Acute Pericardial Diseases

Acute pericarditis:
Acute pericarditis is an inflammation of the pericardium that begins suddenly and is often painful. Inflammation causes the liquid products and the Inflammatory blood (such as fibrin, red cells and leukocytes), deposited in the pericardial space, which is called pericardial effusion.
Causes:
Acute pericarditis has many causes, ranging from viral infections (which may be painful but of brief duration and generally do not produce lasting effects) to the cancer, which is potentially lethal. Other causes include AIDS (acquired imunodeficiãncia syndrome), myocardial infarction, cardiac surgery, systemic lupus erythematosus, rheumatoid disease, renal failure, traumatic injuries, radiation and escape of blood from an aortic aneurysm or acute aortic dissection. The PA may also be a side effect of certain drugs such as anticoagulants, penicillin, procainamide, phenytoin and phenylbutazone. The PA can still be recurrent and without an apparent cause (idiopathic PA).
Complications:
Cardiac tamponade is the most feared complication of a severe and acute pericarditis. In general, the buffering is due to excessive accumulation of fluid or blood in the pericardium (pericardial effusion), affecting the performance of the heart. Tuberculosis, tumors, trauma, surgery, viral and bacterial infections, hypothyroidism and renal failure, are causes of cardiac tamponade. In cardiac tamponade blood pressure may drop sharply, reaching abnormally low levels during inspiration.
To confirm the diagnosis, the doctor uses an echocardiogram (a procedure that uses ultrasound waves to generate an image of the heart). Often, cardiac tamponade is a medical emergency. The disorder is immediately treated by surgical drainage or puncturing the pericardium with a long needle for removal of liquid and reducing the pressure. When possible, the removal of the liquid is performed through monitoring with echocardiography.
In the case of a pericarditis of unknown origin, the physician can drain surgically pericardium, collecting a sample to assist in determining the diagnosis. After the pressure is relieved, the patient is usually kept in hospital as a measure to prevent recurrence of tamponade.
Signs and symptoms:
Typically, acute pericarditis causes fever and chest pain. The pain may be similar to a myocardial infarction, except for its tendency to worsen in the supine position, during coughing or deep breathing (respiratory character). Pericarditis can cause cardiac tamponade, a potentially lethal disorder.
Diagnosis:
A physician may diagnose acute pericarditis through the description of pain by the patient and by auscultation with a stethoscope placed over the patient's chest. Acute pericarditis can produce a sound in cardiac auscultation, like the rubbing of a new leather (pericardial friction rub).
The ECG may show a pattern that is typical of the disease. A chest X-rays may show an increase in heart area and echocardiogram (a technique that uses sound waves to generate an image of the heart) may reveal the presence of an excessive amount of fluid in the pericardium (see illustration above, next to the page title ).
Echocardiography also may suggest the underlying cause of pericarditis, such as a tumor, and show the pressure exerted by the pericardial fluid on the right heart chambers. The high pressure can be an alarm that there is a cardiac tamponade. Blood tests allow the detection of certain disorders that cause pericarditis as leukemia, AIDS, infections such as tuberculosis, rheumatic fever and the increased levels of blood urea and creatinine in renal failure or TSH in hypothyroidism.
Prognosis:
The severity will depend on the cause of acute pericarditis. When caused by viruses or no apparent cause (idiopathic), recovery is usually complete in one to three weeks. Complications or recurrent may delay recovery. People who have a cancer that invaded the pericardium rarely survive more than twelve or eighteen months.
Treatment:
Generally, doctors hospitalizam patients with acute pericarditis, administer drugs that reduce inflammation and pain (such as aspirin or ibuprofen) and observe these patients closely, verifying the occurrence of complications (especially cardiac tamponade). The pain may require the use of an opioid, such as morphine, or a corticosteroid. The drug most commonly used against pain is prednisone. The subsequent treatment of acute pericarditis varies depending on the underlying cause.
Individuals with cancer may respond to chemotherapy (treatment-based cancer drugs) or radiation therapy. However, they are often subjected to surgical removal of the pericardium. Individuals undergoing dialysis because of kidney failure usually respond to changes in their schemes dialysis.
Doctors treat bacterial infections with antibiotics and surgically draining the pus accumulated in the pericardium. Whenever possible, drugs that can cause pericarditis are suspended. Individuals with repeated episodes of acute pericarditis resulting from a viral infection, injury or unknown etiology may get relief with aspirin, ibuprofen or steroids. Generally, when drug treatment is not successful is held surgical removal of the pericardium.