PANCARDITIS

From Big Medical Encyclopedia

PANCARDITIS (pancarditis, grech, pan everything, whole + kardia heart + — itis) — the diffusion inflammatory process taking all covers of heart (an endocardium, a myocardium and a pericardium). This concept does not include the focal damages of heart caused by its wound or a transmural necrosis of a myocardium with a postinfarction syndrome.

Mikropreparata of an endocardium (a) and a myocardium (b) at a pancarditis: and — a mural endocarditis — a reinforced pristenochny endocardium (it is specified by shooters) with focal limfogistiotsitarny infiltration; — productive myocarditis — the centers of limfogistio-cytic infiltration of interstitial tissue of myocardium (are specified by shooters), a hypertrophy of muscle fibers; coloring hematoxylin-eosine; h265.

The most frequent reason of P. — rheumatism (see). The combination valve, chordal or a mural endocarditis (fig., a), focal productive or diffusion interstitial exudative myocarditis (fig., b) and an acute serous, serofibrinous or fibrinopurulent pericardis is stated usually at the maximum activity of a disease, it is preferential at children's and youthful age. In some cases observe a combination of an acute pericardis with rheumatic pleurisy and peritonitis. The item meets also at a system lupus erythematosus, is more rare — at a nodular periarteritis, a pseudorheumatism, Bekhterev's disease, nonspecific myocarditis of Abramov — Fidlera and as manifestation of allergic reaction to drugs. P. with development of a septic endocarditis, abscesses of a myocardium and a purulent pericardis are described also virus, rickettsial and bacterial (streptococcal, staphylococcal, gonococcal and meningococcal).

The combination of the symptoms characteristic of defeat of all covers of heart creates motley a wedge, a picture, in a cut manifestations quite often dominate or myocarditis (see), or pericardis (see). About existence endocarditis (see) explicit variability of already existing noise of heart or emergence new and, to some extent, thromboembolisms of vessels of big or small circles of blood circulation testifies. Myocarditis is shown by expansion of limits of relative dullness of heart (preferential to the left), muting of tones, especially the I tone on a top (to-ry it can be replaced completely with systolic noise), tachycardia, sometimes embriokar days, quite often protodiastolic cantering rhythm, disturbances of conductivity and the progressing circulatory unefficiency. Accession of a pericardis is demonstrated by emergence of a stethalgia, is more often than a constant, stupid, pressing, monotonous (usually amplifying at cough, forced ventilation, turns of a trunk, during the pressing on a thorax in the field of a projection of heart), the scraping or scratching pericardial rub over all zone of absolute dullness of heart or only along the left edge of a breast (sometimes in interscapular area in a phase of a deep exhalation) and the shift of a segment of ST up (with smooth transition to a high positive tooth of T) in all assignments of an ECG. Accumulation of exudate in a cavity of a pericardium is followed by disappearance of painful feelings, increase of an asthma (especially in horizontal position), noticeable expansion of the area of the absolute percussion dullness of heart reaching sometimes limits of relative dullness, sharp strengthening of a circulatory unefficiency, decrease in a voltage of all ECG elements and a small pulsation of contours of heart at radiological and elektrokimografichesky researches.

An outcome of an exudative pericardis at sick P. quite often is education intra-and ekstraperikar-dialny unions. Progressing of a circulatory unefficiency at P. creates threat of a lethal outcome. The forecast is especially adverse at a hemorrhagic exudate in a cavity of a pericardium.

Apply glucocorticoids and other anti-inflammatory drugs to P.'s treatment, combining them if necessary with antibacterial, antihistaminic, diuretic drugs and remedies for the disease which is the cornerstone of the Item.



Bibliography: Gogin E. E. Diseases of a pericardium, M., 1979; Sumarokov A. V. and Moiseyev V. S. Diseases of a myocardium, page 195, M., 1978; F of i e d b e r g C. Diseases of the heart, Philadelphia — L., 1966; The heart, arteries and veines, ed. by 3. Hurst, N. Y., 1978.


V. D. Topolyansky.

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