Chronic cardial compression

Description:

Chronic cardial compression (Latin of contsrictio — a prelum) is characterized by the thickening and an union of leaves of a pericardium (in 50% of cases their calcification) leading to a prelum of cameras of heart and restriction of their diastolic filling.

Chronic cardial compression symptoms:

• Occasionally the complaints characteristic of a dry pericardis can precede. Most often patients begin to be disturbed an asthma at an exercise stress, increased fatigue, weight loss, a loss of appetite. In the subsequent there are symptoms of right ventricular heart failure: weight and pains in right hypochondrium, peripheral hypostases, ascites.
• At the expressed clinical picture of a disease note a peculiar outward of the patient: the patient thin, a stomach is increased. Forced situation (orthopnea) is observed seldom. Cervical veins are expanded and are not fallen down on a breath. Kussmaul's symptom — swelling of cervical veins on a breath because of increase at the same time in venous pressure is characteristic. There is ascites which emergence quite often precedes emergence of hypostases standing, expansion of superficial veins of a stomach. Note arterial hypotension.
• At 1/3 patients define the paradoxical pulse which is characterized by decrease in filling on a breath as a result of decrease in the systolic ABP more than on 10 mm hg. The area of a top of heart is involved during a systole and stuck out during a diastole. Palpate the increased liver and a spleen.
• Cardiac sounds can be not changed, at a considerable obliteration of a cavity of a pericardium are muffled. At one third of patients in a diastole the pericardiac click as a result of the sharp termination of filling of ventricles in a diastole is listened.

Chronic cardial compression reasons:

Can arise after any defeat of a pericardium. In most cases develops after an acute or posttraumatic benign pericarditis. Carry to more rare origins tumors, radiation exposure, tuberculosis, heart operations.

Treatment of Chronic cardial compression:

Surgical treatment. Carry usually out a pericardectomy. The indication — increase in pressure in jugular veins more than 70-80 mm of water column. At suspicion on active tubercular process prepost therapy by antituberculous remedies. Operation consists in full removal of a pericardium between phrenic nerves with release of veins of heart from the fibrous fabric surrounding them. The majority of adverse effects is connected with low cordial emission as a result of the accompanying severe damage of a myocardium. Long-term results of such operation good: considerable improvement is observed at 90% of patients.
Conservative treatment is carried out at it is long the existing chronic cardial compression with involvement in process of a myocardium, the expressed congestive heart failure, a cachexia and disturbance of functions of a liver • Appoint diuretics and cardiac glycosides, in the absence of arterial hypotension captopril • Is shown it is necessary to remember that treatment of heart failure cardiac glycosides at patients with chronic cardial compression can lead to an aggravation of symptoms since the urezheniye of a rhythm is followed by reduction of cordial emission.
The forecast depends on a disease etiology. In most cases after a pericardectomy there occurs the expressed improvement.