Pathology of spasmodic pericarditis

Outline

Spasmodic pericarditis is a consequence of inflammatory fibrosis, with or without calcification of the two pericardial leaves, forming a tight sheath around the heart that prevents ventricular filling in the diastolic period.

Pathology

There are two possible:

Chronic pericardial spasm with effusion

20-25% of cases.

Thick spread with leaf-wall organ, with fluid compartment 100-500ml under pressure.

Appears after fluid pericarditis, fluid aspiration does not improve hemodynamic.

Chronic pericarditis without effusion

75 - 80% calcified, fibrous, granular.

Diagnosis of diastolic syndrome

Detecting circumstances

After subacute hydro cephalitis a history of many years ago with pericarditis, signs of muscle function appeared.

Clinical scene

Mechanical signs

Trouble breathing.

Weakness, pain in the liver.

Entity markers

Peripheral signs:

Painless enlargement (sclerosis).

Ascites.

Lower extremities oedema.

Venous veins floating (1/2 seated posture), increased inhalation.

Feedback liver - neck vein (+/-).

Pleural effusion rales stagnant unilateral or bilateral.

Signs at the heart:

Normally 20% of cases.

Tachycardia.

Sometimes there is a vibrance (pericardial vibrance) due to pericardial calcification.

ECG: Variable but not specific.

Atrial fibrillation, low QRS potential, normal QRS axis, negative T waves.

Chest X-ray:

Normal heart shape, when accompanied by an enlarged ballooning effusion (T / N index).

Pericardial calcification.

Soy: The heart is less mobile.

Unilateral or bilateral effusion (60%).

Doppler ultrasound:

Thick two pericardial leaves, effusion, calcification of the pericardium.

Early opening of the pulmonary placenta valve; paradoxical cell ventricular septum

Normal atrioventricular valve.

Doppler: Gives spasm data (early opening of the pulmonary valve).

Mitral flux: decreased E-wave amplitude (protodiastolique left ventricular repulsion) when inhaled.

3-leaf flus flow: Increased E-wave amplitude on air intake and A-wave increase (télésdias tolique).

Computer tomography or magnetic resonance imaging (Scanner or IRM).

Thick lining of the heart.

Lime.

Heart catheterization:

Pressure curve in chamber: Dip-plateau figure in diastolic plateau.

Pressure changes

Tend to balance pressure (difference <5mmHg) from aorta to pulmonary capillary and left ventricle.

Left ventricular catheter pressure: Right diastolic pressure = pulmonary diastolic pressure = right atrial pressure = left diastolic pressure.

Pericardial biopsy.

The clinical form of spasmodic pericarditis

According to symptoms

Less symptoms

Weakness, shortness of breath, not compressed drainage on examination.

Doppler ultrasound does not provide conclusive data.

Diagnosis is based on hemodynamic exploration after infusion of 200-500cc of polymers.

Potential

Detected when the pericarditis effect due to tuberculosis

Subacute periostitis

Diastolic syndrome.

According to anatomy

Spasmodic pericarditis with effusion (1/3 of cases): Young patient, recent symptoms appear, history of pericarditis due to acute infection.

Spasmodic pericarditis with left ventricular diastole (rarely), pulmonary edema, pleural effusion, pulmonary vascular hypertension, left ventricular dip-plateau.

 Spasmodic pericarditis, myocardial damage: Atrophy, irreversible myocardial fibrosis after pericardial resection, pericardial adhesion and myocardium cause difficulties in surgery.

Reason

Infection.

Differential diagnosis

 Cirrhosis.

Limited cardiomyopathy.

 Myocardial fibrosis and Loeffler dilated fibrous endocarditis

 Chronic non-spasmodic pericarditis.

Treatment

Surgery is essential.

Internal treatment

Temporarily, prepare for surgery.

Symptoms: Intrusion of mucus, pleura, diuretic, heart support.

Causes: Anti-tuberculosis, = infection, corticosteroids in case of systemic disease.

Foreign treatment

Contraindicated

Progressive hepatocellular failure.

Severe myocardial progression.

Hope for limited life.

Skill

Surgery: Open sternum, restrict left ventricular posterior and inferior vena cava.

Left front: Entire left ventricle.

Right front: Release of two aorta.

The two sides cut across the sternum.

Pericardial cutting:

Patient, careful, meticulous.

Lime left.

Release 2 ventricles, right, 2 aortae.

Monitor pressure during surgery.

Result

Dependent dissection, myocardial condition.

Good: Central venous pressure decreased, the liver is no longer large, oedema, lots of urine.

Death 10-20%: Surgical complications (bleeding, coronary veins) heart failure, arrhythmia, pulmonary artery obstruction.