As Perikarditis (heart bag inflammation, ICD-10-Code: ) One designates I31.9 in the medicine an inflammation of the bindegewebigen heart bag (Perikard) of a different cause. Frequently one finds accompanying a Perikarderguss, later also to Fibrosierungen and calcifying, which can entail a substantial impairment of the heart function. Even if the heart muscle (myocardium) with concerned is, one speaks the interior layer of the heart (Endokard) of a Perimyokarditis, is additionally also still involved, by a Pankarditis.
The main symptom of the acute Perikarditis is often a stinging pain behind the breastbone, which strengthens in lying, with movement, deep respiration and cough and is accompanied possible by fever and Tachypnoe. Those are typical indications of a Pericarditis sicca/fibrinosa (dry Perikarditis), which is often present at the beginning of the illness. Are only inflammatory supports within the contact range of the two When hearing (Auskultation) with the Stethoskop a scraping rubbing noise over the heart is noticeable in this case. Additionally a Perikarderguss - a pronounced accumulation of liquid in the heart bag - up, one speaks footstep of a Pericarditis exsudativa (damp Perikarditis), with which the complaints and noise findings improve typically clearly or disappear completely. It arises more frequently than the dry process form. This case speaks then rather for an infectious cause (viruses, Tuberkulose) of the inflammation. The normal heart function can be so far limited by the liquid quantity that it can come to heart cycle insufficiency and in extreme cases to the shock.
In principle one can differentiate infectious from not infectious causes. In approximately 80% of all cases viruses are accepted as trips, even if they cannot be assigned a clear cause.
For the infectious Perikarditis primarily viruses (Coxsackie A and B, Adenoviren, echo viruses among other things) are responsible. More rarely also bacteria (in former times frequently Mykobakterien - e.g. Tuberkulose) can be responsible or in the context of a Sepsis and exeptionally also mushrooms (Candida, Aspergillus).
As causes of the non-infectious Perikarditis several different basic illnesses are applicable. It can appear as complication of a cardiac infarct (Perikarditis epistenocardica) (see Dressler syndrome). One differentiates between an early, which arises within 24 to 48 hours, of a late form, which only 2 to 3 weeks after the myocardial infarction communist manifesto becomes clinical. Autoimmune illnesses like the systemic Lupus of erythematodes, which rheumatism tables fever, which become rheumatoide Arthritis or the Sarkoidose, also regularly as trips of the indicated, whereby then however usually also Endokard, heart muscle (myocardium) and other organs are with concerned. The Perikarditis in the course of allergischer reactions (serum illness, medicament allergy) arises more rarely, with uremia in the context of a kidney insufficiency or after damages by a trauma or a radiotherapy. Karzinome within the range of the heart can lead likewise to an inflammation reaction of the Perikardes like also advanced metabolic illnesses (thyroid subfunction with diabetes mellitus, o.a.) or also heart-surgical interferences.
In the veterinary medicine a Perikarditis arises particularly with cattle due to the hood perforating foreign bodies.
With the Auskultation is a scraping rubbing noise, which disappears typically with the training of a Perikardergusses. In the ELECTROCARDIOGRAM is a stageful process: Initials ST-elevations with rise of the J-point in many derivatives decrease/go back in the process again. In the provisional stage show up flattenings of the T-waves, which terminals T-Negativierungen follow, which regress however usually completely. With a Perikarderguss possibly a peripheral Niedervoltage is to be seen. In the Echokardiographie can one also smallest Ergussmengen recognize, are additional to Verdickungen of the Perikards as well as Binnenechos as reference on Eiteransammlungen.Der Roentgen thorax is remarkable only with pronounced Ergussmengen. A Perikardpunktion could be accomplished with suspicion on a bacterial infection to exciter diagnostics, degenerate cells suggests a tumor.
As basis measures bed peace as well as clinical and echokardiografische monitoring are indicated in the hospital. Against the chest pain pain means can be given. Further, special measures depend on disease picture and a cause.
With a threatening Herzbeuteltamponade (see complications) a Perikardpunktion with derivative of the accumulated liquid takes place for discharge. With always recurring, heavy Ergussbildungen also an operational Fensterung of the heart bag can become necessary.
With a virus infection not steroidale Antiphlogistika and Glukokortikoide are given. The gift effected from antibiotics with bacterial infections, Antimykotika with mushroom illnesses are given.
With the other forms the respective basic illness is treated, e.g.: Immunsuppression when rheumatism tables the fever, stabilization or improvement of kidney or thyroid function, etc.
Two complications are of special importance: With the Herzbeuteltamponade can it by large exudate quantities of the Perikardergusses to the handicap of the heart filling come with the consequence of an influence congestion and a cardiogenic shock. In this case an immediate Entlastungspunktion must be accomplished. The chronic Perikarditis can result after fading away an acute inflammation of the heart bag and/or an insufficient treatment. Itself likewise disturbances of the ventricle filling can devoted by scarred growing together and calcifying of the heart bag (Perikarditis constrictiva, "tank heart "). The Vernarbungen can be cleared away in some cases by the heart surgeon.
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