What are the Symptoms of Pericarditis?

Pericarditis refers to acute inflammatory reactions and exudates due to bacteria, viruses, autoimmune, physical, chemical and other factors, as well as chronic lesions such as adhesions, thickening, narrowing, and calcification of the pericardium. Clinically, there are mainly acute pericarditis and chronic constrictive pericarditis. The patient had fever, night sweats, cough, sore throat or vomiting, and diarrhea. Acute pericardial tamponade can occur when a large amount of fluid is exuded from the pericardium. The patient had chest pain, difficulty breathing, cyanosis, pale face, and even shock. There may also be symptoms of ascites and liver dysfunction.

Basic Information

nickname

Epicarditis

English name

pericarditis

Visiting department

Cardiology

Common causes

Caused by infection, tumor, autoimmunity, endocrine, metabolic disorders, physical factors, chemical factors, etc.

Common symptoms

Fever, night sweats, cough, sore throat or vomiting, diarrhea, etc.

Causes of pericarditis

Pericarditis can be caused by a variety of pathogenic factors, often part of a systemic disease, or the spread of inflammation in adjacent tissues. There are eight common causes of pericarditis:

Infection

Pathogens include bacteria (including Mycobacterium tuberculosis), viruses, fungi, parasites, Rickettsia, and so on.

Tumor

Primary and secondary tumors.

3. Autoimmune

Rheumatic fever and other collagen tissue diseases, such as systemic lupus erythematosus, nodular polyarteritis, rheumatoid arthritis; after heart injury, such as post-pericardial syndrome.

4. Endocrine and metabolic disorders

Uremic, myxedema, cholesterol pericarditis.

5. Physical factors

Trauma and radiation therapy.

6. Chemical factors

Hydrazine, procainamide, etc.

7. Diseases of adjacent organs.

8. Acute nonspecific pericarditis with unknown etiology.

Clinical manifestations of pericarditis

The patient had fever, night sweats, cough, sore throat or vomiting, and diarrhea. Acute pericardial tamponade can occur when a large amount of fluid is exuded from the pericardium. The patient had chest pain, difficulty breathing, cyanosis, pale face, and even shock. There may also be symptoms of ascites and liver dysfunction.

Acute pericarditis

Caused by the primary disease, such as tuberculosis may have afternoon hot flashes, night sweats. Purulent pericarditis may include chills, high fever, and sweating. Pericardial inflammation can be seen behind sternum pain, dyspnea, cough, hoarseness, and difficulty swallowing. Friction of the pericardium can be heard in the anterior region of the pericardium during the early stages of acute pericarditis and during the later period of pericardial effusion absorption, which can last for hours to days. The pericardial effusion volume exceeds 300ml and the apical pulse can disappear. Shock can occur with a significant reduction in cardiac output. Diastolic heart restriction, increased venous pressure can produce jugular venous distension, liver enlargement, ascites, lower extremity edema, odd pulses, etc.

2. Chronic constrictive pericarditis

Most are tuberculous, followed by purulent. After 2 to 8 months of acute pericarditis, there may be obvious signs of pericardial constriction. Acute pericarditis occurs within a year of acute constrictive pericarditis, and chronic constrictive pericarditis occurs more than one year. The main manifestations are dyspnea, weakening or disappearing of apical pulse, jugular vein bloating, liver enlargement, a large amount of ascites and lower limb edema, odd pulses, etc.

Pericarditis examination

1. X-ray inspection

When the fluid volume exceeds 300ml, the heart shadow increases to both sides, and the angle of the heart septum becomes acute. When the volume is more than 1000ml, the heart shadow is flask-shaped and varies with body position. The heart beat weakens or disappears.

2. ECG

In dry pericarditis, in each lead (except aVR), the ST segment is elevated and returns to the isoelectric line a few days later. The T wave is flat or inverted. When the pericardium has fluid leakage, the QRS complex is low voltage.

3. Echocardiography

It shows that there is a dark area of liquefaction in the pericardial cavity, which is an accurate, safe and convenient diagnostic method.

Pericarditis diagnosis

Diagnosis can be made based on the cause, clinical manifestations, and laboratory tests.

Pericarditis treatment

The principle of treatment is: treating the primary disease to improve the symptoms and remove the circulation disorder.

At present, the treatment of this disease is mainly based on the treatment of the primary disease. If necessary, symptomatic treatment measures can be taken, such as chest pain can be given painkillers. If the volume of pericardial effusion is large, pericardial puncture can be performed.

General treatment

In the acute phase, bed rest should be adopted. Patients with dyspnea should be placed in a semi-recumbent position and inhaled oxygen. Those with obvious chest pain can be given analgesics. If necessary, codeine or dulidine can be used to strengthen supportive therapy.

2. Etiology treatment

Tuberculous pericarditis is given antituberculosis treatment. The method and course of treatment are the same as those for tuberculous pleurisy. Prednisone can also be added to promote the absorption of exudate and reduce adhesions. Rheumatic patients should strengthen anti-rheumatic treatment. Non-specific pericarditis is generally treated symptomatically. Those with severe symptoms may consider corticosteroids. In addition to the use of sensitive antibacterial drugs, purulent pericarditis should be repeatedly pumped during the treatment process or placed in the pericardial cavity through a trocar. A thin plastic catheter drains and, if necessary, injects antibacterial drugs into the pericardial cavity. If the effect is not good, pericardial incision and drainage should still be performed as soon as possible to control the infection in time to prevent the development of constrictive pericarditis. Uremic pericarditis should be strengthened with dialysis therapy or peritoneal dialysis to improve uremia. At the same time, indomethacin can be taken. Prednisone can be taken orally in radiation-induced pericarditis; it should be gradually reduced before stopping to prevent recurrence.

3. Remove pericardial tamponade

If there is a large amount of exudate or symptoms of pericardial tamponade, pericardial puncture convulsions can be performed to decompress. Ultrasound should be performed before puncture to understand the needle entry path and the thickness of the effusion layer penetrated into the pericardium. The puncture sites are: often in the left fifth intercostal space, 1 to 2 cm inside the heart dullness (or outside the cusp) Insert the needle at 1 2cm), the puncture needle should be pushed inward and backward, pointing to the spine, and the patient should take a sitting position; or at the angle formed by the sternal process of the sternum and the left costal margin, the needle point should be upward, slightly backward, tight Advancing behind the sternum, the patient takes a semi-seated position. For those with suspected right or posterior enveloping effusion, consider using the right 4th intercostal sternal margin for vertical penetration or the 7th or 8th intercostal scapula on the right back. Puncture at the midline. To avoid puncturing the heart muscle, the chest lead of the electrocardiograph can be connected to the puncture needle during puncture. Under ECG oscilloscope and cardiac B-ultrasound puncture, if the needle tip touches the ventricular muscle, the ST segment is elevated, but the insulation must be closely checked to prevent the patient from electric shock. In addition, using a "hole ultrasound probe", the puncture needle is inserted through the probe hole, and the puncture is performed under ultrasonic monitoring, and the position and movement of the puncture needle tip in the fluid cavity can be observed, and the use is completely reliable.

Pericarditis prevention

Rheumatic and non-specific pericarditis rarely cause pericardial tamponade and constrictive pericarditis. Tuberculous, purulent, and radiation-damaged pericarditis are more likely to develop into constrictive pericarditis. Therefore, early diagnosis and timely treatment are needed to prevent development.