A péricardite is a Inflammation Péricarde.

One distinguishes it from épanchement péricarditique, who corresponds to the presence of liquid in the pericardium, without obligatorily of ignition. These two entities remain however very close.

Diagnosis

Private clinic

Typically, the péricardite appears by a thoracic Douleur:

• prolonged;
• median, or lateralized on the left;
• increased with the inspiration, making difficult the latter;
• much more important when the patient is on the back (décubitus dorsal), relatively calmed in sitting position.

The most constant characters are the prolonged duration and increase with breathing.

In an inconstant way, it can also exist:

• a Fever;
• a current or recent viral syndrome (muscular Cold, Angina, pains…).

The examination of the patient can show in an inconstant way:

• a pericardial friction with the cardiac Sounding: it is about a noise perceived at the time of the Systole and the Diastole, evoking a " sheet of paper froissée" or a " friction of old man cuir".

It will be systematically required signs being able to evoke a form engraves (known as " compliquée") :

• a fall of the blood Pressure, to see cardiovascular collapse;
• the presence of edema S of the lower extremities taking typically the mark of the finger (sign of the cup) when one supports (" above; edema hémodynamique") ;
• a large Liver (Hepatomegaly) painful (hépatalgie);
• of the jugular veins particularly apparent on the level of the neck (jugular turgescence).

Complementary examinations

ECG is primarily made in order to eliminate a Myocardial infarction, other causes thoracic pains prolonged. It can be normal or present anomalies of the diffuse segment ST.

The echocardiography can find a dark edging around the Cœur, more or less thick edging, signing the presence of liquid in the Péricarde, and thus, the diagnosis of péricardite. If this separation pericarditic is visualized, one can appreciate volume and the repercussion of it on the cardiac cavities (primarily right) in the search of a severe form. Frequently, the examination is strictly normal, which does not eliminate however the diagnosis.

Cardiac IRM is more sensitive than echography, it shows and locates an ignition in hypersignal pericardium. It is not however necessary in the event of péricardite banal.

The biological examinations show a inflammatory Syndrome more or less important with an increase in CRP, Sedimentation test or white globules (Hyperleucocytose).

The thoracic Radiographie is abnormal only if there exists épanchement abundant. It then shows an increase in size of the cardiac silhouette ( cardiomégalie ) symmetrical with an aspect in " théière" or in " carafe".

Causes

In nearly eight case out of ten, the cause is viral and the evolution is simple. Subject to the absence of point of call, it is useless to then launch an exhaustive investigation into the cause.

In theory, one distinguishes the infectious causes and not-infectious :

Infectious Péricardite

• viral Infection with the one of the Coxsackie has virus, Adénovirus, Echovirus etc a péricardite can be also seen at the patient carrying HIV.

• much more rarely a bacterial Infection (mycobacteries (Tuberculosis, infection within the framework of a Septicaemia) can cause a péricardite.
• seldom can be responsible a Mycose (Candida, Aspergillus).

Not-infectious Péricardite

• a Myocardial infarction can cause a péricardite ( Epicarditis epistenocardica ), as of the beginning, or several weeks afterwards. In the first case, she testifies to the attack all thickness of the wall ( necroses trans-mural ) and can (seldom) be evocative of a risk of rupture of the heart. In the second case, it is about a reactional inflammatory phenomenon, nonpejorative ( syndrome of Dressler ).

• majority of the autoimmune diseases systemic (Lupus erythematosus, Polyarthritis rhumatoïde, Sarcoidosis…) can become complicated of a péricardite.
• It can see in the event of allergic Réaction (serum Maladie, Allergie Médicament euse).

Pericarditic Epanchement

He sees himself:

• in the event of chronic Impaired renal function;
• after a traumatism of the chest ( hémopéricarde where épanchement is blood);
• after a Radiotherapy on the thorax;
• in the event of Cancer of the pericardium.

In certain cases, the assessment does not show any explanation. One speaks then about péricardite Idiopathique.

Treatment

A viral péricardite is treated by:

• rest;
• the Anti-inflammatory drug S: Aspirine, anti-inflammatory drugs not stéroïdiens, Corticoïde S.
• the treatment must be prolonged at least until the standardization of the inflammatory syndrome (in general a month).

The purulent péricardites are treated by:

• a surgical drainage with installation of a large drain;
• a antibiothérapie prolonged by general way, adapted to the germ.

The péricardites tubercular patients are treated by:

• a anti-tuberculous treatment traditional but prolonged during one year ;
• a corticothérapie in certain cases, which could decrease the risk of constriction

Evolution and complication

The evolution is done, in the major part of the cases, towards the cure without Séquelle S.

It can however repeat.

Two rare complications must be required

The tamponnade

It is about a compression of the cardiac cavities by the liquid under pressure in the pericardium, thus preventing the heart from correctly filling.

The tamponnade appears by a fall of the blood Pressure being able to go until the Collapsus, even with the cardio-circulatory Arrêt. It is about a serious complication requiring the urgent assumption of responsibility in specialized milieu.

One suspects it in front of a péricardite associated with signs with bad tolerance: edema S of the lower extremities, breathlessness (Dyspnea) particularly marked when the patient in position is lengthened, falls of the blood pressure, jugular veins particularly apparent, especially in sitting position (normally are almost not visible in this case), large Foie painful.

The diagnosis is made by the echocardiography which épanchement shows one more or less important in the pericardium, and especially, a flatness of the right cavities (first to be compressed, the wall of the left cavities being thicker), a lower Vena cava dilated, not varying with breathing (normally, it is flattened during the inspiration).

In the event of suspicion of tamponnade, the patient must be left with jeun and maintained in sitting position with a monitoring brought closer to the blood-pressure. A Perfusion must be posed in order to obtain a correct vascular filling.

The treatment is surgical: it consists of the evacuation of épanchement by an incision under the xyphoïde sternale and the installation of a drain (pipe connected to a pocket allowing the flow of the liquid). This intervention, simple and fast, can be made in a department of surgery not specialized. The surgeon benefits from the operation to take a piece of pericardium and liquid for analysis and search for a cause.

In the event of extreme urgency (cardio-circulatory table of Stop or Collapse not answering the filling remotely of an operating room suite), or when the surgery is challenged (general state of the patient), one can have to make a puncture of the pericardium using a long needle, ideally under echocardiographic control.

The constrictive péricardite

It is about a thickening of the layers constituting the pericardium, thus obstructing the expansion of the cavities and their filling.

It is a chronic disease, often insidious and whose diagnosis is difficult.

The most frequent cause remains the Tuberculose. It can be also consequence of a Radiothérapie, more rarely of a Cancer of the pericardium.

It appears by a right Cardiac failure: oedemas of the legs, large sometimes painful liver, particularly apparent jugular veins (" turgescentes"). The table is close to a Cardiac failure, known as restrictive.

The echocardiography can show in an inconstant way a thickening of the pericardium with anomalies of the cardiac filling to the Doppler. The scanner confirms the diagnosis by showing the thickening of the pericardium which can be generalized or localized.

The treatment consists of the surgical ablation of the pericardium (pericardectomy).

Random links:

Friedrich Wilhelm Murnau | Bierné | Cérébelleux syndrome | Pastor Micha Ondo Bile | Thémisto girl of Hypsée