Pathology of spasmodic pericarditis
Spasmodic pericarditis with effusion (1/3 of cases): Young patient, recent symptoms appears history of pericarditis due to acute infection.
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.
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
After subacute hydro cephalitis a history of many years ago with pericarditis, signs of muscle function appeared.
Weakness, pain in the liver.
Painless enlargement (sclerosis).
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.
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.
Normal heart shape, when accompanied by an enlarged ballooning effusion (T / N index).
Soy: The heart is less mobile.
Unilateral or bilateral effusion (60%).
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.
Pressure curve in chamber: Dip-plateau figure in diastolic plateau.
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.
The clinical form of spasmodic pericarditis
According to 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.
Detected when the pericarditis effect due to tuberculosis
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.
Myocardial fibrosis and Loeffler dilated fibrous endocarditis
Chronic non-spasmodic pericarditis.
Surgery is essential.
Temporarily, prepare for surgery.
Symptoms: Intrusion of mucus, pleura, diuretic, heart support.
Causes: Anti-tuberculosis, = infection, corticosteroids in case of systemic disease.
Progressive hepatocellular failure.
Severe myocardial progression.
Hope for limited life.
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.
Patient, careful, meticulous.
Release 2 ventricles, right, 2 aortae.
Monitor pressure during surgery.
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.