Exudative or exudative pericarditis - an inflammatory disease of the heart bag (pericardium), which is accompanied by an increase in the amount of fluid in the cavity of the heart bags. Normally, between the sheets of pericardium in cardiac pouch is 20-30 milliliters of liquid. When pericardial effusion of the number increases to 200-300 milliliters or more.
The most common cause of exudative pericarditis are a variety of infectious diseases - staphylococcal or streptococcal infection, tuberculosis. Many rheumatic diseases are accompanied by accumulation of fluid in the pericardium. In some cases, there is pericardial effusion after cardiac surgery, with traumatic injuries of the heart and heart bag, with injuries of the chest, sometimes with extensive myocardial infarction.
The fluid between the sheets of cardiac bags can accumulate quickly, but sometimes the accumulation is slow. Accumulating in the pericardial fluid leads to compression of the heart. Compressed in the first chamber of the heart (atrial and ventricular cavity). Hard to fill with blood, and atrial and ventricular ejection of blood from the ventricle is reduced. The greater the volume of accumulated fluid, the more compressed the heart. There are severe circulatory disorders that may lead to the death of the patient. If the fluid in the pericardium accumulates slowly, the patient remains satisfactory for a long time. In the initial stage of the disease appear dull pain in the heart. Then there is shortness of breath, heart palpitations. Sometimes all this can be accompanied by chills and a high body temperature.
Over time, join signs of heart failure. The patient during the inspection are cyanosis (cyanosis), lips, wings, nose, ears, swelling of the neck veins, swelling of the legs. Pulse is usually frequent. Blood pressure is low because of decreased cardiac output. Often, an enlarged liver. When listening to heart sounds muffled. On the radiograph is determined by expanding the boundaries of the heart in all directions. An electrocardiogram showed a decrease of all the teeth of cardiac complexes. When echocardiography detected the liquid between the sheets of pericardium. This method allows to determine the presence of fluid in the pouch of the heart from 50 milliliters.
Treatment of exudative pericarditis.
Treatment of such patients is carried out in a hospital. The patient should be in bed. In the presence of fluid in the pouch of the heart, but there are no signs of compression of the heart, performed medical treatment - antibiotics, hormones, nonsteroidal anti-inflammatory drugs, antihistamines, diuretics.
If the amount of fluid in the pericardial cavity increases more than 200-300 ml, or a patient from the start, signs of compression of the heart, pericardial puncture performed by the method of Larrey's. In the left corner between the xiphoid process of sternum and the seventh rib cartilage administered the needle to a depth of 2-3 cm, while introducing a solution of novocaine, pierce the outer layer of the pericardium and remove all liquid from the heart bags. If the resulting fluid is purulent, the cavity bags were washed with an antiseptic solution and injected antibiotics or put drainage for the subsequent washing of the pericardial cavity and the outflow of fluid.
Sometimes the accumulation of fluid in the pouch of the heart takes longer than 6 months. Then this is a chronic pericardial effusion. Often, the disease leads to chronic viral infections, tuberculosis, accumulation of metabolic products of urea in renal disease. Manifestations of chronic exudative pericarditis depends on the degree of compression of the heart. If the degree of compression of the heart is small, chronic pericarditis can occur without complaints, and sometimes accidentally revealed by X-ray examination of the lungs. Only a small proportion of patients have complaints of discomfort in the heart.
With a large amount of fluid in the cavity of the heart bag, if the outer layer of the pericardium is well stretched signs of compression of the heart there, but it can compress the esophagus, trachea, bronchi, the recurrent nerve. Then there are complaints about the violation of swallowing, coughing, hoarseness, and in these cases, even in very large quantities of fluid in the pouch of cardiac complaints from the heart are absent.
Helps to clarify the diagnosis of echocardiography. Sometimes the computer spend or magnetic resonance imaging.
In chronic pericardial effusion pericardial puncture. The resulting liquid is investigated to clarify the nature of the process. Typically, a patient with chronic pericarditis operate. Produce a thoracotomy (incision) of the chest wall and pericardium are removed, leaving only those portions of it, where the nerve. Mortality in these operations is minimal, almost all patients recover