Exudative (exudative) pericarditis
The examination of the patient revealed the following symptoms:
- Pallor with a cyanotic hue of the skin of the face and upper half of the trunk. At the same time there is swelling of these areas, the swollen veins of the neck.
- Can not be determined by the cardiac impulse.
- Voiceless heart tones auscultation.
- Tachycardia, the appearance of paradoxical pulsation (weak pulse on inspiration).
- Increase of borders of the liver.
- Rentgenograficheski visible advanced cardiac shadow straightening of his arcs, that forms the typical pattern of "triangle hearts". Under fluoroscopy, the reduction of cardiac pulsation.
The rapid formation of pericardial effusion between the sheets, even when a small amount (300 ml) can cause a life-threatening state of cardiac tamponade.
Is compression of the heart by accumulated fluid with a pronounced violation of his motor functions (reduce cardiac output) up to acute heart failure and death.
The signs of a cardiac tamponade – a sharp increase in the severity of all symptoms of pericarditis (swelling, which may take the character of ascites, shortness of breath), joined by impairment of consciousness (agitation or depression, fear of death). Further, in the absence of urgent assistance, possible loss of consciousness, collapse and death.
Treatment of exudative pericarditis and its complications
When he developed an acute pericardial effusion, treatment is aimed at normalization of cardiac activity and control of complications.
When the infectious nature of pericarditis is antibacterial and antiviral therapy, depending on the specific pathogen.
Cancer require specific chemotherapy or radiotherapy.
If the cause of the disease was the thoracic injuries or operative complications, performed surgical treatment of these conditions.
The occurrence of cardiac tamponade requiring urgent assistance due to the rapidly increasing severity of the condition.
Cardiac tamponade requires urgent implementation of the following activities:
- Urgent introduction of strong analgesics, including narcotic.
- Corticosteroids in high dosage (shock treatment).
- The purpose of breathing mixtures enriched with oxygen.
- Massive doses of diuretics.
- Puncture of the pericardium, in which the pericardial cavity the needle is injected and pumped out (evacuated) fluid. The procedure should be performed slowly to avoid a sharp increase in cardiac weakness.
The outcomes of exudative pericarditis
In a favorable variant of the disease occursresorption of fluid and normalization of the patient's condition.
The transition to a chronic form with the development of adhesive pericarditis. The symptoms lose their acuteness, but not completely eliminated. There are some spikes or massive adhesions between the visceral (covering the heart) and parietal (outer) leaves heart shirts.
Option in severe adhesive pericarditis can occur in the complete elimination of the pericardial cavity. This condition appears steady decrease in cardiac output and requires mandatory surgical treatment.
The operation is aimed at normalization of cardiac activity by partial dissection of the heart bags with the overlay "window" or the complete removal of the pericardium (pericardectomy).
Exudative pericarditis is a serious complication of some diseases and injuries of the chest, which can worsen their course and prognosis. The diagnosis of exudative pericarditis must be accompanied by measures for its correction.
On the back of pericarditis cardiac tamponade can lead to death and is an urgent condition that requires resuscitation.