Heart Disease (Pericarditis)

 

 

The heart is composed of three tissues, which are from outside inwardly the pericardium, myocardium and endocardium. The "peri" means fabric card located around the heart, which surrounds the heart. This fabric looks like an envelope or bag which is in the heart. Pericarditis is defined as an inflammation of the pericardium, usually responsible for the appearance of fluid in the pericardium. It is a relatively common heart disease that can be serious. Very often, the challenge for the physician is to know the cause.

 

SYMPTOMS:


1 - Typical
Symptoms often occur in the context of infection. Pain is the major symptom of pericarditis. Seat and intensity variables, its duration is often prolonged for several hours to several days. It increases inspiration, coughing and lying on the back, and decreases in the sitting position leaning forward in expiration. Shortness of breath is actually breathing fast and shallow. It is the consequence of pain on inspiration or abundance of the effusion. It is also improved by sitting leaning forward. Other symptoms may also occur such as hiccups, vomiting, hoarseness, or a dry cough.
Fever is constant and may precede other symptoms.


2 - Atypical
The actual frequency of pericarditis is probably underestimated: many forms of pericarditis are not accompanied by any symptoms and spontaneously regressive.


3 - For a complication
Sometimes pericarditis is responsible for a very large effusion around the heart, preventing it from contracting normally.
This mechanism is responsible for the appearance of a very important breathlessness and decreased blood pressure. This disease is called by doctors tamponade is a medical diagnosis and severity.

 

CAUSES pericarditis:


Sometimes pericarditis is immediately linked to a heart disease more generally known or not (which it constitutes the inaugural event), but also the cause is not easy to find an exact cause is found in only 10 to 15% cases. Thus, the physician should investigate according to the following plan:

1 - It must first examine his patient, looking for history of tuberculosis, a chronic inflammatory disease, or cancer. Clinical examination he realized also look for signs of a heart disease responsible for pericarditis.


2 - Then, a chest radiograph is achieved, often followed by effecting a scan of the thorax. Aspiration and biopsy of the pericardium did discuss that if evolution is more than 4 or 6 weeks or especially a compression of the heart by the effusion obliges the physician to intervene quickly. Pericardial puncture under local anesthesia allows the analysis of the liquid. Pericardial biopsy under general anesthesia is more interesting than the analysis of the liquid but is sometimes not very accurate. It must be performed by an experienced surgeon and directed towards a suspicious area sick.


The various causes of pericarditis include:
1 - viral pericarditis
These are the most common, but often the cardiologist can accurately identify the causative virus.
Virtually all viruses can be responsible for the appearance of pericarditis. Very often, the symptoms of pericarditis are characteristic but it is often noted the absence of effusion of fluid in the pericardium during the realization of echocardiography. This type of pericarditis rarely turns to serious complications.


2 - pericarditis due to tuberculosis (5% of cases of pericarditis)
As pulmonary tuberculosis, pericarditis occurs during a resurgence of tuberculosis first. Therefore, it is more common in subjects as fragile and immunocompromised transplant. This is the demonstration of tubercle bacilli which made the diagnosis.


3 - pericarditis due to cancer developed close to the heart (5% of cases)

It is secondary to cancer vicinity (lung cancer, breast cancer, cancer of the esophagus, cancer of the thymus), a blood cancer (lymphoma, myeloma) and more rarely a cancer removed (cancer kidneys, digestive, gynecological ...), and exceptionally a primary cancer of the pericardium.
The outpouring of pericarditis is generally abundant and readily relapsed.

 

4 - pericarditis due to a heart disease of the immune system
The most common heart disease of the immune system lupus erythematosus. Pericardial effusion is frequent but more often it is not accompanied by symptoms. Scleroderma, polyarteritis Knotter (PAN), and dermatomyositis are also accompanied by pericarditis.

5 - pericarditis due to infection of the pericardium
Sometimes, bacteria can enter the pericardium and thereby develop a true infection around the heart. The triggers are secondary to septicemia remote focus, lung infection, trauma or cardiac surgery.


6 - Other rarer causes
Many other causes may be mentioned: rheumatoid arthritis, rheumatic fever, amyloidosis, sarcoidosis, pericarditis in acute myocardial infarction, postinfarction pericarditis or Dressler's syndrome of immunological nature, and parasitic pericarditis.

 

EVOLUTION:


The most common evolutionary mode of viral pericarditis, and post-infarction or spontaneous regression is treated within a few days or weeks.
Trailing evolution justifies the search for a cause by biopsy of the pericardium. In 15-25% of cases of viral pericarditis, there are relapses, sometimes over many years.


TREATMENT:


1 - Purpose
To regress pericarditis fighting against inflammation.
2 - Means
a-Medical
Rest;
Aspirin and nonsteroidal anti-inflammatory;
Corticosteroids;
TB treatment if TB is responsible for the pericarditis.
b-Surgical
The opening of the pericardium and the removal of part of the pericardium.
3 - Indications
Aspirin is prescribed as a painkiller and as an anti-inflammatory (3-4 grams / day) only in case of important inflammatory syndrome. A nonsteroidal anti-inflammatory may be more appropriate in this case.


Relapses are prevented by aspirin 3-6 grams / day or anti-inflammatory drugs in individuals colchicine. It is not uncommon in resistant forms of combined therapy with aspirin with colchicine.


The pericardiectomy is sometimes necessary to overcome relapse and allows more pericardial biopsies, which can sometimes be the etiologic diagnosis of pericarditis. In addition, the pericardiectomy is often associated with the creation of a péricardoscopie to visualize the inside of the pericardium and biopsies directed to areas of pathological lesions.


Corticosteroids are reserved for certain forms and alarming causes, rapidly decreasing the dosage of 0.5 mg / kg.
Dragging in the forms, test TB treatment can be undertaken even in the absence of proof..

4 - Results
They are usually good in viral pericarditis remains the predominant cause. The treatment does not in other cases. Pericarditis collagenosis, rheumatoid arthritis and rheumatic fever declining rapidly to treatment with corticosteroids.
5 - Monitoring
Elements are also useful for the diagnosis to achieve surveillance: Clinical examination by the doctor, blood tests, electrocardiogram and cardiac ultrasounds are performed regularly.


Prolonged bed rest is indicated for persistent fatigue is common. Effusion regressed more quickly it is made quickly and thoroughly.
Treatment with aspirin lasts a month gradually reducing the total daily dose of 500 mg / week. In case of relapse colchicine is systematically associated with aspirin.


CONCLUSION:
Pericarditis is most often due to a viral cause. Besides this there are several other causes as to be feared, including tuberculosis and cancer. Accurate diagnosis of the cause is sometimes very difficult.