Serous pericarditis

Inflammation of the fibrous sac surrounding the heart (pericardium), in which the predominant sign is the formation and accumulation of serous exudate (effusion) - serous fluid in it, is diagnosed as serous pericarditis.

Epidemiology

According to clinical statistics, the prevalence of serous pericarditis in patients with systemic lupus erythematosus is estimated to be 22-26%, in rheumatoid heart disease, on average, 18%, and in the case of oncology, about 23%.

Causes of the serous pericarditis

Serous inflammation of the pericardium is referred to the exudative (effusion) form of pathology, because there is a significant excess of pericardial fluid production compared to its back absorption - with the formation of serous or serous-fibrinous effusion in the pericardial cavity. It is the composition of the effusion that defines the main types as simply serous and serous-fibrinous pericarditis, which represent the same basic process and are the most frequent type of this condition. [1]

Usually serous pericarditis is not associated with infectious inflammation, e.g. It develops in rheumatoid arthritis, which can affect the cardiovascular system with the development of rheumocarditis or rheumatoid heart disease.

Also causes of pericardial serous inflammation include systemic lupus erythematosus (SLE), [2] myocardial infarction, [3] cardiac trauma or cardiac surgery - as an immune system response in the form of postcardiotomy syndrome or Dressler syndrome. [4] In addition, such inflammation of the pericardial sac may be associated with renal failure and excessive nitrogen levels in the blood (azotemia), with malignant neoplasms in the thorax and mediastinum and their radiation therapy.

But there is also serous-purulent pericarditis - with the presence in the pericardial sac of an effusion with pus. And this is already infectious pericarditis, the causes of which may be:

• TB - with exudative tuberculous pericarditis;
• Infective endocarditis;
• Generalized sepsis in case of systemic inflammatory response syndrome.

The most common bacterial agents of inflammation are streptococci and staphylococci, and among viruses are RNA enteroviruses Coxsackie viruses.

Also read: Pericarditis: general information

Risk factors

Serous and serous-fibrinous pericarditis develop as a result of the already mentioned diseases and pathological conditions, and their presence in the history is a risk factor for inflammation of the pericardial sac with the formation of effusion into its cavity. [5]

Pathogenesis

In the absence of inflammation, the volume of fluid in the pericardial cavity does not exceed 50 ml, is filtered blood plasma in composition, and is necessary to reduce friction between the moving heart and adjacent tissues. For more details see. - Fluid in the pericardial cavity

In case of serous pericarditis, the amount of this fluid increases with the formation of exudative pericardial effusion. Specialists explain the pathogenesis of this process by the development of immune system reaction with characteristic activation of inflammatory mediators, in response to the action of which the permeability of the walls of the smallest vessels supplying blood to the pericardial tissues increases, leading to exudation (from Latin exsudare - to excrete, sweat).

Serous exudate may also be produced by mesothelial cells of the inner serous layer of the pericardium (pericardium serosum).

More information in the article - Exudative pericarditis

Symptoms of the serous pericarditis

If the formation of effusion into the cavity of the pericardial sac occurs slowly, there may be no noticeable signs of the pathological process. But when the volume of pericardial effusion increases, symptoms such as:

• shortness of breath;
• discomfort when breathing in the supine position;
• cough;
• dizziness, weakness, a feeling of heaviness in the chest;
• palpitations;
• chest pain of varying intensity - behind the sternum or on the left side;
• swelling of the abdomen or lower extremities.

In rheumatoid arthritis, body temperature usually rises. And in postinfarction syndrome (usually occurring 10-30 days after a heart attack)

Serous pericarditis may be accompanied by fever, a friction noise on auscultation, pleurisy and pleural effusion.

Complications and consequences

Serous and serous-fibrinous pericarditis, especially recurrent pericarditis, can lead to a complication in the form of scarring of the space between the two layers of the pericardial sac, which restricts the movement of the heart during each contraction.

As a result of the involvement of the heart muscle in the inflammatory process, atrial fibrillation develops.

In patients with rheumatic heart disease, the consequences of pericarditis include the occurrence of focal calcium deposits in the pericardium.

In addition, rapid fluid buildup in the pericardium can cause tamponade of the heart - its compression, often requiring surgical opening of the pericardium to remove excess fluid. [6]

Diagnostics of the serous pericarditis

How serous pericarditis is diagnosed - what tests are necessary, what instrumental diagnostics includes, and what diseases should be excluded by differential diagnostics - is detailed in the publication Diagnosis of pericarditis.

Treatment of the serous pericarditis

Serous pericarditis often resolves on its own, and nonsteroidal anti-inflammatory drugs remain first-line treatment.

All details in the material - Treatment of pericarditis

Prevention

The essence of prevention of serous inflammation of the pericardium is reduced to the timely detection and treatment of etiologically related diseases (infectious and non-infectious) and pathological conditions.

Forecast

The prognosis of the outcome of serous pericarditis is complicated not only by the possibility of its recurrence (in 15-32% of cases) and persistent chronicization of inflammation, but also by the threat of lethal cardiac tamponade.