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Fluid in the pericardial cavity: what it means, acceptable norms

 
, medical expert
Last reviewed: 04.07.2025
 
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The heart is our life engine, the work of which depends on many factors, including biological internal processes. Sometimes the cause of pain and discomfort in the heart area is fluid in the pericardium, which surrounds the heart from all sides. And the cause of the malaise is the compression of the heart by fluid or an inflammatory process localized in the tissues of the myocardium or pericardium.

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Epidemiology

According to statistics, about 45% of all pericarditis are viral in nature, in the treatment of which the priority is to increase immunity (vitamins, immunostimulants), while bacteria, to combat which antibiotics are used, cause inflammatory processes in the pericardium in only 15% of episodes of the disease. The rarest types of pathology are fungal and parasitic pericarditis.

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Causes pericardial fluid

Let's try to specifically understand what conditions and pathologies can provoke an increase in the volume of fluid in the pericardium, which is now considered not as a lubricant during heart friction, but as a life-threatening factor.

The most common cause of non-inflammatory fluid accumulation in the pericardium is considered to be edematous syndrome. This is not a disease, but a symptom that can accompany the following pathological and non-pathological processes:

  • congenital diverticulitis of the left ventricle of the heart,
  • heart failure,
  • pathologies of the excretory system, and in particular the kidneys,
  • a disorder in which there is a direct communication between the two layers of the pericardium,
  • deficiency states such as anemia,
  • state of exhaustion of the body,
  • mediastinal tumors, myxedema,
  • metabolic disorders in body tissues,
  • various inflammatory pathologies,
  • injuries accompanied by tissue swelling,
  • allergic reactions.

Sometimes the development of hydropericardium can be seen as a consequence of taking vasodilators or a complication of radiation therapy.

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Risk factors

Pregnancy and old age can be considered risk factors for the development of pathology.

The most common causes of the inflammatory process in the pericardium ( pericarditis ) are considered to be tuberculosis and rheumatic damage to the organ. We are talking about an infectious-allergic reaction, as a result of which a large amount of exudate is formed.

Risk factors in this case can be considered:

As we have already said, fluid in the pericardium can accumulate as a result of stab wounds in the heart, but the same situation can also be observed after surgery on the organ, as a result of a postoperative complication (inflammation).

A peculiar trauma for the heart is myocardial infarction, which can also occur with inflammatory complications and provoke an increase in the level of fluid in the pericardial sac. The same can be said about ischemic (necrotic) changes in the myocardium of the heart.

If you look closely, you can see many coincidences in the causes of pericarditis and hydropericardium. In theory, the second pathology is a type of non-infectious pericarditis, since congestion in the pericardium in any case causes pathological processes in it of the inflammatory type.

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Pathogenesis

It is known from school biology that our heart is born in a "shirt". The name of this "shirt" is the pericardium, it consists of dense physiological tissues and performs a protective function.

The pericardium is also called the pericardial sac, inside which the heart feels comfortable and can work without interruption. The pericardial sac consists of two layers (sheets): visceral or external and parietal (internal), which can shift relative to each other.

The heart, as a mobile muscular organ, is in constant motion (its walls contract and pump blood like a pump). In such conditions, if there were no pericardium around it, it could shift, which would lead to kinking of the vessels and disruption of blood circulation.

Moreover, the pericardium protects the heart from dilation under heavy loads on the organ. It is believed that it is also a protective barrier preventing infection from penetrating the heart tissue during inflammation of the internal organs.

But an equally important function of the pericardium is to prevent friction of the highly mobile heart against nearby immobile structures of the chest. And so that the heart does not experience friction against the pericardium itself and nearby organs, there is a small amount of fluid between its layers.

Thus, there is always fluid in the pericardium, but normally its amount, according to various sources, should not exceed 20-80 ml. Usually this figure is limited to 30-50 ml, and an increase in the volume of pericardial effusion to 60-80 ml is considered pathology. But if with such a quantity of free fluid of a slightly yellowish color a person feels healthy and does not have any suspicious symptoms, there is no reason to worry.

It is a different matter if the fluid in the pericardium accumulates in moderate and large quantities. It can be 100-300 ml, or 800-900 ml. When the indicator is very high and reaches 1 liter, we are talking about a very life-threatening condition called cardiac tamponade (compression of the heart by fluid accumulating in the pericardial sac).

But where does the excess fluid in the pericardium come from? It is clear that this is impossible in the context of absolute health. The fluid in the pericardium is constantly renewed, being absorbed by the pericardial sheets, and its amount remains approximately constant. An increase in its volume is possible only in two cases:

  • in case of metabolic disturbances in the pericardial tissues, as a result of which the absorption of transudate decreases,
  • addition of inflammatory exudate to the existing non-inflammatory fluid.

In the first case, we are talking about diseases associated with hemodynamic disorders, the development of edematous or hemorrhagic syndrome, tumor processes, as a result of which a transparent fluid accumulates in the pericardial cavity, which contains traces of epithelial cells, protein and blood particles. This pathological condition is usually called hydropericardium.

The appearance of inflammatory exudate is most often associated with the penetration of infection into the pericardium through the blood and lymph, if there was already a focus of purulent inflammation in the body. In this case, we are talking about an infectious and inflammatory pathology called "pericarditis", which has several different forms.

But inflammation in the pericardium can also be non-infectious. This is observed in tumor processes with metastases in the heart area, when the process spreads from nearby tissues (for example, in myocarditis), metabolic disorders in the tissues of the pericardium, and trauma to the pericardium (a blow to the heart area, a wound, a stab injury).

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Symptoms pericardial fluid

The clinical picture of pericarditis, in which excess fluid accumulates in the pericardium, may vary depending on the cause and the amount of transudate/exudate. Pericarditis itself does not occur. It acts as a complication of pathologies or injuries already present in the body, so there is no need to talk about specific symptoms.

Very often the patient does not even suspect that fluid is accumulating in his pericardium, i.e. does not think about such a reason for the deterioration of health, suspecting cardiovascular pathologies, colds and diseases of the respiratory system, kidney diseases. It is with these problems that they turn to the therapist, but diagnostic studies show that the symptoms that have appeared are already late manifestations of diseases, i.e. their complication.

So, what complaints might a patient with increased pericardial fluid volume bring to the doctor?

  • shortness of breath both at rest and under exertion,
  • discomfort behind the breastbone, which is especially clearly felt when a person leans forward,
  • pain in the heart area of varying intensity, associated with pressure on the organ, pain can radiate to the back, shoulder, neck, left arm,
  • tightness in the chest, a crushing feeling,
  • difficulty breathing, attacks of suffocation, feeling of lack of air,
  • edema syndrome, which is especially noticeable on the face, upper and lower extremities,
  • decreased systolic and increased venous pressure, swollen veins in the neck,
  • symptoms of tachycardia, arrhythmia,
  • a non-productive barking cough that does not bring relief,
  • hoarse voice,
  • increased sweating, especially against the background of tuberculosis,
  • enlarged liver and pain in the right hypochondrium,
  • problems with the passage of food through the esophagus due to compression by the enlarged pericardium,
  • frequent hiccups as a result of compression of the phrenic nerve,
  • pale blue skin due to circulatory disorders (compression of the heart by pericardial effusion and exudate leads to a disruption of its contractile function),
  • loss of appetite and associated weight loss.

It is clear that patients may complain of a deterioration in their general condition, weakness, headaches and muscle pain, but only some patients experience such symptoms. But fever, caused by an increase in body temperature due to inflammation, is present in most cases of seeking medical attention with discomfort associated with fluid accumulation in the pericardium, especially in cases of infectious lesions. These complaints can be considered non-specific first signs of inflammation, which subsequently causes the pericardium to overflow with fluid.

But shortness of breath, heart pain, fluctuations in pulse and blood pressure can directly indicate that the fluid in the pericardium is interfering with the work of the heart.

It is important to understand that pericarditis can be not only infectious or non-infectious, acute or chronic, it has several varieties that differ in their course and the amount of fluid in the pericardium.

In the acute form, dry (also known as fibrinous) and exudative pericarditis may occur. In the first case, fibrin from the serous membrane of the heart exudes into the pericardial cavity, which is caused by its overflow with blood. In this case, only traces of fluid are found in the pericardium. In exudative pericarditis, free fluid in the pericardium is found in large quantities.

Pericardial effusion may consist of semi-liquid exudate in inflammatory processes and hemodynamic disorders, bloody fluid (hemorrhagic pericardium) in case of wounds, tuberculosis or ruptured aneurysm, and fluid mixed with pus in case of infectious lesions.

Exudative pericarditis can be long-lasting, becoming chronic after 6 months. A small amount of fluid in the pericardium (80-150 ml) may not cause pronounced symptoms of the disease, and the patient may think that he has already recovered. But after a while, the inflammatory process under the influence of various factors may intensify, and the increased level of fluid in the pericardium will cause unpleasant symptoms, which are also completely unsafe.

If a lot of fluid has accumulated in the pericardium, which begins to strongly compress the heart, as a result of which its work is disrupted, we speak of cardiac tamponade. In this case, there is insufficient relaxation of the heart chambers, and they cannot cope with pumping the required volume of blood. All this leads to the appearance of symptoms of acute heart failure:

  • severe weakness, drop in blood pressure (collapse, loss of consciousness ),
  • hyperhidrosis (intensive secretion of cold sweat),
  • severe pressure and heaviness in the chest,
  • rapid pulse,
  • severe shortness of breath,
  • high venous pressure, manifested by an enlargement of the jugular vein,
  • excessive mental and physical excitement,
  • breathing is rapid but shallow, inability to take a deep breath,
  • the emergence of anxiety, fear of dying.

After listening to the patient with a stethoscope, the doctor notes weak and muffled heart tones, the appearance of crunching and murmurs in the heart (observed in a certain position of the patient's body), which is typical of pericarditis, occurring with or without cardiac tamponade.

Pericardial fluid in children

As strange as it may sound, excess fluid in the pericardium can appear even in an unborn child. A small accumulation of pericardial effusion, as a manifestation of a hyperkinetic reaction of the cardiovascular system, may indicate the development of mild to moderate anemia. In severe anemia, the amount of transudate can significantly exceed normal values, which is a symptom that threatens the life of the child.

But fluid in the pericardium of the fetus can also form as a result of disturbances in the development of tissues of the left ventricle of the heart. In this case, in the upper part of the heart on the left ventricle side, there is a protrusion of the walls - a diverticulum, which disrupts the outflow of pericardial effusion (hydropericardium). Transudate accumulates between the pericardial layers and after some time can lead to the development of cardiac tamponade.

Pathologies in the development of the fetal heart and the appearance of a large amount of fluid around it can be detected during an ultrasound examination of the pregnant woman.

Pericarditis in a child can be diagnosed in early childhood. Most often, the disease occurs against the background of previous viral infections, against the background of rheumatism and diffuse (common) diseases of the connective tissue. But non-specific forms of pericarditis caused by fungal infection, intoxication of the body due to kidney disease, vitamin deficiency, hormonal therapy, etc. are also quite possible. In infants, the pathology often develops against the background of a bacterial infection (staphylococci, streptococci, meningococci, pneumococci and other types of pathogens).

It is very difficult to recognize the disease in infants, especially if we are talking about the dry form of pericarditis. Acute pericarditis always begins with an increase in body temperature, which is not a specific symptom, increased heart rate and pain, which can be recognized by frequent episodes of anxiety and crying in the baby.

Older children with a small amount of fluid in the pericardium will complain of chest pain on the left, which becomes stronger when the child tries to take a deep breath. The pain may increase when changing body position, for example, when bending over. Often the pain radiates to the left shoulder, so the complaints may sound exactly like this.

Exudative (effusive) pericarditis is considered especially dangerous, in which the amount of fluid in the pericardium quickly increases and can reach critical levels with the development of cardiac tamponade. In an infant, the symptoms of the pathology can be considered:

  • increased intracranial pressure,
  • significant filling of the veins of the hand, elbow and neck, which become clearly visible and palpable, which is excluded at an early age,
  • the appearance of vomiting,
  • weakness of the muscles of the back of the head,
  • bulging fontanelle.

These symptoms cannot be called specific, but they are important for recognizing a health problem in a child who is not yet able to talk about other symptoms of the disease.

The acute stage of pericarditis exudative in an older child is accompanied by shortness of breath, dull pain in the heart area, and deterioration of the general condition. During pain attacks, the child tries to sit and bend, tilting his head to his chest.

The following symptoms may appear: barking cough, hoarseness, drop in blood pressure, nausea with vomiting, hiccups, abdominal pain. The appearance of a paradoxical pulse with reduced filling of the veins at the entrance is characteristic.

If we are talking about cardiac tamponade, then there is an increase in shortness of breath, the appearance of a feeling of lack of air and fear, the child's skin becomes very pale, cold sweat appears on it. At the same time, increased psychomotor excitability is noted. If urgent measures are not taken, the child may die from acute heart failure.

Chronic exudative pericarditis of any etiology in a child is characterized by a deterioration in the general condition and constant weakness. The child quickly gets tired, has shortness of breath and discomfort in the chest, especially when moving, exercising, playing sports.

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Complications and consequences

Congestion in the pericardial sac and inflammatory processes in it, accompanied by an increase in the volume of fluid in the pericardium, cannot pass without a trace, appearing only in the deterioration of the general condition of the patient, the appearance of shortness of breath and pain behind the sternum.

Firstly, increasing in volume, the fluid increasingly presses on the heart, making it difficult for it to work. And since the heart is an organ responsible for the blood supply to the entire body, failures in its work are fraught with circulatory disorders. Blood, in turn, is considered the main source of nutrition for cells, it also supplies them with oxygen. Blood circulation is disrupted, and various human organs begin to suffer from hunger, their functionality is disrupted, which entails the appearance of other symptoms, for example, manifestations of intoxication, significantly reducing the quality of a person's life.

Secondly, the accumulation of inflammatory exudate is fraught with the development of cicatricial-adhesive process. In this case, it is not so much the pericardium itself that may suffer due to the overgrowth of fibrous tissue and compaction of its sheets by the accumulation of calcium, but the heart, which cannot provide sufficient filling of the chambers with blood during diastole. As a result, the development of venous congestion, causing an increased risk of thrombus formation.

The inflammatory process can also spread to the myocardium, causing degenerative changes in it. This pathology is called myopericarditis. The spread of the adhesive process is fraught with the fusion of the heart with nearby organs, including the tissues of the esophagus, lungs, chest and spine.

Stagnation of fluid in the pericardium, especially with a large amount of blood, can lead to intoxication of the body with its decay products, as a result of which various organs suffer again, and first of all the excretory organs (kidneys).

But the most dangerous condition in exudative and hydropericarditis with a rapid increase in the volume of fluid in the pericardium is the condition of cardiac tamponade, which, in the absence of urgent effective treatment, leads to the death of the patient.

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Diagnostics pericardial fluid

Pericardial fluid is not considered a pathological condition if its amount does not exceed generally accepted norms. But as soon as the volume of effusion becomes so large that it begins to cause symptoms of heart failure and other nearby organs, you cannot delay.

Since the symptoms of pericarditis can resemble various diseases, patients seek advice from a general practitioner, who, after a physical examination, anamnesis, and listening to the patient, sends him to see a cardiologist. The symptoms that patients will name will say little about the true cause of the ailment, but they can push the doctor in the right direction, since most of them still indicate heart problems.

Tapping and listening to the heart will help confirm the guess. Tapping will show an increase in the borders of the heart, and listening will show a weak and muffled heartbeat, which indicates limited movement of the heart structures due to its compression.

Conducting laboratory tests of blood and urine will help to assess the nature of existing health problems, determine the cause and type of pericarditis, and assess the intensity of inflammation. For this purpose, the following tests are prescribed: clinical and immunological blood tests, blood biochemistry, general urine analysis.

But neither physical examination with listening, nor laboratory tests make it possible to make an accurate diagnosis, because they do not allow to assess the presence of fluid in the pericardium and its volume, as well as to determine what exactly is associated with the disruption of the heart. This problem is solved by instrumental diagnostics, many methods of which allow to assess the situation in the smallest details.

The main method that allows determining not only the presence of fluid in the pericardium, but also its level, is considered to be an echocardiogram (EchoCG). Such a study allows identifying even a minimal amount of transudate (from 15 ml), clarifying changes in the motor activity of cardiac structures, thickening of the layers of the pericardium, adhesions in the heart area and its fusion with other organs.

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Determination of the amount of fluid in the pericardium by echocardiography

Normally, the pericardial sheets do not touch each other. Their divergence should be no more than 5 mm. If EchoCG shows a divergence of up to 10 mm, we are talking about the initial stage of pericarditis, from 10 to 20 mm - a moderate stage, over 20 - severe.

When determining the quantitative characteristics of the fluid in the pericardium, an insignificant volume is said to be less than 100 ml, up to half a liter is considered moderate, and over 0.5 l is considered large. In the case of a large accumulation of exudate, a pericardial puncture is mandatory, which is carried out under the control of echocardiography. Part of the pumped out fluid is submitted for microbiological and cytological examination, which helps to determine its nature (transudate has a lower density and an insignificant protein content), the presence of an infectious agent, pus, blood, malignant cells.

If fluid in the pericardium is detected in the fetus, a puncture is performed without waiting for the child to be born. This complex procedure must be performed strictly under ultrasound control, since there is a high risk of injury to the mother or her unborn child. However, there are cases when the fluid in the pericardial cavity spontaneously disappears, and a puncture is not required.

An electrocardiogram (ECG) can also provide some information about the pathology, since exudative and chronic pericarditis reduces the electrical activity of the myocardium. Phonocardiography can provide information about heart noises not related to its work, and high-frequency oscillations indicating fluid accumulation in the pericardium.

Exudative pericarditis and hydropericardium with a fluid volume of more than 250 ml are determined on the radiograph by the increase in size and change in the silhouette of the heart, unclear definition of its shadow. Changes in the pericardium can be seen during ultrasound, computed tomography or magnetic resonance imaging of the chest.

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Differential diagnosis

Since pericardial fluid does not appear by chance and its appearance is associated with certain pathologies, a large role is given to differential diagnostics, which allows identifying the cause of intense pericardial effusion. Acute pericarditis in its symptoms can resemble acute myocardial infarction or acute myocarditis. It is very important to differentiate these pathologies from each other so that the treatment prescribed according to the diagnosis is effective.

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Treatment pericardial fluid

As we already know, there is always fluid in the pericardium, and a slight increase in its level is unlikely to affect the patient's health. The doctor may discover such changes by chance, after which he will want to observe the patient for some time. If the amount of fluid increases, but remains insignificant, it is necessary to find out the cause leading to the accumulation of effusion. Treatment will primarily be aimed at inactivating the factor that caused pathological hydration.

Where the patient will be treated depends on the severity of the pathology. Acute pericarditis is recommended to be treated in a hospital setting. This should help to avoid cardiac tamponade. Mild forms of the pathology with a moderate amount of transudate or exudate are treated on an outpatient basis.

Since pericarditis is an inflammatory process, to reduce the secretion of exudate, it is necessary to first stop the inflammation. In most cases, this can be done with the help of non-hormonal anti-inflammatory drugs (NSAIDs). Among them, the most popular drug is Ibuprofen, which helps relieve fever and inflammation, has a positive effect on blood flow and is well tolerated by most patients.

If the cause of fluid accumulation in the pericardium is cardiac ischemia, treatment with Diclofenac, Aspirin and other drugs based on acetylsalicylic acid, which reduces blood viscosity, will be more effective. The use of Indomethacin is also acceptable, but this drug can cause various side effects and complications, so it can only be used in extreme cases.

If taking NSAIDs does not give the desired result or is impossible for some reason, anti-inflammatory therapy is carried out using steroid drugs (most often Prednisolone).

Pericarditis, as the fluid increases, is accompanied by pain syndrome, which is relieved with the help of conventional analgesics (Analgin, Tempalgin, Ketanov, etc.). To combat edema syndrome, diuretics are used (most often Furosemide). But to maintain vitamin-mineral balance, diuretics are supplemented with potassium preparations (for example, Asparkam) and vitamins.

Along with solving the problem of inflammation and fluid in the pericardium, the underlying disease is treated. If it is an infection, then systemic antibiotic therapy is mandatory. Penicillin and cephalosporin antibiotics are prescribed; in severe purulent infections, preference is given to fluoroquinolones. Due to the resistance of many strains of pathogens to the action of conventional antibiotics, new types of antimicrobial drugs are increasingly used in therapy, to which most bacteria are sensitive (one of these drugs is Vancomycin).

Ideally, after a pericardial puncture, a fluid test should be performed to determine the type of pathogen and its resistance to the prescribed antibiotics.

If exudative pericarditis develops against the background of tuberculosis, special anti-tuberculosis drugs are prescribed. In case of tumor processes, cytostatics will be effective. In any case, antihistamines will help reduce swelling and inflammation, since even the body's reaction to an infectious factor is considered allergic.

In acute pericarditis, strict bed rest and light food are indicated. If the disease has a chronic course, limitation of physical activity and a diet are prescribed during its exacerbation.

In case of generalization of the inflammatory process, hemodialysis is indicated. In case of large volume of fluid in the pericardium, its puncture (paracentesis) is performed, which is the only way of safe non-surgical evacuation of excess fluid. Puncture may be prescribed for cardiac tamponade, purulent form of pericarditis, and also in case if 2-3 weeks of conservative treatment did not lead to reduction of fluid between the pericardial layers. If pus is detected in the exudate, drainage of the pericardial cavity is performed with introduction of antibiotics into it.

In some cases, the puncture has to be performed more than once. If the inflammation cannot be stopped and the fluid in the pericardium continues to accumulate despite multiple punctures, surgical treatment is prescribed - pericardiectomy.

Physiotherapy treatment for pericarditis with effusion is not performed, as it can only worsen the situation. During the rehabilitation period, exercise therapy and therapeutic massage are possible.

During the entire course of treatment of the acute form of pathology, the patient must be under the supervision of medical personnel. His arterial and venous pressure is regularly measured, and heart rate (pulse) indicators are monitored. In the chronic course of the disease, the patient is recommended to have his own device for measuring blood pressure and pulse, which will allow him to independently monitor his condition.

Medicines for pericarditis

Treatment of hydropericardium, when non-inflammatory fluid accumulates in the pericardium, often does not require special treatment. It is enough to remove the provoking factors, and the amount of fluid returns to normal. Sometimes the disease disappears spontaneously without treatment. In other cases, decongestants (Spironolactone, Furosemide, etc.) help.

Furosemide

A fast-acting diuretic, often prescribed for edema syndrome associated with cardiovascular pathologies. Does not put a strain on the kidneys, which allows it to be used even in renal failure. In addition to the diuretic effect, it promotes the expansion of peripheral blood vessels, which makes it possible not only to relieve edema, but also to reduce high blood pressure.

The drug can be prescribed both in the form of tablets (40 mg in the morning daily or every other day) and injections. The maximum permissible daily dose of the drug in tablets is 320 mg. In this case, it is better to take the medicine twice a day. The interval between taking the tablets should be 6 hours.

Furosemide solution can be injected intramuscularly or intravenously (as slow infusions). This practice is used in cases of severe edema and the risk of cardiac tamponade. As soon as the edema decreases, the drug is taken orally. Now the drug is administered once every 2-3 days. The daily dosage of the drug for injection can range from 20 to 120 mg. The frequency of administration is 1-2 times a day.

Injection therapy with the drug is carried out for no more than 10 days, after which the patient is given tablets until the condition stabilizes.

Despite the fact that pregnancy is considered one of the risk factors for the development of hydropericarditis, doctors do not recommend using the drug in the first half of pregnancy. The fact is that diuretics help remove potassium, sodium, chlorine and other electrolytes necessary for the body from the body, which can negatively affect the development of the fetus, the formation of the main systems of which occurs precisely during this period.

It is also prohibited to use the drug in case of potassium deficiency in the body (hypokalemia), hepatic coma, critical stage of kidney failure, obstruction of the urinary tract (stenosis, urolithiasis, etc.).

Taking the drug may cause the following unpleasant symptoms: nausea, diarrhea, drop in blood pressure, temporary hearing loss, inflammation of the connective tissue of the kidneys. Loss of fluid will result in thirst, dizziness, muscle weakness, depression.

The diuretic effect may be accompanied by the following changes in the body: a decrease in potassium levels, an increase in the content of urea in the blood (hyperuricemia), an increase in blood glucose levels (hyperglycemia), etc.

If we are talking about an inflammatory process in the pericardium, as a result of which a large amount of exudate accumulates between the layers of the amniotic sac, decongestant and antihistamine therapy is supplemented with anti-inflammatory therapy (taking NSAIDs or corticosteroids).

Ibuprofen

A nonsteroidal anti-inflammatory and antirheumatic drug that helps reduce fever and fever (lower temperature), reduces swelling and inflammation, and relieves mild to moderate pain. Sometimes these effects are enough to treat non-infectious pericarditis.

The drug is available in the form of coated tablets and capsules intended for oral administration. The drug should be taken after meals to reduce the irritating effect of NSAIDs on the gastric mucosa.

The drug Ibuprofen is prescribed in the amount of 1-3 tablets per dose. The frequency of taking the drug is determined by the doctor and is usually 3-5 times a day. For children under 12 years old, the dose is calculated as 20 mg for each kilogram of the child's weight. The dose is divided into 3-4 equal parts and taken during the day.

The maximum daily dose of the drug for adults is 8 tablets of 300 mg, for children over 12 years old – 3 tablets.

Contraindications to the use of the drug are: individual sensitivity to the drug or its components, acute stage of ulcerative gastrointestinal tract lesions, diseases of the optic nerve and some visual impairments, aspirin asthma, liver cirrhosis. The drug is not prescribed for severe heart failure, persistent high blood pressure, hemophilia, poor blood clotting, leukopenia, hemorrhagic diathesis, hearing impairment, vestibular disorders, etc.

Children are allowed to take the tablets from the age of 6, pregnant women - up to the third trimester of pregnancy. The possibility of using the drug during breastfeeding is discussed with the doctor.

Caution should be exercised in cases of elevated bilirubin levels, liver and kidney failure, blood diseases of unknown origin, and inflammatory pathologies of the digestive system.

The drug is well tolerated by most patients. Side effects are rare. They usually manifest as nausea, vomiting, heartburn, discomfort in the epigastric region, dyspeptic symptoms, headaches and dizziness. There are also reports of rare allergic reactions, especially against the background of intolerance to NSAIDs and acetylsalicylic acid.

Much less frequently (in isolated cases) there is a decrease in hearing, the appearance of tinnitus, swelling, increased blood pressure (usually in patients with arterial hypertension), sleep disorders, hyperhidrosis, swelling, etc.

Among corticosteroids, Prednisolone is most often used in the treatment of pericarditis.

Prednisolone

An anti-inflammatory hormonal drug that simultaneously has antihistamine, antitoxic and immunosuppressive effects, which contribute to a rapid reduction in the intensity of inflammatory symptoms and pain. Promotes an increase in blood glucose levels and insulin production, stimulates the conversion of glucose into energy.

The drug for various diseases that cause the formation of a large amount of fluid in the pericardium can be prescribed for oral administration, as well as for injection (intramuscular, intravenous, intra-articular injections).

The effective dosage of the drug is determined by the doctor depending on the severity of the pathology. The daily dosage for adults usually does not exceed 60 mg, for children over 12 years old - 50 mg, for babies - 25 mg. In severe emergency conditions, these doses may be slightly higher, the drug is administered intravenously slowly or by infusion (less often intramuscularly).

Usually, 30 to 60 mg of prednisolone is administered at a time. If necessary, the procedure is repeated after half an hour. The dose for intra-articular administration depends on the size of the joint.

The drug is intended for the treatment of patients over 6 years of age. The drug is not prescribed for hypersensitivity to it, infectious and parasitic diseases, including the active stage of tuberculosis and HIV infection, some gastrointestinal diseases, arterial hypertension, decompensated CHF or diabetes mellitus, thyroid hormone production disorders, Itsenko-Cushing's disease. The administration of the drug is dangerous in severe liver and kidney pathologies, osteoporosis, diseases of the muscular system with decreased muscle tone, active mental illnesses, obesity, poliomyelitis, epilepsy, degenerative vision pathologies (cataract, glaucoma).

The drug is not used in the post-vaccination period. Treatment with prednisolone is allowed 2 weeks after vaccination. If the vaccine is subsequently required, this can be done only 8 weeks after the end of treatment with a corticosteroid.

A recent myocardial infarction is also a contraindication to the drug.

As for side effects, they occur mainly with long-term treatment with the drug. But doctors usually try to shorten the course of treatment as much as possible until various complications arise.

The fact is that prednisolone is capable of washing calcium out of bones and preventing its absorption, and as a consequence, the development of osteoporosis. In childhood, this can manifest itself as growth retardation and bone weakness. Also, with prolonged use, muscle weakness, various disorders of the cardiovascular system, increased intraocular pressure, damage to the optic nerve, adrenal cortex insufficiency, and can cause seizures can be noted. The steroid stimulates the production of hydrochloric acid, as a result of which the acidity of the stomach can increase with the appearance of inflammation and ulcers on the mucous membrane.

When administered parenterally, prednisolone solution should never be mixed in the same syringe with other medications.

If pericarditis is infectious in nature, or more precisely, if it is caused by a bacterial infection, effective antibiotics are prescribed.

Vancomycin

One of the innovative drugs from the new group of antibiotics - glycopeptides. Its peculiarity is the absence of resistance to the drug in the vast majority of gram-positive bacteria, which makes it possible to use it in case of resistance of the pathogen to penicillins and cephalosporins, which are usually prescribed for bacterial pericarditis.

Vancomycin in the form of lyophilisate, which is subsequently diluted to the required concentration with saline or a five percent glucose solution, is administered primarily by drip. Slow administration over an hour is recommended. The concentration of the solution is usually calculated as 5 mg per milliliter, but since it is recommended to limit the introduction of fluid into the body in case of edema syndrome and a large amount of exudate in the pericardium, the concentration of the solution can be doubled. In this case, the rate of administration of the drug remains constant (10 mg per minute).

The drug, depending on the dose (0.5 or 1 g), is administered every 6 or 12 hours. The daily dose should not exceed 2 g.

For children under 1 week, the drug can be administered at an initial dose of 15 mg per kilogram of weight, then the dosage is reduced to 10 mg per kg and administered every 12 hours. For children under one month, the dose is not changed, but the interval between administrations is reduced to 8 hours.

For older children, the drug is administered every 6 hours at a dosage of 10 mg per kg. The maximum concentration of the solution is 5 mg/ml.

"Vancomycin" is not intended for oral administration. It is not released in such forms due to poor absorption in the gastrointestinal tract. But if necessary, the drug is administered orally, diluting the lyophilisate from the bottle with 30 grams of water.

In this form, the medicine is taken 3-4 times a day. The daily dose should not exceed 2 grams. A single dose for children is calculated as 40 mg per kilogram of the child's weight. The course of treatment for children and adults does not exceed 10 days, but not less than a week.

The drug has very few contraindications. It is not prescribed for individual sensitivity to the antibiotic and in the first trimester of pregnancy. Starting from the 4th month of pregnancy, the drug is prescribed according to strict indications. Breastfeeding should be stopped during the treatment with Vancomycin.

When the drug is administered slowly over an hour, side effects usually do not develop. Rapid administration of the drug is fraught with the development of dangerous conditions: heart failure, anaphylactic reactions, collapse. Sometimes there are reactions from the gastrointestinal tract, tinnitus, temporary or irreversible hearing loss, fainting, paresthesia, changes in blood composition, muscle spasms, chills, etc. The appearance of undesirable symptoms is associated with long-term treatment or the administration of large doses of the drug.

The choice of drugs for fluid accumulation in the pericardium is entirely within the competence of the doctor and depends on the cause and nature of the pathology that caused such a disorder, the severity of the disease, and concomitant pathologies.

Folk remedies

It should be said that the choice of folk recipes effective for pericarditis is not so great. It has long been proven that it is impossible to cure heart pathologies with herbs and spells alone, especially when it comes to the infectious nature of the disease. But folk remedies can help deal with edema and inflammation.

The most popular recipe for pericarditis is considered to be an infusion of young pine needles, which is credited with a sedative and antimicrobial effect. This recipe effectively relieves inflammation in the pericardium and thereby reduces the volume of fluid in it. This is an excellent remedy for the treatment of inflammation of viral etiology. Its use is also allowed for bacterial exudative pericarditis, but only as an addition to antibiotic treatment.

For the infusion, take 5 tablespoons of crushed needles of any coniferous trees, pour ½ liter of boiling water over them and keep on low heat for 10 minutes. Remove the mixture from the heat and put it in a warm place for 8 hours. After straining the “medicine”, take it after meals, 100 g 4 times a day. It gives the body the strength to fight the disease on its own.

You can try making a nut tincture. 15 crushed walnuts are poured with a bottle (0.5 l) of vodka and infused for 2 weeks. The finished tincture is taken 1 dessert spoon (1.5 teaspoons) after breakfast and dinner. The tincture should be diluted in 1 glass of water before use.

Herbal infusions that include herbs with diuretic, sedative, anti-inflammatory and strengthening effects are good for relieving symptoms of the disease. For example, a collection of linden flowers, hawthorn and calendula, dill seeds, oat straw. Pour a glass of boiling water over a teaspoon of the infusion and leave it in a warm place for 3 hours. Drink the finished medicine during the day, dividing it into 4 doses. Take the infusion half an hour before meals.

Or another collection, including hawthorn and chamomile flowers, as well as motherwort and immortelle grass. Take 1.5 tbsp of the collection, pour 1.5 cups of boiling water over them and leave in a warm place for 7-8 hours. Take the strained infusion half a glass three times a day an hour after meals.

Herbal treatment for such dangerous and severe pathologies as inflammation of the pericardium or cardiac membranes cannot be considered the main method of treatment, especially in the acute stage of the disease. Traditional medicine recipes are recommended to be used when the main symptoms of the disease have subsided somewhat. They will also help prevent heart disease and strengthen the immune system.

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Homeopathy

It would seem that if folk treatment for pericarditis, for which the characteristic symptom is fluid in the pericardium in the amount of 100 ml and more, is not so effective, can homeopathy change the situation, because its preparations also contain only natural components that are not considered strong drugs? But some homeopathic doctors claim that pericarditis can be cured with homeopathic remedies. True, such treatment will be long-term and financially expensive, because the prescription will include several far from cheap homeopathic drugs at once.

At the onset of the disease, with an increase in body temperature and fever, the drug Aconite is prescribed. It is indicated for pain that intensifies with inhalation and movement, preventing the patient from resting at night. A dry cough may also be present. Often, the use of Aconite alone removes the symptoms of pericarditis, but sometimes treatment must be continued.

Bryonia is prescribed when dry pericarditis turns into exudative. It is indicated for severe thirst, severe pain in the heart, barking paroxysmal cough, and inability to breathe deeply.

Kali carbonicum is prescribed when Aconite and Bryonia are ineffective or when seeking medical advice is delayed, when the patient is overcome by heart pain, fear of death appears, the pulse becomes weak and irregular, and abdominal distension is noted.

If the fluid in the pericardium accumulates slowly, preference is given to the drug Apis, which is effective for acute heart pain that becomes stronger in warmth, scanty urination, and lack of thirst.

When a certain amount of exudate accumulates in the pericardial cavity, the volume of which has not decreased for several days, but there is practically no pain or temperature, the drug Cantharis is indicated. For it, as for the previous remedy, scanty urination is characteristic.

Cantharis should not be taken in case of severe heart pain or tachycardia.

If the treatment has not yielded the desired result and the disease continues to progress, stronger drugs are prescribed: Colchicum, Arsenicum album, Sulphur, Natrium myriaticum, Lycopodium, Tuberculinum. These drugs help cleanse the body of toxins, mobilize its internal forces, make it possible to reduce the effects of hereditary predisposition, and prevent relapses of the disease.

For the treatment of chronic pericarditis, a homeopathic physician may suggest such drugs as Rhus toxicodendron, Ranucula bulbosa, Asterias tuberose, Calcium fluoricum, Silicea, Aurum.

A treatment plan indicating effective drugs and their dosages is developed by a homeopathic physician individually, based on the symptoms of the disease and the constitutional characteristics of the patient.

Prevention

Prevention of pericarditis consists of preventing pathologies that can be complicated by the accumulation of exudate or non-inflammatory fluid in the pericardium. This primarily involves strengthening the immune system, timely and complete treatment of viral, bacterial, fungal and parasitic pathologies, an active healthy lifestyle that promotes the normalization of metabolism in the body's tissues, and proper balanced nutrition.

Fluid in the pericardium can form for many reasons. Some of them can be prevented, others are beyond our control. But in any case, the preventive measures described above will help maintain health for a long time, and if it was not possible to avoid the development of pericarditis (for example, in case of traumatic pathology or postoperative complications), treatment of the disease with strong immunity will proceed faster and easier, and the probability of relapse will be indecently low.

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Forecast

If we talk about hydropericardium, the prognosis of this disease is generally favorable. It very rarely leads to cardiac tamponade, except in advanced cases, if the fluid in the pericardium has accumulated in critical quantities.

As for other types of pericarditis, everything depends on the cause of the pathology and the timeliness of treatment. The probability of a fatal outcome is high only with cardiac tamponade. But in the absence of proper treatment, acute exudative pericarditis threatens to turn into a chronic or constrictive form, in which the mobility of cardiac structures is impaired.

If the inflammation spreads from the pericardium to the myocardium, there is a high risk of developing atrial fibrillation and tachycardia.

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