Cardiovascular disorders

II/2.5: Pericarditis

II/2.5.1: Acute pericarditis

II/2.5.1.1: Fibrinous pericarditis

The most common form of pericarditis. Macroscopically, the dry fibrinous exudation becomes fibrous as a result of the heart’s movements and it creates the clinical image of villous heart (hairy heart). Auscultation is unmistakebly typical: friction murmurs during heartbeats. The cause is primarily sterile pericarditis associated with acute myocardial infarction (so-called epistenocardiac pericarditis).

Similarly to myocarditis, viral pericarditis can be caused by Coxsackie A and B, HSV or influenza virus infections. The leading symptom is chest pain, and it is often difficult to distinguish from acute myocardial infarction! Sterile fibrinous pericarditis can accompany uremia or be part of rheumatic fever (rheumatic pancarditis) or autoimmune diseases (PCP, SLE). After an open heart surgery – as a serositis usually following body cavity openings – iatrogenic pericarditis (postpericardiotomic pericarditis) occurs.

II/2.5.1.2: Serous pericarditis

It is a rare form which is mostly seen in polyserositis and pericardial carcinosis (carcinomatous pericarditis). In the latter case the fluid accumulation is tingled with blood.

II/2.5.1.3: Purulent pericarditis

It develops in direct bacterial or fungal infections when inflammation of the neighbouring organs spreads to the pericardium – e.g. thoracic or pleural empyema, lobar pneumonia, infective endocarditis, or myocardial abscess. Hematogenous spread via the blood flow (sepsis) is a rare phenomenon. Likewise, iatrogenic origin after cardiac surgeries is also very rare. In its serious form, the pericardiac sac fills with pus (pericardial empyema). The first sign of the process becoming chronic is the septation of the exudation.

II/2.5.2: Chronic pericarditis

II/2.5.2.1: Constrictive pericarditis

It is a result of the organization of undissolved exudation following acute pericarditis. Due to pericardial sac scarrification the narrowing of large (primarily venous) vascular trunks (stricture) is a severe complication of this condition, and – depending on its severity – it might lead to flow obstruction and circulatory failure.

II/2.5.2.2: Adhesive mediastinopericarditis

Scarred adhesion between the parietal pericardium and mediastinal structures.

II/2.5.2.3: Posttuberculotic pericarditis

It develops by the organization of large amount of cheesy exudate (tuberculous pericarditis) and partial calcification of the consequent pericardial fibrosis (so-called (so-called armored heart, or Panzerherz in German).