Causes and treatment of exudative pericarditis: what to do with fluid in the heart

Causes of exudative pericarditis

A small amount of lubricant between the visceral and parietal layers of the outer shell of the heart plays a protective role and performs sliding during organ contraction. Pericardial effusion develops with inflammation and increased vascular permeability. In this state, the serous leaves do not absorb excess fluid, in addition to this, it sweats from the blood, and the level of secretion increases.

Pericardial effusion most often occurs as a secondary process, in the form of a complication of the underlying pathology. The reasons for its development may be:

• severe infections;
• autoimmune disorders;
• allergic reactions;
• injuries (blows, penetrating wounds);
• radiation exposure;
• blood diseases;
• tumors;
• myocardial infarction;
• metabolic disorders;
• surgical intervention on the heart (at the same time, exudative pleurisy may occur after surgery);
• renal failure.

If the fluid in the serous membranes appears for an unknown reason, then the disease is considered idiopathic.

Signs of fluid in the pericardium

When the effusion begins to accumulate, the heart muscle and upper airways are compressed. Common symptoms of pericardial effusion:

• chest pain;
• uncontrollable hiccups;
• fear of death;
• persistent cough;
• hoarseness of voice;
• lack of air;
• attacks of suffocation in a horizontal position;
• periodic fainting.

The nature of the pain

Chest discomfort can mimic angina pectoris, heart attack, and respiratory inflammation.

Pains have the following features:

• aggravated by swallowing, moving the body, inhaling, lying down;
• relieved in a sitting position when bending forward;
• most often start suddenly, but can be growing in nature;
• have a duration from several hours to a day or more;
• vary in intensity (the symptom depends not only on the neglect of the pathology, but also on the patient's pain threshold, as well as the state of his nervous system);
• can be dull, sharp, pressing and burning;
• localized in the area of ​​pericardial projection or radiate to the left shoulder, arm, neck.

What does a patient with pericardial effusion look like?

Patients have the following signs of pericardial effusion:

• pallor of the skin, acrocyanosis;
• swelling of the upper torso and swelling of the neck veins that do not subside on inhalation;
• cardiac impulse on palpation is sharply weakened or not defined;
• increased heart rate and arrhythmia;
• weakening of the pulse on inspiration;
• weakening of heart sounds on auscultation;
• enlargement of the liver;
• rapid buildup of fluid in the peritoneal cavity (ascites);

How to diagnose the disease

To confirm the diagnosis, the following research methods are performed:

1. The most informative and accessible way in this case is an ultrasound of the heart. EchoCG reveals an accumulation of excess fluid volume, atony of intercostal muscles in the affected area and tissue edema. Adhesions and thickening of the serous membrane may also be noticeable.

2. On the cardiogram, there is a significant decrease in voltage, sometimes you can find a malfunction of the conducting system.
3. Computed tomography helps to clarify the degree of neglect of the disease, the condition of the lungs and mediastinal organs.
4. On an MRI of the heart, you can see the earliest signs of pericarditis, pinpoint lesions, adhesions and effusion, even with a small amount.
5. The fluid in the bursa is evacuated by puncture. The procedure allows you to clarify the composition of the effusion - it can be serous, hemorrhagic, purulent, cholesterol.

Features of exudative pericarditis in children

In childhood, the disease is extremely rare, but it is very difficult. Fluid in a child's heart is formed as a result of exposure to infection. This is usually due to Epstein-Barr viruses or influenza. An adult has many more reasons, but many of them are revealed only after a puncture of the cardiac sac.

Exudative pleurisy in a child is accompanied by high fever, pain in the heart and increased blood pressure. The protocol for providing assistance does not depend on the age category of a person; treatment is carried out by prescribing medications, puncture with pumping out the contents or performing an operation.

Treatment algorithms

In the acute stage of the disease, inpatient treatment and bed rest are required. Therapy consists of using the following groups of drugs:

1. If the cause of exudative pericarditis is a bacterial infection, then the patient is recommended to use broad-spectrum antibiotics. These include semi-synthetic penicillins, aminoglycosides, cephalosporins. In the presence of purulent effusion, drugs are administered directly into the cavity after pumping out the exudate and rinsing with antiseptics.
2. For autoimmune damage and connective tissue diseases, glucocorticoids (Prednisolone, Hydrocortisone) are used. The same drugs are used to eliminate severe inflammation in any type of pericarditis.
3. Pain relief in the acute period is carried out by NSAIDs and analgesics. For this purpose, Diclofenac, Meloxicam, Aspirin are taken. The duration of admission is from 2 to 3 days to several weeks.
4. Expressed stagnation in the systemic circulation and a significant volume of effusion require the use of diuretics. To remove excess fluid, Furosemide is prescribed in combination with Spironolactone.

Surgical methods

Surgical treatment of exudative pericarditis includes pericardiocentesis and pericardiectomy:

1. During pericardiocentesis, the needle is inserted into the chest from the side of the xiphoid process and, after determining the place of greatest accumulation of fluid, is replaced by a catheter through which it flows out. This allows you to remove most of the effusion, take it for examination and relieve the person's condition. Manipulation can be performed under the control of X-ray, ECG or ultrasound of the heart. Drainage lasts from several hours to a day.
2. Pericardiectomy involves removing part of the outer lining of the heart. This allows you to restore hemodynamics in most patients with strong compression of the organ. In severe and advanced cases, even this approach is not able to eliminate the problem, mortality after surgery ranges from 6 to 12%.

Rehabilitation

With proper treatment of effusion pericarditis and the absence of complications, recovery occurs after three months. Gradually, a person will be able to return to his usual life. Longer rehabilitation is necessary in the case of a recurrent form of the disease, when from time to time the effusion in the pericardial cavity accumulates again.

Recovery after surgery requires a longer period: the patient is kept in the hospital for 5 days.If nothing threatens a person's life, he is discharged under the supervision of a cardiologist at the place of residence. Usually, the state of health improves after 3 to 4 months, and the full restoration of the functioning of the blood vessels and the heart occurs in six months.

To speed up the rehabilitation process, it is recommended:

• visit a doctor regularly and follow all his instructions;
• monitor nutrition: it must be complete and healthy;
• gradually increase physical activity, but not overload;
• completely eliminate smoking and alcohol intake;
• monitor your health and immediately seek help if problems arise;
• to sanitize the foci of inflammation.

Complications

With exudative pericarditis, a number of complications may develop. The most commonly observed:

• heart failure;
• rhythm disturbances (tachycardia, atrial fibrillation);
• adhesion formation;
• the transition of the disease to a chronic form;
• tamponade (occurs in 40% of cases).

Prognosis: how pericardial effusion affects life expectancy

Timely treatment in the absence of complications allows us to speak of a favorable prognosis. Full therapy or surgery helps restore heart function, and the person will be considered practically healthy. Life expectancy is significantly reduced with the appearance of multiple adhesions, even after surgery.