DISEASE OF BODIES OF BLOOD CIRCULATION : PERICARDITIS ACUTE (PERICARDITIS ASET) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Кровеносная система, сердце, сосуды, кровь
Inflammatory changes of the cardiac shirts are developing on the basis of a common disease (infection, intoxication, etc.,) or are the result of painful transition process with neighboring organs (pleura, mediastinum, aperture and other). PATOLOGOANATOMICHESKOE the changes are the different degree of destruction of the endothelium, fibrin accumulation; in the future can join liquid exudate, which have different character (serous, sero-fibrinous, purulent, ihorozny, hemorrhagic). When a large number of fibrin heart sometimes appears as though covered with hairs; in other cases formed the Union between the individual sections of the epicardial and pericardium, which can spread to neighboring organs, locking them heart, or lead to sardenia cavity of the heart shirts. The accumulation of fluid makes it difficult diastolic phase of the cardiac activity (cardiac tamponade), fusion act negatively on the systole and diastole. In connection with these abnormal conditions for the heart, and depending on concomitant diseases of the heart (heart disease, myocarditis, and others) are, or exaggerated, or, on the contrary, atrofiroval, or reborn and advanced.
Often inflammation of the heart bags remains unrecognized. Sometimes unexpectedly in satisfactory condition of the patient heard the noise pericardial friction (at dry pericarditis), which can disappear within few hours. Often dry pericarditis joins rheumatic endomyocarditis. The clinical picture becomes more severe congestion in heart bag of fluid. Together with the emergence of severe pain reminding stenokardicheskie, the overall condition is much worse:-tradendae breath goes soon in severe dyspnoea; skin and mucous membranes buy inevitablely color; the pulse quickens, becomes small, sometimes irregular. Arterial blood pressure (especially systolic) falls; pulse pressure (the difference between systolic and diastolic) reaches unreasonably small quantities (25 - 15 mm Hg). Cervical veins swell, venous pressure rises (up to 250 mm of water column and above). Noise pericardial friction may after a phase of strengthening begin to subside, together with reduced and pain. The colours become more and more remote. All cardiac region or only intercostal spaces you-patzivota. Percussion borders are pushed in all directions; the relative dullness almost merging with the absolute. The cardiac impulse or not defined at all, or palpated medially from left borders stupidity. X-ray detects stretched pericardial SAC in the form of homogeneous shadows or (very rarely) you can catch more intensive dims according to position of the heart. If a large exudate becomes concentrated mainly in the back parts bags under my left shoulder blade appears dull sound at percussion; listening to the network or bronchial breath (compression of the lung)or weakened vesicular that can lead to diagnostic errors. Electrocardiogram, along with a very small voltage, may be in the form of QRs complex (QRST), reminiscent of pathological changes characteristic of myocardial infarction (see ). The difference, however, is that in myocardial infarction ST segment offset from the isoelectric line in opposite directions in the first and third leads (discordance), and in exudative pericarditis looking in one direction-up. Low voltage also more characteristic of the exudative pericarditis. The involvement of wandering and phrenic nerves causes the symptoms of the digestive tract and diaphragm: a swallowing disorder, hiccups, belching, vomiting, loss of voice.
In differentsialno-diagnostic attitude it is important the ability to distinguish between endogenous and pericardial noises that can exist simultaneously. Valve noise coming from the depth, are quite widespread and are blowing or musical character; noise pericardial friction felt ear, increasing the pressure stethoscope, has scraping or rustling shade, usually dvofast, sometimes three-phase. When pleuropericarditis (pericarditisexterna) pericardial friction noise is heard better at the height of inspiration.
always inspires anxiety in the sense of sudden deterioration of the process or the formation of growths