Constrictive pericarditis is an inflammatory process in the pericardium, which is accompanied by a tightening of the inner layer of the pericardium. With inflammation, the inner pericardial sheet compresses the heart, thus preventing the blood from filling normally after contractions. So, let's talk today about constrictive pericarditis of the heart, its symptoms in children and adults, diagnosis and treatment.
Features of the disease in children and adults
Constrictive pericarditis is a fairly rare disease, according to statistics: 1% of cardiovascular diseases. The most common disease is found in men aged 20-50 years.
The signs of the disease in all age groups are the same, however, children may experience anxiety, a tendency to whims and irritability.
Types and forms of
There is a general classification of pericarditis that divides them according to the etiology:
- Infectious caused by infection:
- Rheumatic. It is caused by beta-hemolytic streptococcus.
- Bacterial. It is caused by bacteria arising from various diseases, such as pneumonia, sepsis, typhoid, anthrax and others.
- Tuberculosis, arising on the background of tuberculosis.
- Protozoal. The simplest microorganisms cause this form.
- Viral, appearing against the background of a viral infection.
- Aseptic, not associated with infections, arising in the background:
- allergies( allergic);
- connective tissue diseases;
- malignant tumors;
- wounds of the heart( traumatic);
- radioactive irradiation of the body( radiation);
- myocardial infarction( postinfarction);
- heart surgery( postcomussorotomy);
- metabolic disorders;
- for long-term use of medications;
- bleeding in the pericardial cavity;
- of hypovitaminosis;
- Idiopathic constrictive pericarditis, which occurs without a particular cause.
Also constrictive pericarditis may be:
- Exudative-constrictive. The form is distinguished by the accumulation of fluid in the pericardial cavity, significantly worsening the work of the heart.
- Without exudative component or dry. With this form of fluid accumulation is not observed.
Depending on the form, the symptoms of the disease and its treatment will differ.
Causes of constrictive pericarditis
Most often constrictive pericarditis appears against the background of other pathologies, that is, as a complication. The reason for this can serve:
- An infectious disease, for example, viral, protozoal, fungal and others. The most common causes are rheumatism and tuberculosis.
- Allergy or autoimmune process.
- Trauma of the pericardium. Pericardial damage can occur as a result of traumatism of the chest, for example, due to injury or a fall.
- General disease of the body. Such can serve as diseases of connective tissue or blood, oncological diseases.
- Heart Disease. The most frequent is myocardial infarction.
- Heart surgery.
- Metabolic disorders. Usually, the disorder is caused by gout, hypothyroidism and kidney failure.
About what signs for a constrictive pericardium are characteristic, read further.
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Symptoms of
In the majority of patients, constrictive pericarditis progresses gradually, which allows us to distinguish 4 periods of the course:
- Hidden, which can last several years. The patient does not experience any discomfort, and the disease itself is detected during the examination.
- Initial, which is manifested by general weakness, increased fatigue, puffiness, cyanosis of the face, swelling of the cervical veins, increased CVP, tachycardia, bloating, dyspepsia, weight loss and other symptoms.
- Expressed. Symptomatology of the previous period is aggravated: weakness becomes strong, puffiness increases, ascites appears.
- Dystrophic. During this period the patient feels extremely bad, changes in internal organs of a degenerative nature are noted, muscles atrophy, trophic ulcers and joint contractures appear.
Individual symptoms may also appear in patients, for example, heart failure.
Diagnosis
Primary diagnosis is reduced to the analysis of complaints and the collection of a family anamnesis. Also the physician conducts physical examination and auscultation. Based on the findings, the doctor can make a primary diagnosis, which must be confirmed with the help of:
- General and biochemical anzov urine, blood. These tests reveal inflammation, metabolic disorders and other indirect signs of concomitant diseases.
- Immunological examination to exclude autoimmune processes.
- Heart ultrasound for the detection of fluid accumulation or adhesions in the pericardial region.
- Chest X-ray. To identify the size of the heart.
- Puncture of the pericardium, which is prescribed only with an increasing tamponade or severe pericarditis.
Other examinations may also be given to the patient: Echo and EchoCG, MRI, cardiac catheterization, angiography.
Treatment of
Treatment is reduced to eliminating the cause of the disease, and only then exposure directly to pericarditis. Usually, conservative treatment does not give a positive result, because it can not destroy spikes, therefore it is carried out as preoperative preparation and in those cases when surgical treatment is contraindicated.
Therapeutic
The patient is indicated to receive:
- multivitamins;
- drugs that improve metabolism;
- immunomodulators;
It is also important to follow a diet with low salt content and limit physical activity.
Medication
The basis of drug treatment is the anti-inflammatory drugs of the hormonal and nonhormonal plan. Also, the patient is prescribed drugs that improve cardiac work and antibiotic therapy.
Operation
Pericardectomy is the only 100% treatment for pericarditis. The operation consists in removing the pericardial sac, which relieves the heart and blood vessels from squeezing when squeezing the pericardial.
Before operation it is necessary to observe a low-salt diet and drink diuretics. The lethality of the operation is 5% of the cases.
Prevention of disease and recommendations
No special prevention in this case. There are recommendations that reduce the risk of pericarditis:
- Proper treatment of emerging diseases, especially infectious.
- Avoid injury to the chest.
- Compliance with the principles of a healthy lifestyle.
- Admission of multivitamins at the rate.
At the first suspicion of pericarditis it is necessary to urgently consult a doctor.
Complications of
Unless treated with constrictive pericarditis or its cause, complications such as
- Cardiac tamponade. In this case, the fluid accumulating in the pericardium will make it difficult to contract and relax the heart.
- Arrhythmia and other disorders of the heart rhythm.
- Armstrong heart. Pathology, in which calcium is deposited in the pericardium, gradually forming a shell around the organ.
- Ascites, when a large volume of fluid will accumulate in the abdominal cavity.
- Heart failure.
Many of these complications, if untreated, can lead to cardiac arrest and death.
Forecast
If the patient has not operated pericarditis, or the effect of the operation is not observed, then the prognosis for a ten-year survival rate is unfavorable. If the patient was operated, he will live 15 more years with more than 90% probability.
On the constrictive and other types of pericarditis, Elena Malysheva will tell in the following video: