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Chest pain of pericardial origin

  1. Gastroepato
  2. Cardiology
  3. Chest pain of pericardial origin
  4. Chest pain
  5. Myocardial infarction
  6. Coronary syndrome UA / NSTEMI
  7. Patient with ACS
    (Acute Coronary Syndrome)

notes by dott. Claudio Italiano

 

Definition of pericardial pain

The thoracic pain of pericarditis is often intense and sudden onset. The pain is acute, increases with the inspiration and the movement of the trunk and can be relieved by bending forward.
This type of pain may be due, at least in part, to often concomitant pleurisy. Together with this puncture pain, you can have a sense of pressure or deep pain that is sometimes radiated to the neck, arms and back.

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Pain can be accentuated by swallowing or coughing, whereas it is usually not affected by stress.

Particularly characteristic, but less frequent, is intermittent pain that appears with every heartbeat.

 Careful medical history can be useful in determining the etiology of pericarditis. A very common form of idiopathic or viral pericarditis is usually preceded by an infection of the upper airways, while tuberculous pericarditis is preceded by an old history (at least a few months) of asthenia, fever and weight loss.

Postinfectional pericarditis or Dressler's syndrome is primarily related to a recent transmural myocardial infarction, although sometimes this morbid event has not been clinically recognized.
On the basis of the anamnesis, other etiological motives such as uremia, lupus erythematosus, traumas, neoplasms or radiation syndrome may also be suspected.

At the physical examination, pericardial rubbing is characteristically found. This gross noise has three components: presystolic (atrial systole), systolic and diastolic, and one or all of these components may be present.
In general, rubbing is best heard at the end of exhalation with the patient in a sitting position.
 Rubbing can be reduced in intensity or disappear when the pericardial sheets are separated from one another by a spill.

Etiology of the causes of pericarditis

- Trauma: pericardiotomy, injection of m.d.c., perforations of the right ventricle from the catheter, pacemarker implantation, stroke on the thorax;

- Viral infections: coxackie virus, adenovirus, infectious mononucleosis, influenza, venereal lymphogranuloma, mycoplasma, AIDS;
- bacterial infections: TB, staphylococcal, pneumococcal, meningococcal, streptococcal, from haemophilus influenzae, chlamydiae,
rickettia
- fungi, histoplasm, aspergillus, amyloidosis
- Radiation
- Primitive tumors: mesothelioma, teratoma, fibroma, leiomyofibroma, lipoma
- Metastasis: bronchogenic carcinoma, breast carcinoma, lymphoma, leukemia, melanoma.
- Granulomatosis: diseases of collagen, rheumatic fever, SLE, vasculitis, scleroderma;
- Anticoagulants: heparin and dicumarolics
- Myocardial infarction or Dressler's syndrome
- Drugs: procainamide, disodiocromoglicate, hydralazine, dantrolene
- Dissecting aneurysm
- Hemopericardium
- Hydro pericardium.
- Chilo pericardio

Signs and symptoms

With pericarditis, chest pain and rubbing appear simultaneously, in contrast to acute myocardial infarction in which a rubbing usually follows the onset of chest pain by hours or days.

The objective findings found in cases of large pericardial or pericardial constricting syndrome are represented by the sign of Ewart (a small area of ​​hypophonesis, bronchial breath and tactile tremor increased near the angle of the left shoulder blade due to compression of the base of the left lung), inspiratory turgor of the veins of the neck and paradoxical pulse.

In acute pericarditis, the electrocardiogram usually shows an elevation of the ST segment. This finding is found in most of the derivations, with the exception of the AVR and the VI, in which we often have specular sub-levels. During acute pericarditis, the amplitude and shape of the T wave are usually unchanged and the elevated ST tract is concave, whereas in acute myocardial infarction T waves can be isoelectric or inverted and the ST segment appears convex.

 

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