Pericarditis: symptoms and causes

Pericarditis is inflammation of the outer lining of the heart. Most often it is infectious, rheumatic or post-infarction. Pericarditis has the following symptoms:

• Weakness;
• Constant pain behind the sternum, which intensifies when inhaling;
• Cough;
• Severe shortness of breath.

Pericarditis occurs with fluid leaking between the pericardial layers (observed with exudative pericarditis). This pathology is dangerous due to the development of suppuration and cardiac tamponade (when accumulated fluid compresses the heart and blood vessels) and may require immediate surgical intervention.

Pericarditis can be a symptom of a systemic, infectious, cardiac disease, as well as a complication of various pathologies of internal organs or injuries. Often it is pericarditis that becomes of paramount importance in the clinical picture of the disease, and other manifestations of pathology fade into the background. Diagnosis of pericarditis is not always made while the patient is alive; in approximately 4–7% of cases, signs of past pathology are determined only at autopsy. Pericarditis can occur at any age, but, as a rule, occurs among the adult and elderly population, and the incidence of pericarditis in females is higher than in males.

With serous pericarditis, the inflammatory process spreads to the serous tissue membrane of the heart (parietal, visceral plate and pericardial cavity). Permeability increases and blood vessels dilate, leukocytes infiltrate, fibrin is deposited, adhesions are added and scars are formed, pericardial layers become calcified and the heart is compressed.

Pericarditis has the following causes:

• Rheumatism (endocarditis and myocarditis are also affected);
• Tuberculosis (when infection spreads from foci in the lungs through the lymphatic ducts to the lymph nodes.)

Both diseases are manifestations of an infectious-allergic process.

Certain conditions increase the risk of developing pericarditis, including:

• Infectious and viral diseases - influenza, measles;
• Bacterial processes - tuberculosis, tonsillitis, scarlet fever;
• Sepsis;
• Fungal and parasitic infection;
• Pneumonia;
• Pleurisy;
• Endocarditis (lymphogenous or hematogenous route);
• Allergic damage (serum sickness, drug allergy);
• Systemic connective tissue diseases (lupus erythematosus, rheumatoid arthritis, rheumatism and others);
• Heart pathologies (myocardial infarction, endocarditis or myocarditis);
• Surgical interventions;
• Malignant processes;
• Metabolic disorders (toxic effects due to uremia and gout);
• Radiation damage;
• Heart malformations (pericardial cysts and diverticula);
• Edema;
• Hemodynamic disturbances (as a result, fluid accumulates in the pericardial space).

At the Yusupov Hospital, patients with pericarditis are provided with all types of treatment by highly qualified doctors. Specialists collect all anamnestic data in detail and conduct diagnostic studies using the latest equipment. The staff of the Yusupov Hospital takes care of their clients not only in a hospital setting, so patients with pericarditis are given precise clinical recommendations after discharge.

Classification of pericarditis

There are primary and secondary pericarditis. The disease can be limited, occupying the base of the heart, partial, or general diffuse (the entire serous membrane is involved).

Considering clinical data, pericarditis can be acute or chronic.

Acute pericarditis develops quickly, lasting no more than six months, among them there are:

• Fibrinous pericarditis (dry);
• Exudative;
• Serous-fibrinous pericarditis;
• Hemorrhagic;
• Purulent;
• With and without cardiac tamponade.

Chronic pericarditis develops slowly, lasts more than six months and is divided into:

• Effusion pericarditis;
• Adhesive;
• Exudative-adhesive;
• Asymptomatic;
• Pericarditis with functional disorders of cardiac activity;
• Pericarditis with extracardial adhesions;
• Constrictive;
• Pericarditis with dissemination of inflammatory granulomas.

Non-inflammatory pericarditis includes:

• Hydropericardium;
• Hemopericardium;
• Chylopericardium;
• Pneumopericardium;
• Effusion due to myxedema, uremia, gout.

Pericardial neoplasms include:

• Primary tumors (benign and malignant);
• Secondary;
• Paraneoplastic syndrome.

Among the rare diseases of the pericardium, pericardial and coelomic cysts are distinguished separately. Such cysts can be congenital or acquired.

Pericarditis and myocarditis: what is the difference?

The main distinguishing feature is that myocarditis is an inflammatory lesion of the heart muscle, and pericarditis is an inflammation of the lining of the heart. Myocardial symptoms may include fever, rapid heart rate, fatigue, difficulty breathing, and chest pain. Patients with pericarditis often complain of sharp chest pain, difficulty breathing, and pain when taking a deep breath. For diagnostics use:

• Chest X-ray;
• Electrocardiogram;
• Echocardiogram;
• UAC;
• Biopsy of areas of the heart muscle.

The International Statistical Classification of Diseases and Problems, 10th revision (ICD-10), currently in use, is a normative document that ensures the formation of unified statistical control over the activities of medical institutions, assessment of the epidemiological situation in the country, and allows for the unity and comparability of incoming medical data [1] . ICD-10 is one of the important methodological tools for processing statistical data, which is extremely necessary for automating basic planning, regulatory and management work [2]. Unfortunately, this classification contains errors, both in the structural design of clinical sections and in the coding of a number of diseases. Some of the diagnoses that exist in it sound somewhat absurd; there is a confusion of placement of individual polyetiological diseases and syndromes in sections, which are often located in chapters that have a very indirect relationship to this nosology. In addition, many nosological forms, syndromes and symptoms that are currently common are not included in the accepted classification, which undoubtedly significantly limits the practical application of ICD-10.

The variety of different forms of diseases complicates the structure of the classification, so the latest revision has become much larger in volume and was accompanied by extensive guidelines, unfortunately, often without taking into account clinical practice. As a result, some of the clinical diagnoses ended up within the limits of unrefined conditions or conditions that were not sufficiently differentiated, and not in the headings or subheadings of the corresponding sections of the classification.

A number of difficulties arise with regard to the topographic classifications and terms used in ICD-10, many of which are imprecise, contradictory and do not correspond to clinical practice. Unfortunately, it should be noted that ICD-10 cannot currently be recommended as a model for terminology and recording of clinical diagnoses in medical records and other medical records.

To solve the problem of uniform standardization of medical diagnoses and statistical records, back in the late 70s of the last century, the idea arose of creating a “family” of classifications of diseases and health problems based on the ICD, adapted to a specific specialty, taking into account modern achievements of medical science.

Classification options for dentists, oncologists, dermatologists, rheumatologists and orthopedists, pediatricians, psychiatrists, and general practitioners have been published and recommended by WHO. Unfortunately, in the field of andrology there is still no unified classification [2].

Currently, the Research Institute of Urology is developing printed and electronic versions of a similar classification for urology and andrology, which is based on three-digit and four-digit ICD-10 codes. The coding system for urological and andrological diseases is presented in the form of a tree, where each subnode refines the information of the previous node. When forming a subnode, a number from zero to nine is added to the main code through a dot. The proposed system also provides for taking into account the localization of the pathological process, its stage and/or phase [3-5].

The creation of a printed and electronic version of a new unified clinical and statistical classification of andrological diseases will allow:

• facilitate data collection and improve the analysis of statistical material on andrology by increasing the reliability of statistical information and reducing the number of errors due to inconsistency of clinical diagnoses with ICD-10 diagnoses;
• provide a detailed assessment of the complexity of clinical cases and final treatment results when providing specialized (including high-tech) medical care;
• standardize the formulation of andrological diagnoses in medical documents and computer information systems of health authorities of the Russian Federation;
• improve the economic and statistical analysis of the provision of medical care in the field of andrology in the interests of healthcare of the Russian Federation, individual medical institutions and compulsory health insurance (CHI);
• optimize costs for diagnosis and treatment of andrological diseases.

It should be taken into account that andrological diseases, as a rule, are multi-etiological and many of them do not fit only into the framework of the block “Diseases of the male genital organs”. The modern concept of andrology is, of course, based on interdisciplinary interaction and is at the intersection of related medical disciplines (urology, endocrinology, psychiatry, genetics, neurology, therapy, etc.). Therefore, andrological diseases are heterogeneous in nature and are widely represented in different sections of ICD-10 (Table 1).

Table 1. General classification of andrological diseases according to ICD-10 and proposals for its correction

This summary table shows those symptoms, syndromes and nosological forms according to ICD10 that a practicing specialist in the field of andrology encounters in real practice. At the same time, in our opinion, some of them no longer correspond to the modern understanding of pathophysiological processes and require terminological and classification clarification (right column).

Naturally, the above classification needs to be supplemented and refined, and fundamental amendments be made taking into account interdisciplinary interaction. With our publication, we would like to provoke a discussion among specialists in the field of andrology, the main goal of which would be to create a single, integral classification of andrological diseases. This is undoubtedly valuable and convenient for medical practitioners, health authorities, scientific research, and insurance companies. We will be grateful for your comments and remarks, which can be sent to the email address

Key words: ICD-10, andrological diseases, clinical and statistical classification.

Keywords : ICD-10, andrology diseases, clinical and statistical classification.

Literature

1. International classification of diseases and related health problems. WHO, 1992
2. Order of the Ministry of Health of the Russian Federation dated May 27, 1997 No. 170 (as amended on January 12, 1998) “On the transition of health authorities and institutions of the Russian Federation to the international statistical classification of diseases and health-related problems of the X revision.”
3. Sivkov A.V., Kakorina E.P., Keshishev N.G. Unified clinical and statistical classification of urological diagnoses // Materials of the XI Congress of Urologists of Russia. M. 2007. pp. 598-599.
4. Unified clinical and statistical classification of urolithiasis / Apolikhin O.I., Dzeranov N.K., Sivkov A.V., Kakorina E.P., Keshishev N.G. // Urology. 2008. No. 6. P. 3-6.
5. On the creation of a unified clinical and statistical classification of oncological urological diseases using the example of kidney tumors / Apolikhin O.I., Sivkov A.V., Chernyshev Yu.V., Kakorina E.P., Keshishev N.G., Zhernov A.A. // Experimental and clinical urology. 2010. No. 1. pp. 23-28.