chronic pericarditis
Introduction
Introduction to chronic pericarditis After acute pericarditis, scar adhesion and calcium deposition can be left on the pericardium. Most patients have only mild scar formation and loose or local adhesion, no obvious thickening of the pericardium, does not affect the function of the heart, known as chronic adhesion pericarditis (chronicadhesive pericarditis), clinically non-important, some patients with pericardial infiltration The long-term existence of liquid, the formation of chronic exudative pericarditis (chronic effusive pericarditis), may be a chronic process of acute non-specific pericarditis, mainly manifested as pericardial effusion, good prognosis, a small number of patients due to the formation of thick scar tissue, pericardial loss of flexibility , which significantly affects the contractile and diastolic function of the heart, called constrictive pericarditis, which includes typical chronic constrictive pericarditis and subacute effusion that has undergone pericardial constriction at the same time as pericardial effusion Subacute effusive constrictive pericarditis, which has clinical manifestations of both pericardial occlusion and pericardial constriction, and eventually evolves into a typical chronic constrictive pericarditis. basic knowledge The proportion of illness: 0.21% Susceptible people: no special people Mode of infection: non-infectious Complications: heart failure
Cause
Causes of chronic pericarditis
Constrictive pericarditis is secondary to acute pericarditis, and sometimes acute progression to constriction is observed clinically. However, in most cases, the symptoms are not obvious in the acute phase. When the performance of constrictive pericarditis is obvious, it is often lost. The pathological features of the original disease, so many patients are not sure of the cause, tuberculous pericarditis is the majority in the affirmative cause, followed by non-specific pericarditis, radiation therapy and open heart surgery are gradually increasing, a few are suppurative pericardium Inflammation and traumatic pericarditis.
Prevention
Chronic pericarditis prevention
Chronic pericarditis can be caused by the incomplete development of acute pericarditis. Therefore, the treatment of acute pericarditis should be timely and thorough, which can prevent the occurrence of chronic pericarditis. In addition, when chronic pericarditis occurs, it should be actively treated. Preventing the formation of chronic constrictive pericarditis, these diseases are a gradual development process, so any aspect needs timely treatment.
Complication
Chronic pericarditis complications Complications heart failure
The disease can be found in some of the following surgical complications:
1. Low heart is discharged in the process of pericardial dissection. Due to acute heart dilation, especially after pericardial dissection on the right ventricle, under the action of autologous venous hypertension, the ventricle rapidly fills and expands rapidly, resulting in acute low cardiac output. Therefore, In the middle of the body should limit the input of fluid, the left ventricle is relieved, immediately after the application of cedilan and furosemide, in the strong heart, while queuing too much liquid to reduce the burden on the heart, within 12 ~ 48h after surgery, the application of catecholamines such as dopamine If the reaction to the drug is poor, the low cardiac output cannot be corrected, and the intra-aortic balloon counterpulsation can be used.
2, sacral nerve injury left anterior incision before the start of pericardial detachment, Kirklin JW proposed that the left phrenic nerve should be freed, as much as possible with the phrenic nerve to retain fat and soft tissue, such as injury to the phrenic nerve, can cause paralyzed respiratory movement of the diaphragm, affecting Gas exchange is not conducive to the discharge of respiratory secretions.
3, coronary artery injury in the separation of the anterior interventricular sulcus, it is necessary to pay special attention, do not damage the coronary artery, its branch or end bleeding, can be sutured to stop bleeding, when there are limited calcified plaque in this area, you can leave it Treatment, can not be reluctantly removed.
4, myocardial rupture for calcification lesions embedded in the myocardium, generally can be retained in the shape of the island, can not be barely stripped, for the peeling boundary is unclear, severe adhesions, the thickened pericardium can be used as a "well" to cut, partially relieve the myocardium The surface is bound, in case of myocardial rupture, the surgeon uses the left index finger to press on the crack, and use the free pericardium to cover the rupture around the rupture, which can save the patient's life.
Symptom
Chronic pericarditis symptoms Common symptoms: fatigue, sitting, breathing, dyspnea, pleural effusion, ascites, shoulder, pain, dizziness, heart failure, hepatomegaly, pericardial inflammation
(a) Symptoms:
Dyspnea after exertion is often the earliest symptom of constrictive pericarditis. It is due to the relatively fixed amount of cardiac output and can not be increased correspondingly during activities. Later, due to a large amount of pleural effusion, ascites will raise the lungs and lungs. The part is congested, so that breathing difficulties occur during rest, and even sitting breathing, a large amount of ascites and swollen liver compress the abdominal organs, resulting in abdominal swelling, in addition to fatigue, decreased appetite, dizziness, weakness, palpitations, cough , upper abdominal pain, edema, etc.
(2) Signs:
1, the performance of the heart itself:
The heart sounds are normal or slightly enlarged, the apical beats are weakened or disappeared, and the heart sounds are light and far. These manifestations are related to the limitation of cardiac activity and the decrease of cardiac output. The pulmonary heart valve component of the second heart sound can be enhanced, and some patients are in the left sternum. The third to fourth intercostal space can hear an early diastolic extra tone (pericardial snoring sound) about 0.1 second after the second heart sound. The nature is similar to that of acute pericarditis with cardiac tamponade. The heart rate is often faster, and the heart rate is generally It is sinus, and there may be ectopic heart rhythms such as premature beat, atrial fibrillation, and atrial flutter.
2, the performance of the heart pressure:
Jugular vein engorgement, hepatomegaly, ascites, pleural effusion, lower extremity edema, etc., which are blocked by diastolic blood pressure, which reduces the amount of blood output from the heart, leading to retention of water and sodium by the kidneys, resulting in increased blood volume and venous return. Obstruction is related to the increase of venous pressure. The ascites of constrictive pericarditis appears earlier than subcutaneous edema, and it is mostly large, which is different from general heart failure.
Examine
Chronic pericarditis
1, laboratory examination: no characteristic changes, may have mild anemia.
2, ECG check: QRS wave low voltage, T wave flat or inverted.
3, X-ray examination: pericardial calcification is the most reliable X-ray signs of acute pericarditis, can be seen in most patients with constrictive pericarditis, often incomplete ring, more than half of patients The shadow is slightly enlarged, and the rest of the heart is normal.
4, magnetic resonance imaging: can distinguish the pericardial thickening and the presence or absence of narrowing.
5, enhanced CT shows: the left outdoor rear pericardium thickening.
6, cardiac catheterization: constrictive pericarditis right heart catheterization is characterized by "pulmonary microvascular" pressure, pulmonary artery diastolic pressure, right ventricular end-diastolic pressure, right atrial mean pressure and vena cava pressure are significantly increased and tend to be equal The heart discharge is reduced.
Diagnosis
Diagnosis and diagnosis of chronic pericarditis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
The clinical manifestations of this disease and restricted primary cardiomyopathy are very similar, and identification is often difficult.
Restricted primary cardiomyopathy
The onset is relatively slow, there may be fever in the early stage, gradually appear fatigue, dizziness, shortness of breath, left ventricle mainly left heart failure and pulmonary hypertension such as shortness of breath, cough, hemoptysis, lung basal rales, pulmonary valve area The second sound is hyperthyroidism; the lesions with right ventricle are mainly caused by left ventricular dysfunction, such as jugular vein engorgement, hepatomegaly, lower extremity edema, ascites, etc., heart beats are often weakened, dullness is slightly increased, heart sound is light, The heart rate is fast, there may be diastolic galloping and arrhythmia, pericardial effusion may also exist, visceral embolism is not uncommon.
Surgical treatment of pericarditis often yields good results, while cardiomyopathy has a poor prognosis. Therefore, hemodynamic and imaging (CT or MRI) should be performed in cases where individual identification is difficult, and endocardial biopsy should be performed if necessary. If imaging shows thickening of the pericardium, unless all three hemodynamic examinations are consistent with restrictive cardiomyopathy, open thoracic exploration should be considered; if endocardial biopsy shows endocardial myocardium, it is not necessary to open the chest; Endometrial biopsy shows endocardial myocardium, which does not require open chest exploration. In addition, it needs to be differentiated from cirrhosis, tuberculous peritonitis and other heart failure caused by heart disease.
