollow and hepatic veins, right auricula, that complicates the diastole of the ventricles; development of cirrosis false of the liver
The pericarditis causes changes inflamatorios and degenerativos in the layers of spill adjacent to the myocardium (miopericarditis). Because of the development of fabric cicatricial, observes the fusion of the myocardium with the near organs, the thorax and the vertebral column (mediastinopericarditis)
In the threat the apparition of a taponamiento cardiac, has to be treated immediately by a specialist of the corazon, to relieve this through a punción.
Here, a hollow needle of the inferior part of the sternum aventuró to the heart.
Once that has penetrated in the pericardium, the liquid can be downloaded to the outside, what causes a fast download of the heart.
The pericarditis occurs repeatedly, the pericardium deletes during the surgery for the prevention of the recaidas back.
Treatment of Pericarditis Acute?The doctor chooses the method of treatment of the pericarditis according to the clinical and morphological form and the cause of the illness. To a patient with pericarditis acute shows him rest in bed until the activity of the process diminishes. In the case of the pericarditis chronic, the diet is determined by the state of the patient (restriction of the physical activity, dietary nutrition: total, fraccional, with a restriction of the consumption of salt).
In the pericarditis acute fibrinosa (dry), prescribes mainly the treatment sintomático: anti-inflammatories no esteroideos (sour acetilsalicilico, indometacina, ibuprofen, etc.), analgesics for the elimination of the syndrome of severe pain, medicines that normalise the metabolic processes in the cardiac muscle, preparations of potassium.
The treatment of the pericarditis exudativa acute without signs of cardiac compression is basically similar to the of the pericarditis dry. It is compulsory the strict monitoring and regulate of the main parameters of the hemodinámica (arterial pressure, CVP, cardiac frequency, cardiac indexes and of crash, etc.), volume of efusión and signs of development of taponamiento cardiac acute.
If the pericarditis exudativa develops in a context of infection bacteriana, or in cases of pericarditis purulenta, use antibiotics (by road parenteral and locally through a catéter after draining the cavity pericárdica). The antibiotics prescribe taking into account the sensitivity of the pathogen identified. With the origin tuberculosa of the pericarditis, use of 2 to 3 medicines antituberculosos during 6-8 months. The drainage also uses for the insertion in the cavity pericárdica of agents citostáticos in case of injury tumoral of the pericardium; for the aspiración of blood and the introduction of drugs fibrinoliticos in the hemopericardio.
The treatment of the pericarditis secondary. The use of glucocorticoids (prednisolona) promotes an absorption of the spill faster and complete, especially with the pericarditis of allergic origin and the development in a context of illnesses sistémicas of the fabric conectivo. It is included in the therapy of the underlying illness (lupus eritematoso sistémico, fever reumática acute, arthritis reumatoide juvenile ).
With a fast increase in the accumulation of exudate (threat of taponamiento cardiac), realises a punción pericárdica (pericardiocentesis) to delete the spill. It uses the punción of the pericardium and with the reabsorción prolonged of the spill (for the treatment more than 2 weeks) to reveal his nature and nature (tumor, tuberculosis, funguses, etc.).
The patients with pericarditis constrictiva in the case of estasis venous chronic and cardiac compression operate in the pericardium : resección of the areas of the pericardium modified with scar and adherencias ( pericardectomia subtotal).
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