Acute pericarditis. Many pericarditis is relatively mild and ends in recovery even in the absence of targeted treatment. At one time, this became the reason for the unreasonable inclusion in the clinical classifications of the so-called acute benign pericarditis, which presumably has a viral etiology.
However, the nature of most of these pericarditis turned out to be allergic: viral pericarditis occurs only in combination with viral myocarditis (this is indirectly confirmed by the fact that viral pleurisy and peritonitis are extremely rare).
However, the determination of the etiology of pericarditis after its discovery often remains a very difficult task.
The disease can be caused by an infectious agent, pericarditis may be a complication of chronic diseases, including tuberculosis, rheumatism, kidney disease leading to uremia (aseptic pericarditis).
Sometimes pericarditis develops acutely in patients with pneumonia, also with myocardial infarction.
The earliest and most frequent complaint of patients with acute pericarditis is pain in the region of the heart, localized at the apex of the heart or at the bottom of the sternum, radiating to the left arm, left shoulder blade, neck, and possibly in the epigastrium. The pain resembles a picture of myocardial infarction or pleurisy. By nature, as a rule, she is strong, sometimes singing, stupid. Patients complain of an unpleasant sensation and heaviness in the region of the heart. Heart pain is the main symptom of dry pericarditis.
The appearance of exudate and its rapid accumulation in the pericardial cavity causes severe shortness of breath in patients. The patient notes an increase in shortness of breath in a horizontal position, lying on the bed, so he is forced to take the position of orthopnea (sitting position); sometimes they try to relieve the condition by tilting the body forward. Shortness of breath is traditionally accompanied by a dry cough. If irritation of the phrenic nerve occurs, vomiting occurs.
In patients with nodostroy cardiac tamponade, some time after the onset of the disease, stagnation appears in the system of the superior and inferior vena cava, which causes edema, liver enlargement, ascites, and swelling of the neck veins. With percussion, the borders of the heart with dry pericarditis are traditionally not changed.
With exudative pericarditis, a decrease, and not often the disappearance of the apical impulse, is detected, which is associated with a large exudate. The boundaries of relative cardiac dullness increase in all directions.
There is also a tendency to increase absolute cardiac dullness. Swelling of the cervical veins is noted. With dry pericarditis, the tops of the heart, as a rule, are not changed or are slightly muffled. With exudative tops, the tops are sharply muffled, sinus tachycardia occurs. If there is a small amount of effusion, then with dry fibrinous pericarditis and exudative pericardial friction noise appears.
Noise is better heard in the sitting position, its character is high, scratching, it is determined to the left of the parasternal line and on the sternum. The friction noise of the pericardium during the accumulation of exudate weakens, when the condition improves, it appears again. Note the decrease in blood pressure, more systolic.
There are a number of common symptoms: subfebrile temperature, leukocytosis with a shift to the left, an increase in ESR. An effusion is seen on x-ray. On the ECG with dry pericarditis, damage to the surface layers of the myocardium is noted, which confirms the ST interval is elevated above the isoline in all leads, a negative T wave may appear. As the disease progresses, the ST interval normalizes. Unlike myocardial infarction, the S-T interval is not short, there are no changes in the Q wave and the QRS complex.
On the ECG with exudative pericarditis, a decrease in the voltage of all teeth is noted.
Pericardial murmur indicates the presence of pericarditis.
If acute dry pericarditis is an independent disease, then its course is benign and without a trace is instilled for one to two months. Exudative pericarditis often has a subacute or chronic protracted course of exudative pericarditis, with exacerbations, accompanied by the accumulation of large amounts of fluid in the pericardial cavity.
To relieve pain, 2 ml of a 50% solution of analgin, 1 ml of a 2.5 solution of pipolfen or (or additionally) subcutaneously (or intravenously) 2 ml of a 2% solution of promedol or 1-2 ml of a 2% solution of pantopon are administered intravenously. A good result is achieved by inhaling a mixture of equal volumes of nitrous oxide and oxygen. It is necessary to start treatment with anti-inflammatory drugs (corticosteroid products, salicylates, etc.).
If tamponade occurs in patients with a large pericardial effusion and is accompanied by heart failure, the emergency may require pericardial puncture (see Medical Technique) and slow removal of 150-200 ml of fluid. The procedure must be carried out very carefully. If pus is removed from the pericardial cavity, then 300,000 IU of penicillin is injected into it through a needle. Therapy with cardiac glycosides in these cases is ineffective.
With severe pain syndrome, urgent hospitalization by special transport is indicated.