Acute idiopathic pericarditis

Introduction to acute idiopathic pericarditis Acute idiopathic pericarditis (acuteidiopathic pericarditis) is the first in foreign countries for pericarditis, and there has been an increasing trend in China in recent years. The cause is not well understood, it may be that the virus directly invades the infection or the autoimmune response after infection. basic knowledge The proportion of sickness: 0.01% Susceptible people: more common in young people Mode of infection: non-infectious Complications: pericarditis, pericardial effusion, constrictive pericarditis

The cause of acute idiopathic pericarditis

Viral infection (55%):

In addition to the common Coxsackie virus B and ECHO virus, which cause acute idiopathic pericarditis, other viruses that cause pericarditis include mumps virus, influenza virus, and infection. Sexual mononucleosis, polio, chickenpox and hepatitis B virus.

Other disease factors (45%):

Infectious mononucleosis can cause acute pericarditis with severe cardiac tamponade and constrictive pericarditis. Varicella can be associated with severe viral pneumonia and acute pericarditis. Mycoplasma pneumonia is an important non-bacterial in adults. Pneumonia can also cause heart and pericarditis, cytomegalovirus and other uncommon pathogens that can cause pericarditis in some patients with low immunity.

Pathogenesis

Idiopathic pericarditis can cause inflammation of the visceral and parietal pericardium. It begins with polymorphonuclear leukocyte infiltration, followed by infiltration of lymphocytes around small blood vessels. Fibrin deposition in the pericardial space makes the pericardial surface rough and congestive. Inflammation can cause serous, fibrinous, suppurative and bloody exudates. Coxsackie B virus and Echovirus can produce suppurative exudate with the disappearance and mechanization of exudate, and finally lead to pericardial thickening. Constrictive pericarditis

Acute idiopathic pericarditis prevention

1. Should actively prevent viral infections, focus on enhancing physical fitness and improve immunity.

2. In the acute phase, bed rest, close observation of changes in the condition, observation of the growth of pericardial effusion, and early treatment of changes in the condition.

Acute idiopathic pericarditis complications Complications pericardial pericardial effusion constrictive pericarditis

Acute idiopathic pericarditis generally has a short course of disease, lasting for 1 to 3 weeks, and has obvious self-limiting characteristics, but there are also a few that can be prolonged for several years. About 15% to 40% of patients can re-expose pericarditis after several weeks. This may not be a reinfection of the virus, but an immune response to the initial viral damage. This argument is supported by the anti-Coxsackie B virus neutralizing antibody effect in the blood of patients with severe recurrent pericarditis. The increase in price is only effective in the first week of onset, and it is effective to inhibit recurrent pericarditis with interferon. A few idiopathic pericarditis may have the following complications:

Recurrent pericarditis

Approximately 15% to 40% of patients may develop pericarditis after a few weeks, which may not be a reinfection of the virus, but an immune response to the initial viral damage.

2. Pericardial effusion

Pericardial exudate is generally small or moderate, rarely produces severe pericardial tamponade symptoms, and rarely requires pericardial puncture to remove fluid.

3. Constrictive pericarditis

Both Coxsackie B virus and Echovirus can produce suppurative exudate with the disappearance and mechanization of exudate, and finally lead to pericardial thickening to form constrictive pericarditis, but the incidence is low.

Acute idiopathic pericarditis symptoms Common symptoms Chest pain weakness, missed heat, dyspnea, relaxation, hot appetite, sternal pain, pericardial effusion, pericardial fiber, thickened pericarditis

1. Idiopathic pericarditis often has prodromal symptoms of upper respiratory tract infection from a few days to several weeks before onset. Excessive physical labor, emotional excitement and cold may be the cause.

2. Fever is the main symptom of this disease, which may be heat retention or relaxation, lasting for several days or weeks. Other accompanying symptoms are difficulty breathing (resulting in deep breathing due to chest pain), cough, weakness, loss of appetite, etc.

3. About 60% of patients have acute onset. The most prominent symptom is pain in the anterior region or sternum. It is often more severe than other pericarditis. It can be knife-like pain, crushing pain or sorrow. Most patients have pain in a short time. The peak is reached, and gradually reduced, and very few patients can have no pain.

4. About 25% of patients with pleurisy or pneumonia, the pain is mostly located behind the sternum and the lower part of the sternum, can be radiated to the neck, left shoulder, left shoulder, upper abdomen, etc., cough, breathing, body position changes can increase the pain.

5. Pericardial friction sound is the most important sign, which can be heard in about 70% of patients. It usually appears on the first day of onset. It lasts for several days to several weeks. The pericardial exudate is usually small or medium. Severe pericardial tamponade symptoms are rarely produced, and pericardial puncture is rarely required to remove fluid.

Examination of acute idiopathic pericarditis

ESR increases, myocardial zymogram is normal, but when the inflammation spreads to the subepicardial myocardium, the zymogram level can be increased, and the white blood cells are increased, mainly lymphocytes.

Electrocardiogram examination

The typical ECG changes are divided into four stages. In the first stage, in addition to the corresponding aVR, the ST segment of the V1 lead is low in normal pressure, and the ST segment elevation of all other leads is concave, generally < At 0.5mV, in some cases, the PR segment was depressed and disappeared within about 1 week. In the second phase, the ST and PR segments returned to the normal baseline, and the T wave was flat; in the third phase, the T wave was inverted in the original ST elevation lead. Not accompanied by R wave reduction and pathological Q wave; Stage 4, may be several weeks after the onset, several months, T wave returns to normal or due to the development of chronic pericarditis, T wave is permanently inverted, and pericarditis under the epicardium Myocardial damage or inflammation recovery process in different parts of the pericardium is inconsistent, and the ECG shows atypical changes, such as only ST-segment elevation or T-wave changes; localized ST and T-wave changes; an electrocardiogram can simultaneously show the evolution of pericarditis Changes in ST and T waves at different stages, such as ECG with atrioventricular block or bundle branch block, suggest a combination of extensive myocardial inflammation, and stage 1 ST elevation needs to be identified with:

1 Acute myocardial infarction: There is no pathological Q wave in pericarditis, no T wave inversion when ST segment elevation, and normal electrocardiogram before T wave inversion during evolution;

2 variant angina: ST segment elevation is mostly temporary;

3 Early repolarization syndrome: ST segment elevation is common in young people, especially blacks, athletes and psychiatric patients. The ST segment does not dynamically evolve and the PR segment does not shift.

2. Chest X-ray examination

In the stage of acute fibrinous pericarditis or pericardial effusion below 250ml, the heart shadow does not increase, even if there is abnormal hemodynamics, chest X-ray examination can be normal;

Diagnosis and diagnosis of acute idiopathic pericarditis

The clinical features of patients with pericarditis with prodromal symptoms of upper respiratory tract infection and acute chest pain, electrocardiogram changes and elevated myocardial enzymes should first suspect idiopathic pericarditis.

The most powerful supportive diagnosis of idiopathic pericarditis is that the viral antibody titer is four times higher in the first 3 weeks of the disease, and it is rare to isolate the virus in the blood or pericardial effusion. It has been reported in 30 cases. In patients with enterovirus infection, the positive rate of radioimmunoassay IgM specific for anti-Coxsackie B virus was 49%, while the normal subjects were rare. Other reports, polymerase chain reaction (PCR) DNA virus antigens can be detected in pericardial tissues, such as Coxsackie B, Echovirus, and the like.

Idiopathic pericarditis should be differentiated from traumatic, suppurative, infectious, and systemic lupus erythematosus. For elderly patients, prior to the diagnosis of viral pericarditis, acute myocardial infarction, rheumatoid, and tuberculosis should be excluded. Or the possibility of a tumor.

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