Pericarditis – inflammation of the pericardium (outer pericardial membrane of the heart) is often infectious, rheumatic, or post-infarction. Manifested by weakness, persistent pain behind the sternum, aggravated by inspiration, cough (dry pericarditis). It may occur with sweating between the sheets of pericardium (exudative pericarditis) and is accompanied by severe shortness of breath. Pericardial effusion is dangerous by suppuration and the development of cardiac tamponade (compression of the heart and blood vessels with accumulated fluid) and may require emergency surgical intervention.
Pericarditis can manifest itself as a symptom of a disease (systemic, infectious or cardiac), can be a complication of various pathologies of internal organs or injuries. Sometimes in the clinical picture of the disease, it is pericarditis that becomes paramount, while other manifestations of the disease go to the background. Pericarditis is not always diagnosed during the life of the patient, in about 3–6% of cases, signs of previously transferred pericarditis are determined only by autopsy. Pericarditis is observed at any age, but is more common among adults and the elderly, and the incidence of pericarditis in women is higher than in men.
In pericarditis, the inflammatory process affects the serous tissue membrane of the heart – the serous pericardium (parietal, visceral plate and pericardial cavity). Pericardial changes are characterized by an increase in permeability and expansion of blood vessels, leukocyte infiltration, fibrin deposition, adhesions and scar formation, calcification of the pericardial sheets and cardiac compression.
Symptoms of pericarditis
Manifestations of pericarditis depend on its form, stage of the inflammatory process, the nature of the exudate and the rate of its accumulation in the pericardial cavity, the severity of adhesions. In acute inflammation of the pericardium, fibrinous (dry) pericarditis is usually noted, the manifestations of which change in the process of exudate secretion and accumulation.
Manifested by pain in the heart and pericardial friction noise. Chest pain – dull and pressing, sometimes extending to the left shoulder blade, neck, both shoulders. More often there is moderate pain, but there are strong and painful, resembling an attack of angina. In contrast to the pain in the heart in case of stenocardia, pericarditis is characterized by its gradual increase, duration from several hours to several days, lack of response when taking nitroglycerin, temporary silence from taking narcotic analgesics. Patients can simultaneously feel shortness of breath, palpitations, general malaise, dry cough, chills, which brings the symptoms of the disease closer to manifestations of dry pleurisy. A characteristic sign of pain in pericarditis is its increased with deep breathing, swallowing, coughing, changing the position of the body (decrease in a sitting position and strengthening in the supine position), shallow and frequent breathing.
Pericardial friction noise is detected when listening to the patient’s heart and lungs. Dry pericarditis can result in a cure in 2-3 weeks or go into exudative or adhesive.
Exudative (effusion) pericarditis develops as a result of dry pericarditis or independently with rapidly beginning allergic, tuberculosis or tumor pericarditis.
There are complaints of pain in the heart, chest tightness. With the accumulation of exudate, there is a violation of blood circulation through the hollow, hepatic and portal veins, shortness of breath develops, the esophagus is compressed (the passage of food is disturbed – dysphagia), the phrenic nerve (hiccup appears). Almost all patients have fever. The patient’s appearance is characterized by a swollen face, neck, anterior surface of the chest, swelling of the veins of the neck (“Stokes’ collar”), pale skin with cyanosis. On examination, the intercostal spaces are smoothed.