What are the symptoms of serous pericarditis
The Pericarditis is an inflammation of the heart sac (pericardium).
A distinction is made between acute and chronic pericarditis according to the onset and course.
Special forms of pericarditis are pericarditis constrictiva ("armored heart") and pericarditis epistenocardica ("early pericarditis"), which are discussed elsewhere.
The following causes are possible:
- Viral infection: Often after previous infection of the respiratory tract, pathogens include coxsackie virus, influenza virus, adenovirus.
- bacterial infection: by Streptococcus pneumoniae, staphylococci, haemophilus or tubercle bacteria as part of a sepsis or by spreading to neighboring organs, for example in pneumonia.
- Mycoses: Especially with immunosuppression, the pathogens are mostly Candida species or Aspergillus flavus.
- Parasitic infection
- in the context of systemic diseases
- in the context of other organ diseases (myocarditis, endocarditis, pneumonia, terminal renal failure with uremia, esophageal diseases, aortic aneurysm)
- Paraneoplasia: As a rule, hemorrhagic pericarditis is found after malignant neoplasms have spread to the pericardium, e.g. breast cancer, bronchial carcinoma and lymphoma.
- post-traumatic: post-traumatic heart syndrome after operations; Epistenocardic pericarditis after myocardial infarction
- idiopathic: without an identifiable / demonstrable cause
Acute pericarditis manifests itself in the form of retrosternal, thoracic pain with accompanying fever. The pain can be aggravated by forced breathing and coughing. There may be tachycardia. Chronic pericarditis, on the other hand, can be very discreet and hardly cause any symptoms.
The most important complication of pericarditis is pericardial tamponade caused by a pericardial effusion.
With advanced effusion and tamponade, the action of the heart can be restricted, with signs of right heart failure in particular appearing.
During auscultation, a scratchy, superficial rubbing of the pericardium can be heard if the effusion is not very pronounced - especially during end expiratory or when the patient is bent over. The pericardial rubbing occurs not only systolic, but also in three phases as a "locomotive noise":
Echocardiography allows evidence of effusion and pericardial thickening.
The ECG typically shows various changes, e.g. non-anatomical ST elevations, PR depressions and T flattening, which must be differentiated from a myocardial infarction in the differential diagnosis. With pronounced effusion or pericardial tamponade, you can also see a low voltage.
In acute pericarditis, the ECG changes go through four successive stages:
- Stage I: Diffuse ST elevations with elevation of the J point in several leads. They develop in the first few days after the onset of the disease and can last for up to two weeks. Due to the subepicardial damage, there is a decrease in the PQ interval in almost 2/3 of the cases.
- Stage II: regression of the ST elevations, flattening of the T wave
- Stage III: T-negativity from the end of the 2nd to 3rd week
- Stage IV: The T-wave changes dissolve again.
Atrial fibrillation also occurs more frequently in the acute stage.
The laboratory results show characteristic changes depending on the etiology:
- Bacterial or mycotic pericarditis: increase in inflammation parameters (ESR, CRP, leukocytosis and detection of the pathogens in the blood (blood cultures).
- Viral pericarditis: possibly lymphocytosis and positive serology
- Specific autoantibodies can often be detected in autoimmune diseases or Dressler's syndrome.
- Elevations in CK, CK-MB and troponin T are possible as an expression of an affection of the myocardium.
A puncture of the pericardium is useful for diagnosis, especially if there are indications of bacterial origin to detect the pathogen.
Therapy depends on the etiology. Bed rest is generally ordered.
In the case of bacterial or mycotic pericarditis, antibiotics or antimycotics must be treated causally. Proof of tuberculosis requires consistent therapy.
Viral pericarditis can be treated symptomatically with NSAIDs, colchicine and / or glucocorticoids. Autoimmune pericarditis is usually treated by immunosuppression (glucocorticoids, cyclophosphamide, methotrexate).
If the pericarditis is caused by uremia, hemodialysis should be sought. If a malignant neoplasm is the cause, drainage and radical tumor therapy are crucial.
If there are signs of tamponade, a pericardial puncture must be performed as soon as possible to relieve the strain. This measure is life-saving.
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