acute pericarditis clinical manifestations

Written by Liu Ying
Cardiology
Updated on September 03, 2024
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The clinical manifestations of acute pericarditis include symptoms and signs. The symptoms of acute pericarditis are pain behind the sternum and in the precordial region, which often occurs during the fibrinous exudative phase of inflammation. The pain can radiate to the neck, left shoulder, left arm, and even the upper abdomen. The nature of the pain is sharp, related to respiratory movements. As the condition progresses, the pain can disappear and be replaced by difficulty breathing. Some patients may develop significant pericardial effusion leading to cardiac tamponade, resulting in symptoms such as difficulty breathing, edema, and other related symptoms. During acute pericarditis, the most diagnostically valuable sign is the pericardial friction rub, typically located in the precordial area. A typical friction rub can be heard consistent with atrial contraction, ventricular contraction, and ventricular relaxation, known as a triphasic friction rub, and so on.

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Written by Liu Ying
Cardiology
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Constrictive pericarditis clinical manifestations

Patients with constrictive pericarditis often have a history of pericarditis, pericardial effusion, malignant tumors, and other diseases. Some patients have an insidious onset with no obvious clinical symptoms in the early stages. The main symptoms can include palpitations, exertional dyspnea, decreased exercise tolerance, fatigue, enlarged liver, pleural effusion, abdominal effusion, and edema of the lower limbs. Patients with constrictive pericarditis commonly present with elevated jugular venous pressure, and often have a reduced pulse pressure. Most patients exhibit a negative apical beat during systole, with a commonly faster heart rate. The rhythm can be sinus, atrial, or ventricular, with premature contractions possible, as well as Kussmaul's sign. In the late stages, muscle atrophy, cachexia, and severe edema can occur.

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Written by Liu Ying
Cardiology
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Symptoms of acute pericarditis

Acute pericarditis is an acute inflammatory disease of the visceral and parietal layers of the pericardium, with the most common cause being viral infections. The hallmark of acute pericarditis is pain in the precardiac area behind the sternum. The nature of the pain is very sharp, typically occurring during the fibrinous exudation phase of inflammatory changes, caused by friction between the visceral and parietal layers of the pericardium. The pain can radiate to the neck, left shoulder, and even the upper abdomen. It is associated with respiratory movements and often worsens with coughing, deep breathing, or changing body positions. When fluid exudes into the pericardium, separating the visceral and parietal layers, the patient's pain may decrease or disappear. However, some patients may experience symptoms such as breathing difficulties and edema due to cardiac tamponade.

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Written by Tang Li
Cardiology
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What are the clinical considerations for acute pericarditis?

The treatment and prognosis of acute pericarditis mainly depend on the cause, and are also related to whether it is diagnosed and treated correctly early on. For various types of pericarditis, if constrictive syndrome occurs, pericardiocentesis should be performed immediately to relieve symptoms. In cases like tuberculous pericarditis, if not treated aggressively, it can usually progress to chronic constrictive pericarditis. Acute nonspecific pericarditis and post-cardiac injury syndrome may lead to recurrent attacks of pericarditis after the initial episode, known as recurrent pericarditis, with an incidence rate of about 20%-30%. This is one of the most difficult complications of acute pericarditis to manage. Clinically, it generally presents similar to acute pericarditis, with recurrent attacks months or years after the initial episode, accompanied by severe chest pain. Most patients should be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering over several months until the medication can be stopped. If ineffective, corticosteroid treatment may be administered; in severe cases, intravenous methylprednisolone may be given, and symptoms in most patients may improve within a few days. However, it is important to note that symptoms often reappear during steroid tapering.

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Written by Li Hai Wen
Cardiology
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Is pericarditis serious?

Pericarditis refers to a group of diseases mainly characterized by inflammation and effusion of the pericardium. The severity of pericarditis depends on the condition of the disease. Firstly, if the inflammation and effusion of the pericardium are not severe, patients often experience symptoms such as chest tightness or chest pain. In general, this type of pericarditis is not considered severe. Secondly, if the inflammation and effusion of the pericardium are more pronounced, it can lead to pericardial effusion, especially in cases of large amounts of pericardial fluid. At this time, the condition is often quite serious, and it is essential to undergo formal treatment under the guidance of a doctor, including pericardial drainage therapy.

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Written by Tang Li
Cardiology
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What are the clinical considerations for acute pericarditis?

The treatment and prognosis of acute pericarditis depend on the cause, as well as early diagnosis and correct treatment. For various types of pericarditis, such as those presenting with tamponade syndrome, pericardiocentesis should be performed to relieve symptoms. Tuberculous pericarditis, if not actively treated, can evolve into chronic constrictive pericarditis. Patients with acute nonspecific pericarditis and post-cardiac injury syndrome may experience recurrent pericarditis after their initial episode, which is the most challenging complication of acute pericarditis. Clinically, it presents similarly to acute pericarditis, with recurrent episodes months to years after the initial onset, accompanied by severe chest pain. Most patients can be treated again with high doses of non-steroidal anti-inflammatory drugs, slowly tapering to normal over several months. If ineffective, corticosteroid therapy may be administered. (Medications should be used under the guidance of a doctor according to specific circumstances.)