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[edit | edit source]

ECG changes in pericarditis: elevation of the ST segment in the chest leads and depression of the ST segment in the aVR lead.

2 forms:
1. Dry, fibrinous - chest pain, pericardial friction murmur, ECG changes (typical pericardial changes of the ST segment and T wave)
2. Exudative - effusion (diagnosed using echocardiography)^[1]
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.

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^[1]

Definition: a chronic condition in which a rigid pericardium barrier impedes normal filling of the heart with blood.^[1]
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^[1]
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.