Fluid in the pericardial cavity: which means, allowable norms

The heart is our vital motor, the work of which depends on many factors, including biological internal processes. Sometimes the cause of pain and discomfort in the heart is the fluid in the pericardium, which surrounds the heart from all sides. And the cause of malaise is the squeezing of the heart with a liquid or an inflammatory process with localization in the tissues of the myocardium or pericardium.

[1], [2], [3]

Epidemiology

According to statistics, about 45% of all pericarditis have a virusinuyu pirodu, in the treatment of which the increase in immunity (vitamins, immunostimulants) comes to the fore, while bacteria, for the control of which antibiotics are used, cause inflammatory processes in the pericardium of only 15% episodes of the disease. The most rare types of pathology are fungal and parasitic pericarditis.

[4], [5], [6], [7], [8]

Causes of the pericardial fluid

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

The most common cause of congestion in the pericardium of non-inflammatory fluid is the 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 cardiac ventricle,
• heart failure,
• pathology of excretory system, and in particular kidneys,
• a disorder in which there is a direct communication between two pericardial sheets,
• Deficient conditions, such as anemia,
• a state of exhaustion of the body,
• tumor mediastinum, myxedema,
• the disturbance of metabolic processes in the tissues of the body,
• various inflammatory pathologies,
• trauma, accompanied by edema of tissues,
• allergic reactions.

Sometimes the development of hydropericardia can be considered as a consequence of the use of vasodilator drugs (vasodilators) or complication of radiation therapy.

[9], [10]

Risk factors

Risk factors for the development of pathology include pregnancy and advanced age.

The most frequent causes of the inflammatory process in the pericardium ( pericarditis ) are tuberculous and rheumatic organ damage. This is an infectious-allergic reaction, as a result of which a large amount of exudate is formed.

Risk factors in this case can be considered:

• bacterial, viral and fungal diseases: scarlet fever, ARVI, HIV, pneumonia, pleurisy, endocarditis, candidiasis, etc.,
• presence in the body of parasites ( echinococcal infection, toxoplasmosis, etc.),
• allergic pathologies, including food and drug allergies,
• autoimmune diseases ( rheumatoid arthritis, lupus erythematosus, systemic scleroderma, dermatomyositis, etc.)
• autoimmune processes ( rheumatic fever, etc.),
• chronic heart failure,
• inflammatory diseases of the heart membranes ( myocarditis, endocarditis),
• any traumas of the heart (penetrating and non-penetrating),
• cancer and radiation therapy,
• congenital and acquired pathologies of pericardial development (presence of cysts and diverticula in it),
• violation of hemodynamics, edematous syndrome,
• diseases of the endocrine system and metabolic disorders ( obesity of the heart, glucose metabolism and diabetes mellitus, hypothyroidism ).

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

A peculiar trauma to 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 a lot of coincidences in the causes of pericarditis and hydropericardia. The idea is that the second pathology is a kind of noninfectious pericarditis, because congestive phenomena in the pericardium cause any pathological processes in it as inflammatory.

[11], [12], [13], [14], [15], [16], [17], [18]

Pathogenesis

Even from the school course of biology, it is known 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.

Pericardium is also called a pericardial bag, inside which the heart feels comfortable and can work without interruption. There is a pericardial bag of two layers (leaves): visceral or external and parental (internal), which can be displaced relative to each other.

The heart as a moving muscular organ is in constant motion (its walls contract and pump blood as a pump). In such conditions, if there were no pericardium around it, it could shift, which would result in an inflection of blood vessels and a violation of blood circulation.

Moreover, the pericardium protects the heart from dilatation with large loads on the organ. There is an opinion that it is also a protective barrier preventing the penetration of the infection of the heart by inflammation of the internal organs.

But no less important function of the pericardium is the prevention of the friction of a strongly mobile heart about the nearby immobile structures of the chest. And that the heart does not feel friction about the pericardium itself and the surrounding organs between its sheets there is a small amount of fluid.

Thus, the liquid in the pericardium is always, but in the norm its quantity according to different information 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 a pathology. But if with such a quantity of free liquid a slightly yellowish color a person feels healthy and does not have any suspicious symptoms, there is no cause for concern.

Another thing is if the liquid in the pericardium accumulates in moderate and large amounts. It can be either 100-300 ml or 800-900 ml. When the indicator is very high and reaches 1 liter, it is a very life-threatening condition called a cardiac tamponade (squeezing the heart with fluid that accumulates in the pericardial bag).

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

• when the metabolic processes in the pericardial tissues are disturbed, as a result of which the absorption of the transudate decreases,
• addition to the existing fluid is not an inflammatory nature of the inflammatory exudate.

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

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

But inflammation in the pericardium can also have a non-infectious character. This is observed in tumorous processes with metastases to the heart area, with the spread of the process from nearby tissues (for example, in myocarditis), metabolic disturbances in the tissues of the pericardial sac, traumatization of the pericardium (stroke in the heart, injury, crushed injury).

[19], [20], [21], [22]

Symptoms of the pericardial fluid

The clinical picture of pericarditis, in which accumulation of excess fluid in the pericardium is observed, can vary depending on the cause and the amount of the exudate / exudate. Pericarditis does not occur by itself. It acts as a complication of already existing pathologies or injuries in the body, therefore it is not necessary to talk about specific specific symptoms.

Very often the patient generally does not suspect that the liquid accumulates in the pericardium, i.e. Does not think about such a cause of deterioration of health, suspecting cardiovascular pathologies, colds and respiratory system diseases, kidney diseases. It is with these problems that they turn to the therapist, but diagnostic studies show that the symptoms that appear are already late manifestations of diseases, i.e. Their complication.

So, with what complaints can the patient come to the doctor, whose volume of fluid in the pericardium is increased:

• shortness of breath,  both at rest and during exercise,
• discomfort behind the sternum, which is particularly clearly felt when a person leans forward,
• pain in the heart area of  varying intensity associated with pressure on the body, pain can give back, shoulder, cervical, left arm,
• tightness in the chest, pressing pressure,
• violation of breathing,  attacks of suffocation, a sense of lack of air,
• edematic syndrome, which is particularly noticeable on the face, upper and lower extremities,
• decrease in systolic and an increase in venous pressure, swollen veins on the neck,
• symptoms of  tachycardia, arrhythmias,
• An unproductive  barking cough that does not bring relief,
• a hoarse voice,
• increased sweating, especially against tuberculosis,
• an increase in the liver  and pain in the right hypochondrium,
• problems with the passage of food through the esophagus due to squeezing it with an enlarged pericardium,
• frequent  hiccups  as a result of compression of the diaphragmatic nerve,
• pale with blue skin due to circulatory disorders (squeezing the heart with pericardial effusion and exudate leads to a violation of its contractile function),
• loss of appetite and associated weight loss.

It is clear that patients can complain of worsening general condition, weakness, headaches and muscle pains, but only a part of patients feel such symptoms. But the fever caused by the increase in body temperature due to inflammation is present in most cases of treatment to the doctor with a malaise associated with the accumulation of fluid in the pericardium, especially with an infectious lesion. These complaints can be considered as nonspecific  first signs of  inflammation, causing later the pericardial overflow with liquid.

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

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

In acute form, dry (also fibrinous) and exudative pericarditis can occur. In the first case, fibrin sweat out into the pericardial cavity from the serous shell of the heart, which is caused by overfilling with its blood. In this case, only  traces of fluid in the pericardium are found. With exudative pericardial  fluid in the pericardium  is in large quantities.

Pericardial effusion may consist of a semi-fluid exudate in inflammatory processes and hemodynamic disorders, bloody fluid (hemorrhagic pericardium) in wounds, tuberculosis or rupture of an aneurysm, a fluid with an admixture of pus in case of infection.

Exudative pericarditis can proceed for a long time, after 6 months of transition to a chronic form. A small amount of fluid in the pericardium  (80-150 ml) may not cause severe 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 can increase, and the raised level of a liquid in a pericardium will cause unpleasant symptomatology which besides is absolutely unsafe.

If a lot of fluid has accumulated in the pericardium, which starts to squeeze the heart, as a result of which his work is disturbed, they speak of cardiac tamponade. In this case, there is not enough relaxation of the heart chambers, and they do not cope with pumping the required volume of blood. All this leads to the appearance of symptoms of acute heart failure:

• severe weakness, a drop in blood pressure (collapse,  loss of consciousness ),
• hyperhidrosis  (intense release of cold sweat),
• strong pressure and heaviness in the chest,
• rapid pulse,
• severe shortness of breath,
• high venous pressure, manifested by an increase in the jugular vein,
• excessive mental and physical arousal,
• breathing is frequent, but superficial, the inability to take a deep breath,
• the appearance of anxiety, the fear of dying.

Having listened to the patient with a stethoscope, the doctor observes weak and muffled heart tones, the appearance of crunches and noises in the heart (observed in a certain position of the patient's body), which is characteristic of pericarditis, flowing with a cardiac tamponade or without it.

Fluid in the pericardium of children

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

But the  fluid in the pericardium of the fetus  can be formed and as a result of disturbances in the development of the left ventricular tissue of the heart. In this case, in the upper part of the heart from the left ventricle there is a bulging of the walls - diverticulum, which breaks the outflow of pericardial effusion (hydropericardium). The transudate accumulates between the pericardial sheets and after a while can lead to the development of cardiac tamponade.

The pathology of the development of the heart in the fetus and the appearance around it of a large amount of fluid can be detected during the passage of an ultrasound-screened pregnant woman.

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

Recognize the disease in infants is very difficult, especially when it comes to the dry form of pericarditis. Acute pericarditis always begins with an increase in body temperature, which is not a specific symptom, an increase in heart rate and pain, which can be learned from frequent episodes of anxiety and screaming 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 can increase when the body position changes, for example, with inclinations. Often pains are irradiated to the left shoulder, so complaints can sound like this.

Especially dangerous is exudative (effusive) pericarditis, in which the amount of fluid in the pericardium increases rapidly and can reach critical standards with the development of cardiac tamponade. In a nursing child, symptoms of 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 occipital part of the head,
• bulging fontanel.

These symptoms can not be called specific, but they are important for recognizing the disability of a baby who is not yet able to tell about other symptoms of the disease.

The acute stage of effeminate pericarditis in a child of older age proceeds with shortness of breath, blunt pain in the heart, deterioration of the general condition. A child with painful attacks tries to sit down and bend, tilting his head to his chest.

Perhaps the appearance of such symptoms: barking cough, hoarse voice, falling AD, nausea with vomiting, hiccough,  abdominal pain. Characteristic is the appearance of a paradoxical pulse with a decreased filling of the veins at the entrance.

If it is a  tamponade of the heart, then there is an increase in shortness of breath, a feeling of lack of air and fear, the skin of the child becomes very pale, they appear cold sweat. In this case, there is increased psychomotor excitability. Unless urgent measures are taken, a child may die from acute heart failure.

Chronic exudate pericarditis of any etiology in a child is characterized by worsening of the general condition and constant weakness. The child quickly gets tired, he has shortness of breath and chest discomfort, especially during movement, exercise, sports.

[23], [24], [25]

Complications and consequences

Stagnant phenomena in the area of the pericardial sac and inflammatory processes in it, accompanied by an increase in the volume of fluid in the pericardium, can not pass without a trace, appearing only in worsening the general condition of the patient, the appearance of dyspnea and pain behind the sternum.

First, by increasing in volume, the liquid presses more and more on the heart, hindering its work. And since the heart is the organ responsible for the blood supply of the whole organism, failures in its work are fraught with circulatory disorders. Blood in turn is considered the main source of nutrition of cells, it also supplies them with oxygen. Violated blood circulation, and various human organs begin to suffer from hunger, their functionality is violated, which leads to the emergence of other symptoms, for example, manifestations of intoxication, significantly reducing the quality of life.

Secondly, the accumulation of inflammatory exudates is fraught with the development of cicatricial-adhesive process. It may suffer not so much the pericardium itself due to the overgrowth of the fibrous tissue and the compaction of its sheets by the accumulation of calcium, how much the heart that can not provide enough filling of the chambers with blood during diastole. As a result, the development of venous stasis, which causes an increased risk of thrombus formation.

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

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

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

[26], [27], [28], [29], [30], [31], [32]

Diagnostics of the pericardial fluid

The fluid in the pericardium is not considered a pathological condition if its amount does not exceed the generally recognized norms. But as soon as the amount of effusion becomes so great that it begins to cause symptoms of heart failure and other nearby organs, you can not delay.

Since the symptoms of pericarditis can resemble a variety of diseases, patients seek advice from a therapist who, after a physical examination, studying an anamnesis and listening to the patient, directs him to see a cardiologist. Symptoms that patients will say will not say much about the true cause of the ailment, but they can push the doctor in the right direction, since most of them still indicate problems with the heart.

Confirm the conjecture will help percussion and listening to the heart. A tapping will show an increase in the boundaries of the heart, and listening is a weak and dull heartbeat, which indicates the limited movement of the heart structures due to its squeezing.

Conducting laboratory tests of blood and urine will help evaluate the nature of existing health problems, determine the cause and type of pericarditis, and assess the intensity of inflammation. To this end, the following tests are prescribed  : clinical and immunological analysis of blood, 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 the violation of the heart. This problem is solved by instrumental diagnostics, many methods of which allow to assess the situation in the smallest detail.

The main method that allows to determine not only the fact of the presence of fluid in the pericardium, but also its level, is considered an echocardiogram (echocardiogram). Such a study makes it possible to detect even a minimal amount of transudate (from 15 ml), to clarify the changes in the motor activity of cardiac structures, thickening of the layers of the pericardial sac, adhesions in the heart and its fusion with other organs.

[33], [34], [35]

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 the echocardiography shows a discrepancy of up to 10 mm, this refers to the initial stage of pericarditis, 10 to 20 mm is a moderate stage, more than 20 is severe.

When determining the quantitative characteristics of a liquid in a pericardium about an insignificant volume, say, if it does not exceed 100 ml, up to half a liter the volume is considered moderate, over 0.5 liters - large. With a large accumulation of exudates, it is mandatory to perform a puncture of the pericardium, which is performed under the control of echocardiography. Some of the pumped liquid is given for microbiological and cytological testing, which helps to determine its character (the transudate has a lower density and a small amount of protein), the presence of an infectious agent, pus, blood, and malignant cells.

If the fluid in the pericardium is found in the fetus, the puncture is performed without waiting until the baby is born. This complicated procedure should be carried out strictly under the supervision of ultrasound, because the risk of injury to the mother or her unborn child is great. However, there are cases when the fluid in the pericardial cavity spontaneously disappears, and puncture is not required.

Some information about the pathology can give and electrocardiogram (ECG), because exudative and chronic pericarditis reduces the electrical activity of the myocardium. Phonocardiography can provide information on heart murmurs not associated with its functioning, and high frequency oscillations that indicate the accumulation of fluid in the pericardium.

Exudative pericarditis and hydropericardium with a fluid volume of more than 250 ml is also determined on the roentgenogram for increasing the size and changing the silhouette of the heart, an indistinct definition of its shadow. Changes in the pericardium can be seen when performing ultrasound, computer or magnetic resonance imaging of the chest.

[36], [37], [38], [39], [40]

Differential diagnosis

Since the fluid in the pericardium appears not accidentally, and its appearance is associated with certain pathologies, a major role is assigned to differential diagnosis, which allows to identify the cause of intensive pericardial effusion. Acute pericarditis in its symptoms may resemble acute myocardial infarction or acute myocarditis. It is very important to differentiate these pathologies from each other so that the medication prescribed for diagnosis is effective.

[41], [42]

Treatment of the pericardial fluid

As we already know, there is always a liquid in the pericardium, and a slight increase in its level is unlikely to affect the patient's health. To detect such changes the doctor can accidentally, after which he wants to watch the patient for some time. If the amount of fluid increases, but remains insignificant, you need to find out the cause, leading to accumulation of effusion. Treatment in the first place will 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. This should help to avoid cardiac tamponade. Light forms of pathology with a moderate amount of transudate or exudate are treated on an outpatient basis.

Since pericarditis is an inflammatory process, in order to decrease the secretion of exudate, it is necessary first of all to stop the inflammation. In most cases, it can be done with non-hormonal anti-inflammatory drugs (NSAIDs). Among them, the most popular drug is Ibuprofen, which helps to remove heat and inflammation, positively affects the blood flow and is well tolerated by most patients.

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

If the NSAID does not give the desired result or is impossible for some reasons, anti-inflammatory therapy is performed using steroid drugs (most often Prednisolone).

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

Along with the solution of the problem of inflammation and fluid in the pericardium, the main disease is treated. If it is an infection, then systemic antibiotic therapy is mandatory. Prescribe antibiotics penicillin and cephalosporin series, with severe purulent infections give preference to fluoroquinolones. In connection with the resistance of many strains of pathogens to the action of habitual antibiotics, new types of antimicrobials are increasingly used in therapy, the sensitivity to which is manifested by most bacteria (Vancomycin is one such drug).

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

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

With an acute pericardium, strict bed rest and light food are shown. If the disease has a chronic course, the restriction of physical activity and the diet is prescribed when it is aggravated.

When generalizing the inflammatory process, hemodialysis is indicated. With a large volume of fluid in the pericardium, its puncture (paracentesis) is performed, which is the only way to safely nonsurgical evacuation of excess fluid. Puncture can be prescribed with cardiac tamponade, a purulent form of pericardial inflammation, and also if a 2-3-week conservative treatment does not lead to a decrease in fluid between the pericardial sheets. If pus is found in the exudate, the pericardial cavity is drained with antibiotics.

In some cases, the puncture has to be done more than once. If the inflammation can not be suppressed and the fluid in the pericardium continues to accumulate, despite multiple punctures, surgical treatment is prescribed - pericardectomy.

Physiotherapeutic treatment for exudate pericarditis is not carried out, because it can only exacerbate the situation. In the rehabilitation period, exercise therapy and therapeutic massage are possible.

During the entire course of treatment of the acute form of pathology, the patient should be under the supervision of the medical staff. He is regularly measured by arterial and venous pressure, and heart rate (pulse) is 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 you to independently monitor your condition.

Medications for pericarditis

Treatment of hydropericardium, when non-inflammatory fluid accumulates in the pericardium, often does not require special treatment. It is only necessary to remove the provoking factors, and the amount of fluid comes back to normal. Sometimes the disease disappears spontaneously without treatment. In other cases, anti-edema drugs ("Spironolactone", "Furosemide", etc.) help.

Furosemide

A fast-acting diuretic, often prescribed for oedematous syndrome associated with cardiovascular pathologies. It has no burden on the kidneys, which allows it to be used even with kidney failure. In addition to diuretic effect promotes the expansion of peripheral blood vessels, which makes it possible not only to remove swelling, but also to reduce high blood pressure.

The drug can be prescribed as a pill (40 mg every morning or every other day) or as an injection. The maximum allowable daily dose of the drug in tablets is 320 mg. In this case, the medicine should be taken twice a day. The interval between tablets should be 6 hours.

Injectable solution of furosemide can be administered intramuscularly or intravenously (as a slow infusion). This practice is resorted to with severe swelling and the risk of cardiac tamponade. As soon as edema decreases, they switch to oral administration of the medicine. Now the drug is administered 1 time in 2-3 days. The daily dosage of the drug for injection may range from 20 to 120 mg. Multiplicity of administration - 1-2 times a day.

Injection therapy with the drug is carried out for not more than 10 days, after which the patient begins to give the pill before stabilizing the condition.

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

It is forbidden to apply the drug and with potassium deficiency in the body (hypokalemia), hepatic coma, critical stage of kidney failure, obstruction of the urinary tract (stenosis, urolithiasis, etc.).

Reception of the drug can cause the following unpleasant symptoms: nausea, diarrhea, falling AD, temporary hearing loss, inflammation of the connective tissue of the kidneys. Loss of fluid will be affected by thirst, dizziness, muscle weakness, depression.

Diuretic effect can be accompanied by the following changes in the body: a decrease in the level of potassium, an increase in the blood urea (hyperuricemia), an increase in glucose in the blood (hyperglycemia), etc.

If it is an inflammatory process in the pericardium, as a result of which a large amount of exudate is collected between the sheets of the amniotic sac, anti-edematous and antihistamine therapy is supplemented with anti-inflammatory (NSAID or corticosteroids).

Ibuprofen

Nonsteroidal anti-inflammatory and antirheumatic drug that helps to reduce fever and fever (lowering of temperature), reduces swelling and inflammation, relieves pain of mild and moderate intensity. Sometimes these effects are sufficient to treat non-infectious nature of pericarditis.

The preparation is released in the form of tablets in a shell and capsules intended for oral administration. Take medication after meals to reduce the irritating effect of NSAIDs on the gastric mucosa.

Assign the drug Ibuprofen in an amount of 1-3 tablets per 1 reception. Multiplicity of medication is prescribed by a doctor and is usually 3-5 times a day. For children under 12, the dose is calculated as 20 mg per 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 medication for adults - 8 tablets of 300 mg, for children over 12 years - 3 tablets.

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

Children are allowed to give pills from the age of 6, pregnant women - up to the third trimester of pregnancy. The possibilities of using the drug during breastfeeding are discussed with the doctor.

Caution should be observed with an increased level of bilirubin, liver and kidney deficiency, blood diseases of an undetermined nature, inflammatory pathologies of the digestive system.

The drug is transferred by most patients well. Side effects occur rarely. Usually they are manifested in the form of nausea, vomiting, the appearance of heartburn, discomfort in the epigastric region, dyspeptic phenomena, headaches and dizziness. There are also reports of infrequent allergic reactions, especially against the background of intolerance to NSAIDs and acetylsalicylic acid.

Significantly less often (in isolated cases) there is a decrease in hearing, the appearance of noise in the ears, edema, increased blood pressure (usually in patients with hypertension), sleep disorders, hyperhidrosis, edema, etc.

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

Prednisolone

Anti-inflammatory hormonal drug, which in parallel antihistamine, antitoxic and immunosuppressive actions, which contribute to a rapid decrease in the intensity of inflammatory symptoms and pain. Promotes increased blood glucose 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 perrural admission, as well as for injection (intramuscular, intravenous, intraarticular injections).

The effective dosage of the medicine 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 - 50 mg, for babies - 25 mg. In severe emergency conditions, these doses may be slightly higher, the drug is administered intravenously slowly or infusion (less intramuscularly).

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

The drug is designed to treat patients older than 6 years. The drug is not prescribed for hypersensitivity to it, infectious and parasitic diseases, incl. Active stage of tuberculosis and HIV infection, certain gastrointestinal diseases, hypertension, dodecompensated CHF or diabetes mellitus, disorders of thyroid hormone production, and Isenko-Cushing's disease. It is dangerous to administer the medication for severe liver and kidney pathologies, osteoporosis, x muscle system diseases with a decrease in their tone, active mental illness, obesity, poliomyelitis, epilepsy, degenerative vision pathologies (cataracts, glaucoma).

Do not use the drug in the postvaccination period. It is possible to treat prednisolone 2 weeks after vaccination. If a vaccine is subsequently required, this can only be done 8 weeks after corticosteroid treatment.

Contraindication to the drug is the recently transferred myocardial infarction.

With regard to side effects, they occur mainly with long-term treatment with the drug. But doctors usually try to minimize the course of treatment until there are various complications.

The fact is that prednisolone is able to wash calcium out of bones and interfere with its digestibility, and as a consequence the development of osteoporosis. In childhood this can be manifested by a slowing of growth and weakness of bones. Also, long-term admission may show muscle weakness, various cardiovascular disorders, increased intraocular pressure, damage to the optic nerve, insufficiency of the adrenal cortex, can cause seizures. The steroid stimulates the production of hydrochloric acid, as a result of which the acidity of the stomach may increase with the appearance of inflammation and ulcers on the mucosa.

With parenteral administration, prednisolone solution is by no means mixed in one syringe with other medicines.

If pericarditis has an infectious nature, more precisely its cause is a bacterial infection, prescribe effective antibiotics.

Vancomycin

One of the innovative drugs from a new group of antibiotics - glycopeptides. Its feature is the lack 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 causative agent to penicillins and cephalosporins, which are customarily prescribed for bacterial pericarditis.

The drug Vancomycin in the form of lyophilate, which is subsequently diluted to the required concentration with saline solution or a 5% solution of glucose, is administered mainly as a dropper. A slow introduction is recommended within an hour. Usually, the concentration of the solution is calculated as 5 mg per milliliter, but since with edematous syndrome and a large amount of exudate in the pericardium, it is recommended to restrict the introduction of the liquid into the body, the concentration of the solution can be doubled. The rate of drug administration 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.

Children up to 1 week of 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. Children do not change the dose for a month, but the interval between administrations is reduced to 8 hours.

Older children are given medication 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 digestive tract. But if necessary, the drug is administered orally, diluting the lyophilate from the vial with 30 grams of water.

In this form, the medicine is taken 3-4 times a day. The daily dose should not be above 2 grams. A single dose 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.

Contraindications for the drug is very small. It is not prescribed for individual sensitivity to the antibiotic and in the first trimester of pregnancy. Beginning from the 4th month of pregnancy, the drug is prescribed according to strict indications. From breastfeeding for the period of treatment, "Vancomycin" should be abandoned.

With the slow administration of the drug for an hour, side effects usually do not develop. The rapid administration of the drug is fraught with the development of dangerous conditions: heart failure, anaphylactic reactions, collapse. Sometimes there are reactions from the GI tract, tinnitus, temporary or irreversible hearing impairment, syncope, paresthesia, changes in blood composition, muscle spasms, chills, etc. The appearance of unwanted symptoms is associated with long-term treatment or the administration of large doses of the drug.

The choice of drugs with the accumulation of fluid 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, the accompanying pathologies.

Alternative treatment

I must say that the choice of alternative recipes, effective in pericardial, is not so great. It has long been proven that it is impossible to cure cardiac pathologies with herbs alone and conspiracies, especially when it comes to the infectious nature of the disease. But with swelling and inflammation, alternative drugs can help you figure it out.

The most popular prescription for pericardial is the infusion of young needles, which is credited with a sedative and antimicrobial effect. This recipe effectively removes inflammation in the pericardium and thereby reduces the volume of fluid in it. This is an excellent harm for the treatment of inflammation of the viral etiology. It can be used for bacterial exudative pericarditis, but only as an adjunct to antibiotic treatment.

For infusion we take shredded needles of any coniferous trees in an amount of 5 tablespoons, fill them with ½ liter of boiling water and let stand on low heat for 10 minutes. We remove the composition from the fire and put it in a warm place for 8 hours. Stretching the "medicine", we take it after eating 100 grams 4 times a day. It gives strength to the body to fight the disease on its own.

You can try to make a nut tincture. 15 pcs. Shredded walnuts pour a bottle (0.5 liters) of vodka and insist 2 weeks. Ready tincture take 1 dessert spoon (1.5 teaspoons) after breakfast and dinner. Tincture before use should be diluted in 1 glass of water.

Good help to remove the symptoms of herbal diseases, including herbs with a diuretic, sedative, anti-inflammatory and strengthening effect. For example, the collection of flowers of lime, hawthorn and marigold, dill seeds, oat straw. A teaspoon of the collection is filled with a glass of boiling water and we insist in the heat for 3 hours. Finished medicine for a day, divided into 4 divided doses. Take infusion is necessary for half an hour before meals.

Or another collection, including the flowers of hawthorn and chamomile, as well as herbage of motherwort and cucumber. We take 1.5 tablespoons. Collecting them with 1.5 cups of boiling water and leave in a warm place for 7-8 hours. Filtered infusion take half a cup three times a day after an hour after eating.

Treatment with herbs in such dangerous and severe pathologies as inflammation of the pericardium or heart membranes, can not be perceived as the main method of treatment, especially in the acute stage of the disease. Recipes of alternative medicine is recommended to be used when the main symptoms of the disease somewhat subside. They will also help to prevent heart disease, as well as to strengthen immunity.

[43], [44], [45], [46]

Homeopathy

It would seem that if the alternative treatment with pericarditis, for which the characteristic symptom is a pericardial fluid in the amount of 100 ml or more, is not so effective, how can homeopathy change the situation, because its preparations also contain only natural components that are not considered strong medicines? But some homeopathic doctors say that it is possible to cure pericarditis using homeopathic remedies. True, such treatment will be long and financially costly, because in the appointment there will be a cut of several far from inexpensive homeopathic medicines.

At the beginning of the disease with increasing body temperature and fever prescribed drug Aconite. It is indicated for pains that are worse when inhaled and moving, do not allow the patient to rest at night. There may also be a dry cough. Often, the use of a single Aconite removes the symptoms of the pericardium, but sometimes the treatment has to continue.

Bryony is prescribed in the case when dry pericarditis passes into the exudative. It is indicated with a pronounced thirst, severe pain in the heart, barking of a paroxysmal cough, inability to breathe deeply.

Kali carbionicum is prescribed if Akonita and Brionia are ineffective or when the doctor goes belatedly, when the patient contracts from pains in the heart, the fear of death appears, the pulse becomes weak and irregular, bloating is noted.

If the fluid in the pericardium accumulates slowly, preference is given to the Apis preparation, which is effective in acute pain heart pain, which becomes stronger in heat, poor urination, and lack of thirst.

With the accumulation of a certain amount of exudate in the pericardial cavity, the volume of which has not decreased for several days already, but there is practically no pain and temperature, the preparation Kantaris is shown. For him, as for the previous remedy, a poor urination is characteristic.

Cantharis can not be taken with severe pain in the heart and tachycardia.

If the treatment does not produce the desired result and the disease continues to progress, more powerful drugs are prescribed: Colchicum, Arsenicum Albumum, Sulfur, Natrium myriaticum, Lycopodium, Tuberculinum. These drugs help to cleanse the body of toxins, mobilize its internal forces, make it possible to reduce the consequences of hereditary predisposition, prevent recurrence of the disease.

For the treatment of chronic pericarditis, the homeopathic doctor can offer such drugs as Rus toxicodendron, Ranukuluz bulbozes, Asterias tuberose, Calcium fluoride, Silicea, Aurum.

The treatment plan with the indication of effective drugs and their dosages is developed by a homoeopath physician individually, based on the symptoms of the disease and the constitutional characteristics of the patient.

Prevention

Prevention of pericarditis is to prevent pathologies, a complication of which may be a buildup of exudate or non-inflammatory fluid in the pericardium. This is primarily the strengthening of immunity, timely and complete treatment of viral, bacterial, fungal and parasitic pathologies, an active healthy lifestyle, which facilitates the normalization of metabolism in the tissues of the body, a balanced diet.

The fluid in the pericardium can be formed for many reasons. Some of them can be warned, others do not depend on us. But in any case, the preventive measures described above will help to maintain health for a long time, and if pericarditis can not be avoided (for example, in the pathology of a traumatic plan or postoperative complications), treatment of the disease with strong immunity will proceed faster and easier, and the probability of relapses will indecently be low.

[47], [48], [49], [50], [51]

Forecast

If we talk about hydropericardia, the prognosis of this disease is generally favorable. It very rarely leads to cardiac tamponade, except in neglected cases, if the liquid in the pericardium gathered in critical quantities.

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

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

[52], [53]