Pericarditis

Case report:

A 27 year old patient appears in ambulatory practice and reported on for three weeks increasing power loss, night sweats, palpitations, insomnia and Belastungsluftnot. Moreover, he had noticed in the last few days a high pulse rate. About three weeks ago a violent respiratory infection expired, the was accompanied by dry cough and retrosternal chest pain.

Diagnosis:

On physical examination, a tachycardia at 110 beats per minute with little pronounced arrhythmia and extrasystoles individual falls on. In addition, it can be shown with a soft, holosystolischen noise over the apex, a third heart sound. The body temperature is measured with 37.8 � C, the blood pressure is 110 / 70mmHg, liver and spleen are not enlarged palpable, the physical lung findings are unremarkable. In ECG are a significant sinus arrhythmia and supraventricular extrasystoles increased and also hinted ST elevations, especially in the left ventricular leads, registered. Routine blood tests show a moderate increase to 20mm BSG N.W. in the first hour, a slight leukocytosis with 12,000 / ul, combined with a discreet differential blood count, CRP is increased slightly with 7mg / dl. Specific cardiac enzymes are within the normal range. In the following echocardiographic examination of cardiology specialist a significant pericardial effusion before about 200 ml is detected with less dilation of the left ventricle and low-grade relative mitral regurgitation. Significant wall motion abnormalities are not registered.

Pathogenesis:

In so-called idiopathic pericarditis enteroviruses such as Coxsackie viruses and Echo are the predominant pathogens. However, in severe cases can also be involved in bacterial pathogens such as pneumococcus, Staphylococcus aureus or Streptococcus pyogenes, they were detected in about half of the bacterial pericarditis. Other pathogens such as E. coli, Proteus species, Pseudomonas aeruginosa, Salmonella and Shigella, Neisseria meningitidis, chlamydia, mycoplasma and Borrelia burgdorferi can also be saved in rare cases as a pathogen. In patients with florid tuberculosis specific pericarditis must be considered to be considered in the differential diagnosis even in immunocompetent disturbed patients (for example, AIDS).

Therapy:

In the rather small extent perikarditischen disease with viral etiology obviously (this should be backed up serologically), there is no causal therapy. A puncture of the pericardial effusion appears not indicated for diagnostic and hemodynamic reasons in the outpatient setting. It should be prescribed bed rest and avoiding efforts in the next four weeks. Corticosteroids have shown no therapeutic benefit in controlled trials; ACE (angiotensin converting enzyme) inhibitors and calcium channel blockers (ex. Amlodipine ) were effective in experiments with myocarditis, there are compelling clinical data for these substances do not. The prognosis of viral pericarditis is quite favorable, problematic symptoms in terms of prognosis are persistent arrhythmias, cardiomegaly and developing heart