Serous pericarditis

Inflammation of the fibrous sac surrounding the heart (pericardium), in which the predominant symptom is the formation and accumulation of serum exudate (effusion) in it - serous fluid, is diagnosed as serous pericarditis.

Epidemiology

According to clinical statistics, the prevalence of serous pericarditis in patients with systemic lupus erythematosus is estimated at 22-26%, with rheumatoid heart disease, on average, at 18%, and in the case of oncology, about 23%.

Causes of the serous pericarditis

Serous inflammation of the pericardium refers to the exudative (effusion) form of pathology, since there is a significant excess in the production of pericardial fluid compared to its reverse absorption - with the formation of a serous or serous-fibrinous  effusion in the pericardial cavity . It is the composition of the effusion that determines such main types as simply serous and serous-fibrinous pericarditis, which represent the same basic process and are the most common type of this condition. [1]

Usually serous pericarditis is not associated with infectious inflammation, for example, it develops in rheumatoid arthritis, which can affect the cardiovascular system with the development of rheumatic heart disease or  rheumatoid heart disease .

Other causes of serous inflammation of the pericardium include  systemic lupus erythematosus  (SLE),  [2] myocardial infarction ,  [3]heart injury, or cardiac surgery - as a reaction of the immune system in the form of postcardiotomy syndrome or  Dressler's syndrome . [4]In addition, such inflammation of the pericardial sac may be associated with kidney failure and excessive levels of nitrogen in the blood (azotemia), with malignant neoplasms in the chest and mediastinum and their radiation therapy.

But there is also serous-purulent pericarditis - with the presence of effusion with pus in the pericardial sac. And this is already infectious pericarditis, the causes of which may be:

• tuberculosis - with exudative  tuberculous pericarditis ; [5]
• infective endocarditis ;
• generalized sepsis in case of development  of systemic inflammatory response syndrome .

The most common bacterial causative agents of inflammation are streptococci and staphylococci, and among viruses, RNA enteroviruses Coxsackie viruses.

Also read:  Pericarditis: general information

Risk factors

Serous and serofibrinous pericarditis develop as a result of the already named diseases and pathological conditions, and their presence in the anamnesis is a risk factor for inflammation, inflammation of the pericardial sac with the formation of effusion in its cavity. [6]

Pathogenesis

In the absence of inflammation, the volume of fluid in the pericardial cavity does not exceed 50 ml; in composition, it is a filtered blood plasma and is necessary to reduce friction between the moving heart and adjacent tissues. For more details, see -  Fluid in the pericardial cavity

In the case of serous pericarditis, the amount of this fluid increases with the formation of an exudative pericardial effusion. Experts explain the pathogenesis of this process by the development of an immune system reaction with a characteristic activation of inflammatory mediators, in response to which the permeability of the walls of the smallest vessels supplying blood to the tissues of the pericardium increases, which leads to exudation (from Latin exsudare - to exude, sweat).

Serous exudate can also be produced by mesothelial cells of the inner serous layer of the pericardium (pericardium serosum).

More information in the article -  Exudative pericarditis

Symptoms of the serous pericarditis

If the formation of effusion in the cavity of the pericardial sac occurs slowly, there may be no noticeable signs of the pathological process. But when the volume of the pericardial effusion increases, symptoms such as:

• dyspnea;
• discomfort when breathing while lying down;
• cough;
• dizziness, weakness, feeling of heaviness in the chest;
• cardiopalmus;
• pain in the chest of varying intensity - behind the sternum or on the left side;
• swelling of the abdomen or lower extremities.

In rheumatoid arthritis, body temperature usually rises. And with postinfarction syndrome (usually occurring 10-30 days after a heart attack)

Serous pericarditis may be accompanied by fever, friction noise on auscultation, pleurisy, and pleural effusion.

Complications and consequences

Serous and serofibrinous pericarditis, especially recurrent, can lead to the complication of scarring of the space between the two layers of the pericardial sac, which limits the movement of the heart during each contraction.

As a result of involvement in the inflammatory process of the heart muscle, atrial fibrillation develops.

In patients with rheumatic heart disease, the consequences of pericarditis include the occurrence of focal calcium deposits in the pericardium.

In addition, rapid accumulation of fluid in the pericardium can cause  cardiac tamponade  —compression of the heart, often requiring surgical opening of the pericardium to remove excess fluid. [7]

Diagnostics of the serous pericarditis

How serous pericarditis is diagnosed - what tests are needed, what includes instrumental diagnosis, and what diseases differential diagnosis should exclude - is detailed in the publication  Diagnosis of Pericarditis

Treatment of the serous pericarditis

Serous pericarditis often resolves on its own, and NSAIDs remain the first-line treatment.

All the details in the material -  Treatment of pericarditis

Prevention

The essence of the prevention of serous inflammation of the pericardium is the timely detection and treatment of etiologically related diseases (infectious and non-infectious) and pathological conditions.

Forecast

The prognosis of the outcome of serous pericarditis is complicated not only by the possibility of its recurrence (in 15-32% of cases) and persistent chronic inflammation, but also by the threat of deadly cardiac tamponade.