Chronic pericarditis. The pericardial space normally contains between 15-50 mL of fluid. Pericardial effusion is understood as the presence of a greater quantity of fluid. When the duration of the spill is more than 3 months with stable characteristics, it is considered chronic.
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- 1 Classification
- 1 Serous
- 2 Serosanguineous
- 3 Serofibrinous
- 4 Hemorrhagic
- 5 Chiloso
- 6 Cholesterol
- 2 Clinical picture
- 3 Physical exam
- 4 Complementary exams
- 5 Treatments
- 6 Sources
The characteristics of the pericardial fluid allow to classify the pericardial effusions in:
- Congestive heart failure
- Recurrent viral pericarditis
- Primary neoplasmor metastasis
- Thoracic contusion
- Collagen diseases.
- Post-cardiac surgery.
- Acute myocardial infarctionand anticoagulant treatment.
- Lymphatic obstruction.
The clinical and hemodynamic characteristics of the patient with chronic pericardial effusion vary in severity and depend on the time of fluid accumulation and the compliance of the pericardium. Many patients are asymptomatic, or have dyspnea on exertion, a feeling of heaviness, or fullness of the chest .
Massive effusions may be accompanied by cough, hoarseness, or dysphagia, when compression of the phrenic, recurrent laryngeal, or esophageal nerves occurs, respectively.
- The tip shock can be diffuse or absent. It can be palpated when the patient is in the supine position, but not when sitting: in others it can be palpated with the patient lying down and disappears when he adopts the left lateral decubitus position.
- Heart sounds may be muffled and vary in intensity with changes in the patient’s position due to redistribution of fluid in the pericardial cavity.
- Ewart’s sign (dullness below the angle of the left scapula) usually occurs in large effusions.
- They may also be present: protodiastolic noise, pericardial and pleural friction, and engorgement of the neck veins.
- Chest x– ray
- Study of pericardial fluid
- Biopsyof pericardium
Once the etiological diagnosis has been established, the treatment of the causal disease is indicated. If a specific etiology is not discovered, no treatment will be administered but the patient will be followed periodically. In large pericardial effusions, a pericardiocentesis will be performed, and in the event of a recurrence of the massive effusion, a pleuropericardial window or total pericardiectomy will be indicated.