PERICARDITE

Etiologie
- idiopatica

- infectioasa: bacteriene, TBC, virale,

parazitoze : trichineloza,
echinococoza
- neoplazii
- vasculite/boli de tesut conjunctiv

- hipersensibilitate
Etiologie

- boli ale tesutrilor vecine ( miocard,

pleura, mediastin,esofag, abces subfrenic, pancreatita, )

- boli metabolice (mixedem, insuf renala)

- traumatisme

- iatrogen insertie pacemaker,

scleroterapie varice esofagiene,
doxorubicina, radiatii X
Lichid pericardic

- transudat
- Insuficienta cardiaca, Sindr nefrotic,
Sindr retentie volumica)

- exudat
- infectii, neoplazii,boli tesut conjunctiv,
imunopatii, boli tes vecine)
- proteine >45mg/dl, LDH > 200U/L
Lichid pericardic

- sero-hemoragic ( neoplazii, infectii + sindr.

hemoragipar, terapie anticoagulanta)

- hemopericard - traumatisme

- chilopericard comunicatie cu duct toracic,

hamartom chistic,
 PERICARDITE ACUTE

Manifestari clinice

- debut acut, uneori insidios

- durere
- simptome asociate: tuse, etc
- febra
- asimptomatic
 PERICARDITE ACUTE
Manifestari clinice

- frecatura pericardica

- Zg cardiace asurzite
- matitate cardiaca marita

- semn Pins Ewart suflu

interscapulovertebral stg
Rx cord plaman

- cardiomegalie
> 250 ml lichid pericardic

- silueta cardiaca
stearsa carafa

- circulatie
pulmonara redusa
Rx cord plaman
ECG

- supradenivelare difuza ST
- alternanta electrica
- microvoltaj
- aritmii

- cardiomegalie > 250 ml lichid pericardic

 ECO
- spatiu transonic
pericardic
- lichid putin: posterir,
in sistola
- lichid moderat: anterior,
in diastola - circumfeterntial
- lichid important:
tamponada

- pericar ingrosat +/-

- structuri ecodense in
lichidul pericardardic
 ECO
- semne tamponada
- AD colaps protdiastolic

- VD descrec dimensiunile,
colaps protodiastolic
- AS colaps telediastolic

- VS miscare paradoxala
a peretelui liber
- Doppler creste inspir flux
tricuspida, scade
concomitent fluxul mitrala

- VCI < 50% reducere in

inspir
 CT, RMN
- spatiu transonic
pericardic

- pericar ingrosat +/-

- structuri ecodense in
lichidul pericardardic

- structuri mediastinale,
pulmonare
Pericardocenteza
Pericardocenteza
- examen lichid pericardic
- exudat, transudat
- ex bacteriologic
- ex biochimic: ph, glucoza,
LDH, ADA, amilaza,
- ex imunologice: complement,
FR, etc
- ex citologic - imunocitochimic

- Pericardotomie - biopsia pericardica

- ex. imunohistochimie
Complicatii
- tamponada pericardica
compresie cardiaca prin cresterea
presiunii in sacul pericardic

egalizarea presiunii in VD cu VS

reducerea umplerii diastolice

scaderea debitului cardiac

hTA
hipoperfuzie coronara
Bradicardie sinusala, disociatie electro-mecanica
DECES
- Tamponada pericardica aparitie acuta,
subacuta
- dispnee

- tahicardie, bradicardie
- Zg cardiace asurzite
- soc apexian absent
- jugulare turgestcente, hepatomegalie
- hTA
- puls paradoxal reducerea inspiratorie puls
( TA <10mmHg in inspir)
- puls alternant
- recurenta pericardita
- 20-30% cazuri
Tratament

- antiinflamatorii aspirina, indometacina,

ibuprofen,
- corticoterapie

- tamponada pericardocenteza, drenaj

Pericardita tbc

- febra, subfebrilitate

- lichid pericardic exudat serocitrin,

serohemoragic, glucoza <
limfocite, BK - prezent
- biopsie pericard granulom tbc

- evolutie resorbtie, recidive,

pericardita constrictiva

- tratament tuberculostatice: hidrazida,

pirazinamida, rifampicina

- antiinflamatorii
Pericardita neoplazica

- debut insidios, evolutie progeresiva

- lichid pericardic exudat serocitrin,

serohemoragic, glucoza <
limfocite, celule atipice
- biopsie pericard celule atipice,
imunohistochimie

- evolutie tamponada, recidive

- tratament pericardectomie larga

- drenaj pericardic
PERICARDITA CONSTRICTIVA

Etiologie

- idiopatica

- infectioasa:
TBC, bacteriene,

- neoplazii

- radiatii
Manifestari clinice

- durere toracica
- dispnee

- jugulare turgescente,
hepatomegalie, edeme

- cord mic
- vibranta pericardica
ECG
- P largi
- blocuri AV
- Fibrilatie atriala - uneori
ECG
- P largi
- blocuri AV
- Fibrilatie atriala
uneori
Rx
- cord mic

- pericard
ingrosat,
calcificari
ECO

- pericard ingrosat, calcificari

- VD, VS dimensiuni normale,

oprirea expansiunii diastolice
- tricuspida - cresterea fluxului inspirator

- mitrala - scade fluxului inspirator

- pletora cava
CT, RMN
- pericard ingrosat, calcificari
Tratament

- pericardectomia

- mortalitate 6- 25%

- supravietuirea la 5 ani 84%