Pericarditis (internal)

''This article discusses internal diseases. Pathology is discussed in the article Pericarditis (pathology).''

Pericarditis is an inflammatory disease of the pericardium.
 * It occurs either as acute inflammation with effusion (this is accompanied by a risk for cardiac tamponade) or as a chronic inflammation with pericardial fibrosis, leading to constrictive pericarditis.
 * Usually, it is part of a systemic disease. For this reason, affected individuals must be monitored for a long time even after the pericarditis has diminished.

Acute pericarditis

 * 2 forms:
 * Dry, fibrinous - chest pain, pericardial friction murmur, ECG changes (typical pericardial changes of the ST segment and T wave)
 * Exudative - effusion (diagnosed using echocardiography)
 * Often takes place without clinical manifestations
 * Etiology: most often viral, but tumor involvement must always be excluded.
 * Therapy: symptomatic, according to etiology. Sometimes, antibiotics or corticoids are necessary.
 * The prognosis is favorable.
 * If there is a large effusion, a cardiac tamponade can ensue (symptoms and signs include shortness of breath, low cardiac output, paradoxical pulse, weakened pulse, dilatation of the heart shadow on chest X-ray).
 * One must consider the possibility of effusion in the pericardium in the first month after a heart operation.

Etiology

 * Idiopathic
 * Infectious: viruses (coxsackie viruses, EBV, hepatitis B virus, HIV, cytomegalovirus), bacteria (pneumococci, staphylococci, streptococci)
 * Acute myocardial infarction (pericarditis epistenocardiaca above the lesion)
 * Uremia
 * Cancer (lung cancer, breast cancer, leukemia,…)
 * Autoimmune diseases
 * Sarcoidosis, intestinal inflammation, amyloidosis
 * Drug (hydralazine, procainamide, isoniazid, diphenylhydantoin)
 * Post-traumatic: chest trauma (hemopericardium)
 * Postoperative: postpericardiotomy syndrome
 * Myxedema
 * Chylopericardium

Constrictive pericarditis (pericarditis constrictiva)

 * Definition: a chronic condition in which a rigid pericardium barrier impedes normal filling of the heart with blood.
 * Consequences: decreased cardiac output and marked blood congestion in the liver.
 * Clinical picture: shortness of breath, fatigue, and later on edema of the lower limbs, ascites, anorexia, weight loss, and dyspepsia
 * In children it is very rare. In the past, it often was an inflammatory complication of TB.
 * It is very difficult to distinguish this condition from restrictive CM.

Related Articles

 * Infectious endocarditis
 * Myocarditis
 * Pericarditis (pathology)
 * Pericarditis (pediatrics)

Source

 * BENEŠ, Jiří. Studijní materiály [online]. ©2007. [cit. 2010]. .