Myocardial damage syndrome

Under the syndrome of pericardial lesions is usually understood an inflammatory process in the area of the pericardium, which is accompanied by an intense accumulation of liquid contents. This may be transudate, blood, any exudate or infiltrate.

There may be many reasons for the occurrence of such a condition. First of all, it is worth noting the role of infectious agents in the development of pathology. Any infection, whether bacterial, viral infection, or parasitic invasion, can provoke the development of cardiac pathology when penetrating into the heart cavity. Rather dangerous is considered a rheumatic lesion of the pericardium, which develops as a consequence of rheumatoid and autoimmune processes occurring in the human body. Often such a condition develops against the background of a sharp immunodeficiency, violation of the functional state of the immune system and nonspecific defense of the body. Tuberculosis can cause a serious lesion of the pericardium. Rickettsia, protozoa, prions, which are intracellular parasites, can lead to the development of the syndrome in question.

As aseptic lesions of the pericardium are considered various inflammatory processes that are not accompanied by bacterial and viral infection. In this case, we are talking about diseases of allergic, rheumatoid nature. Such conditions can develop against the background of diseases of the circulatory system, after heart attacks, with significant violations of metabolic processes in the body. The cause may be injuries and wounds of the pericardium. Attention is drawn to the fact that the syndrome of pericardial lesions can develop under the influence of certain drugs, for example, antituberculosis drugs, drugs for the treatment of uremia, gout. Glucocorticoids, other hormones, and vitamin C deficiency also negatively affect the pericardium.

Idiopathic pericarditis, the origin of which remains unknown, can be distinguished in a separate category.

Speaking of the pericardial lesion syndrome, it can be noted that it most often occurs in two forms: dry or exudative pericarditis. The dry form is also called fibrinous, because it is associated with the process of deposition of fibrin threads on the pericardial sheets. Accordingly, the pericardium seems to acquire a "hair cover". A large amount of fluid in dry pericarditis is not observed (whence the name, dry pericarditis). As the main clinical manifestations of this condition can be called pain in the heart area of different localization and intensity. At the same time, the pain is not controlled with nitroglycerin. As accompanying symptoms can be distinguished hiccups, nausea, vomiting, appetite disorders. Body temperature may rise (up to subfebrile indicators). There is a significant increase in sweating. As a leading symptom, by means of which it is possible to recognize this condition, there is a pericardial friction murmur. There are marked changes in ECG parameters, which last at least 10-15 days. Thickening of the pericardial sheets is noteworthy.

In the exudative (effusion) syndrome of pericardial lesions, there is an intense accumulation of fluid in the pericardial area. In this case, the cardiac cortex is significantly stretched, thus disrupting the process of stretching the heart during diastole. Vein compression occurs.

The main symptoms are constant shortness of breath. The patient does not adopt a natural forced body position to alleviate the condition. The position can be extremely strange, up to the fact that the patient kneels down and presses his face to the ground (pillow). This allows you to relieve the condition, reduce the load on the heart, provide some outflow of fluid. It is also worth noting that often against the background of the pericardial lesion syndrome, pain develops in the liver region, and also edema appears. Such edema is known as Stokes collar, in which the neck, face swells, veins swell. In more severe cases, edema develops in the legs. The sternum in the heart area acquires unusual shapes, becomes convex. The area of cardiac bluntness expands. On auscultation, the tones become deaf, signs of arrhythmia develop, there is a noise of friction of the pericardium. Pulse and blood pressure sharply decreases. On the radiograph, the shadow in the area of the heart increases. Hydrothorax may develop.

Pericardial effusion

pericardial effusion refers to the pathological process of accumulation of excessive amounts of fluid in the pericardium. The effusion is also called exudate, its accumulation in the cavity is accompanied by the development of the inflammatory process. There is sweating of the pericardium, through the sheets. In the process of developing inflammation and accumulation of fluid in the pericardium of the heart, there is an intense release of biologically active components, mediators that cause and support the inflammatory process. This contributes to the attraction of blood cells to the focus of inflammation. Gradually, the fluid is released through the capillaries. If we talk about norms, then it can be noted that with the pericardial cavity is allowed the presence of a small amount of fluid (no more than 50 ml). This amount of fluid is necessary for the heart to maintain its normal functioning. In particular, the fluid provides free movement of pericardial sheets and reduces friction between them, which significantly reduces the load on the heart and prevents its wear and tear, mechanical damage. If the amount of fluid exceeds physiological parameters, the process becomes pathological. Increased load on the heart is created, congestion and edema develop.

With microscopic and histological examination of the fluid accumulated in the pericardium of the heart, it is possible to note the fact that it has a relatively low density, the indicators of which vary from 1200 to 1800. The presence of individual cellular elements is also noted. The exudate contains quite a lot of protein, individual amino acids. Conditionally, it is possible to distinguish moderate and high fluid content in the pericardium, which are associated, respectively, with a state of medium severity and a severe course of the pathological process. In the first case, minor pain, shortness of breath are noted. In general, the condition can be called as satisfactory. With a severe condition, however, severe pain in the heart area develops, weakness appears, severe dyspnea. Moderate amount of effusion - up to 500 ml. Under the severe condition is understood the accumulation of fluid in the amount of up to 2000 ml. And more. In this condition, the condition may deteriorate sharply, there may be attacks with a sharp drop in pulse and blood pressure, up to loss of consciousness and coma. A person can become completely immobile, which only aggravates the situation, since edema, fluid stagnation, blood circulation and trophic processes are intensely developed. In fact, the condition in which the volume of fluid in the heart is within 2000 ml or more is a critical condition representing cardiac tamponade.

Pericardial tamponade

Under pericardial tamponade is understood a pathological condition accompanied by an increased content of fluid in the pericardial cavity. In this case, the indicators are extremely high - 2000 ml or more. This is an extremely severe, critical condition, which is characterized by severe congestion, circulatory dysfunction, edema, up to a drop in pulse and blood pressure, loss of consciousness. Such a condition lasts for quite a long time - up to 6 weeks, and more. It all depends on the form. As a rule, the acute form passes in 5-7 weeks, while the subacute form can last from 2 to 6 months. In this case, there is a wavy course with alternating states of remission and exacerbation.

Associated symptoms are rapid breathing, pain, fever, and decreased blood pressure. The fluid may put pressure on the mediastinal organs, resulting in a severe cough and possible pain when swallowing. In severe cases, swallowing, and even breathing is difficult. Especially worsens the condition if a person is standing for a long time. Often a person experiences and the corresponding reactions from the nervous system: hypersensitivity and irritability, insomnia, cramps, because there is irritation of nearby nerves. This condition is dangerous because dense adhesions can form, mineralization of tissue can occur, which prevents normal contraction of the heart muscle.

Blood in the pericardium

Appearance of blood in the pericardium is a rather unfavorable sign, which is most often manifested in traumatic damage to the pericardium, as well as in disorders of hematopoietic function, in the development of bleeding, on the background of hemophilia. Sometimes blood in the pericardium accompanies hemorrhagic pericarditis. The accumulation of blood in the pericardium significantly disrupts the normal functioning of the heart muscle, leads to a violation of trophics, metabolic processes, blood supply of the pericardium itself. In the future, the condition may worsen, up to the development of necrosis, tissue appoptosis.

Diagnosing blood in the pericardium is quite simple. Often with such a condition, the patient feels bad and seeks help himself. Often the patient needs emergency care, resuscitation measures, because with a sharp accumulation of blood, the pulse rate and blood pressure may drop sharply, up to shock, coma, loss of consciousness.

Often the patient will need to consult a thoracic surgeon as emergency surgery may be required. If the patient's condition is tolerable and does not require emergency treatment, a cardiologist should be consulted. Often the symptomatology is similar to that of pulmonologic diseases, so patients often first turn to a pulmonologist. It should be noted that consultation with a pulmonologist may also be required to exclude a number of pathologies of the thoracic cavity, including rupture of the lung, thorax, pleura, in which there is an effusion of blood into the pericardial cavity.

At percussion, weakened respiration is often heard, the sound is dulled, vascular noises, various additional sounds and noises are noted. As the main symptom may be tachycardia, however, this is not a specific symptom, it is impossible to make a diagnosis by it. There are some patients who, on the contrary, have bradycardia and a sharp drop in pulse and blood pressure. The ECG almost always reveals specific changes. As the first and obligatory methods of research are chest X-ray, cardiac fluoroscopy, contrasting cavities. If these methods do not provide enough information, there is a need for CT or MRI. In case of a large volume of accumulated blood, puncture and drainage of the pericardial cavity may be required.