Pericarditis

introduction

At a Pericarditis, which is technically as Pericarditis is called, it comes to an inflammation of the pericardium, which limits the heart to the outside. Per year there are probably 1,000 diseases per million inhabitants, so the disease is not that rare.
However, the disease often goes undetected because it is common symptomless expires and usually heals on its own within one to two weeks.

Forms of pericarditis

The pericardium, that Pericardium, consists of two leaves - an inner and an outer leaf. There is a small amount of liquid between the two leaves so that the two layers can slide together without friction.

In the case of pericarditis, a distinction is made between a dry and a wet form.

In the case of dry (fibrinous) pericardial inflammation, both sheets of the pericardium rub against each other without any additional fluid formed. The dry form often changes into the wet form of pericarditis.

In the wet (exudative) form, too much fluid develops between the two pericardial leaves.
A so-called pericardial tamponade can develop from a damp pericardial inflammation. This is the case when too much fluid accumulates and presses on the heart from the outside, so that it is restricted in its pumping function and can no longer fill properly. A pericardial tamponade is a life-threatening condition that is acutely treated by puncturing the fluid in the pericardium.

Read more on the subject below Pericardial effusion

If a tumor is responsible for the development of pericarditis, a so-called hemorrhagic pericarditis form, in which there is an accumulation of blood between the two sheets of the pericardium.

In addition to dry and wet pericarditis, a distinction is also made between acute pericarditis and a chronic form.

Chronic inflammation can lead to scarring or calcification, which can also limit the heart's pumping function.
Calcification and scarring cause the pericardium to harden, so that the work of the heart is restricted. This form of pericarditis is known as Constrictive pericarditis, or figuratively speaking as "Panzerherz".

causes

In general, a distinction is made between non-infectious and infectious causes for the causes of pericardial inflammation.

In more than 50% of the cases, the cause of the inflammation remains unexplained, since in most cases a proven cause would not result in any further consequences for the therapy. An inflammation of the pericardium of unexplained cause is called idiopathic pericardial inflammation.

Viruses are probably the most common cause of pericardial inflammation. Viral pericarditis is mainly caused by coxsackieviruses, followed by adeno- and echoviruses.
In rare cases, bacteria and fungi can also be the cause of infectious pericarditis.
Active tuberculosis can also lead to pericarditis.

Autoimmune diseases, which also include rheumatic diseases, play a role as non-infectious causes.

Furthermore, a gout disease, kidney failure, a tumor disease, as well as a heart attack or the result of a heart operation can be the cause.

Medication can also cause pericarditis. Radiation as part of cancer therapy can also cause inflammation.

In rare cases, "Still's disease", a rheumatic disease, can also be the cause. For the most important information, read the article under: Still's disease - what's behind it?

Symptoms

A acute pericarditis solves sharp chest pain out. The pain usually occurs depending on the breathing, which means that with every breath there is stabbing pain in the chest.
In addition to breathing, the pain can also come through to cough or To swallow be reinforced.
Classically, this pain occurs in one dry pericarditis, in which the inflamed leaves of the pericardium rub against each other.
The pain is typically on the left side of the chest, where the heart is located.

It can become a Radiation of pain into the upper abdomen as well as coming towards the neck and shoulder blade.
In addition to breathing, the pain is also position-dependent. When seated and in a slightly bent position, patients usually feel the least pain. in the Lie however, increased pain occurs.
Additionally it can act as a sign of inflammation too fever and increased breathing.

Is it a moist pericarditis, in which there is an increased accumulation of fluid between the two pericardium leaves, the pain diminishes or even disappears completely, since the two leaves do not rub painfully against each other due to the fluid.

The patients have wet pericarditis often symptom-freeso that pericarditis often heals unnoticed.

More severe symptoms arise when there is one Pericardial tamponade comes. In this case, symptoms of a Heart failure such as Shortness of breath, decreased exercise capacity, increased heart rate, drop in blood pressure, fluid retention and sweating because the heart can no longer pump enough blood into the body's circulation.

If the pericardial tamponade increases, the symptoms worsen and become worse Clouding of consciousness. This speaks for one entering Circulatory shock.

diagnosis

At the beginning of the doctor's visit, the treating doctor first takes an anamnesis. He asks the patient about his current symptoms and any other abnormalities.
Then one closes physical examination on.

With an inflammation of the pericardium, a stethoscope can be used over the heart scraping noise (Pericardial rub) can be heard.
However, it already has a effusion formed, so one damp inflammation, this sound can no longer be heard. So it's only with one dry pericarditis available.

The examination is usually followed by a EKG, in which one usually has pericarditis from one Heart attack can delimit.
In addition, another Ultrasound scan of the heart (Echocardiography) and a blood sample.

Since the symptoms of pericarditis are one Heart attack are similar, the diagnostics are used, among other things, to differentiate between the two diseases.

The ultrasound examination is inconspicuous with a dry inflammation. However, if an effusion has formed, the examination can clearly show one moist pericarditis diagnosed and determine the extent of the effusion.

In addition, statements about the Pump function of the heart are hit. The analysis of the laboratory results of the blood sample serves primarily to distinguish between myocardial infarction and pericarditis, as already mentioned.

In the case of moist pericardial inflammation, a Pericardial puncture be made.
The puncture not only has a diagnostic effect, but also a therapeutic one, as it relieves the heart at the same time.

The puncture can be used to determine whether a bacterial pathogen is responsible for the inflammation, which can then be specifically treated with an antibiotic.
A puncture is also performed if a malignant process is feared or a tubercular or purulent effusion is suspected.

A X-ray examination if one is suspected lung infection performed as a trigger. The same applies to a suspected Tuberculosis disease, as well as one Lung tumor.
In the X-ray you can see an effusion of pericardial inflammation as a so-called goat bag-like Broadening of the shadow of the heart.

If you have chronic pericarditis, you can also have a CT or MRI examination may become necessary, especially if surgery is pending.

blood values

As part of the blood test, the parameters Troponin and Creatine kinase certainly.

Since there is a heart attack too Cell damage comes, both markers are increasingly released and are correspondingly increased in the event of a heart attack.

Has the pericardial inflammation already on the Heart muscle If there is an overlap, both parameters can also be increased in the case of pericarditis.

In addition to the troponin and creatine kinase values, Inflammation parameters certainly.
This includes that C-reactive protein (CRP), as well as the Sedimentation rate.
If the levels are elevated, this is a sign of inflammation in the body, which makes pericarditis more likely.

To get to the bottom of the cause, you can try to detect a causative pathogen or certain parameters of an autoimmune disease by means of a blood test.

• CRP value
• Sedimentation rate

therapy

An inflammation of the pericardium is primarily treated symptomatically, i.e. one tries to alleviate the pain that occurs.
This is usually done Painkiller from the group of so-called NSAIDs (non-steroidal anti-inflammatory drugs). This group includes well-known pain relievers such as Ibuprofen or Diclofenac. In addition to having an analgesic effect, they also have an anti-inflammatory effect.

Especially with a so-called idiopathic inflammation, an inflammation for which the cause is not known, this is usually the treatment of choice Colchicine (Part of the autumn crocus), as it has an anti-inflammatory effect on inflammation of serous membranes such as the pericardium.

Since studies have shown that recurrences occur less frequently after therapy with colchicine, it is also used especially when the pericardial inflammation has flared up again. In rare cases, especially with proven Autoimmune diseasethat will fight the inflammation too cortisone used.

There is a trigger viral cause firmly, must not be treated with cortisone, as this increases the risk of recurrence.

If anti-inflammatory therapy is not enough, hospital treatment may sometimes be necessary.

Is a bacterial pathogen Known as the trigger of pericarditis, this can be done with the help of a Antibiotic be treated.

To the emergence of a Pericardial tamponade To prevent this, a Puncture this can be done. A special long needle is used for this, with which the pericardium is punctured. In the case of small accumulations of fluid of 10 to 50 ml, which are typical for a wet pericardial inflammation, no puncture is required.

Is another disease like one Rheumatic disease or one Tumor disease Responsible for the development of pericardial inflammation, the pericardial inflammation is also treated at the same time by treating the underlying disease.

surgery

Surgery for pericarditis becomes necessary if it becomes one calcified and scarred pericarditis comes. This usually comes as part of a chronic inflammation comes about in which the pericardium hardens.

By hardening, the heart loses its elasticity, which it does for its own Pump function required and this is affected accordingly.
As a result, the blood backs up in the body's circulation and it comes to Symptoms of Heart Failure. In this case, a surgeon can attempt to remove the calcareous layer or the scarring by means of an operation.

The operation can usually be done without the use of a Life-support-machine be performed. Such an operation is seldom necessary, but should not be carried out too late to avoid consequential damage from permanent cardiac stress.

Sports

In any case, no sport should be carried out during acute inflammation. It must no bed rest are adhered to, but you should definitely take care of yourself.
Often, the accompanying pain alone leads to a decision not to exercise.

The inflammation is usually after one to two weeks healed. Then you can start exercising again. So you shouldn't do sports for about two weeks.

The sports ban is more strict if the inflammation affects the pericardium Heart muscle has encroached (Perimyocarditis). Then you should take care of yourself after the disease has healed so that the heart is not directly overstrained at the beginning. Because with perimyocarditis the heart is muscular in its pump function.

Sometimes, however, the pathogen can also be spread if you have an infection such as a cold or one Abdominal influenza not cured properly.
Pericarditis is in most cases caused by a viral pathogen triggered. Correspondingly, pericarditis usually precedes a harmless one one to two weeks beforehand cold or the like ahead.
If you do not take it easy during the infection, but continue to exercise, the disease will not heal properly and the pathogen can spread further and spread to the pericardium, for example.

Duration

If, as in most cases, it is a viral inflammation of the pericardium, it takes about one to two weeks, until the disease heals on its own. This is the case in 70 to 90% of patients.
If there is another cause, the inflammation usually lasts longer and the duration cannot be quantified across the board.

consequences

In about 70% of cases, pericarditis heals on its own without any further consequences.
In some cases, however, the inflammation can spread to the Heart muscle come. This is known as perimyocarditis, in which the heart is restricted from working.

In addition, if the pericardial inflammation has healed, a relapse can occur a few weeks later, i.e. a recurring pericarditis. This occurs in almost 30% of the cases. If there is a recurrence, the risk is increased that a recurrence will occur again.

Recurrent pericardial inflammation is usually caused by one effusion accompanied. It is then usually about one wet pericarditis.

If the inflammation does not heal, the acute form can change into the chronic form. This is mostly from Limescale and scarring accompanied, so that a so-called armored heart, or a Constricitiv pericarditis arises.

Alcohol for an inflammation of the pericardium

So that the body is sufficiently of a Pericarditis can recover or heal it, alcohol should definitely not be consumed during an acute illness.

Furthermore, statistically speaking, alcoholics are more likely to develop pericarditis. The heart can be more susceptible to diseases and infections such as pneumonia can be more serious in alcoholics, so that the pathogen can also spread to the pericardium more often.