CHRONIC ADHESIVE PERICARDITIS

This condition occurs following an attack of fibrinous pericarditis leading to adhesion between the two layers of pericardium and to the surrounding structures of the mediastinum. There is usually no symptom during life.

SiINGS OF CHRONIC ADHESIVE PERICARDITIS

  1. Indrawing of posterior and lateral aspect of chest wall during systole (Broadbent’s sign).
  2. Pulsus paradoxus.
  3. Fixed apex beat-no change with posture. Sometimes there may be indrawing in the area of apical impulse.

INVESTIGATIONS

helpful for the diagnosis. Chest X-ray, CT scan, MRI are

TREATMENT OF PERICARDITIS

Acute Dry Pericarditis

  1. Rest in bed till pain subsides.
  2. Analgesics: NSAIDS are very helpful.
  3. Specific therapy: Where the underlying cause is tuberculosis, antituberculous chemotherapy or appropriate antibiotics in pyogenic cases should be instituted. Sometimes steroids may also be given.

Pericardial Effusion

The above treatment is to be continued along with pericardial paracentesis.

Pericardial paracentesis is done to diagnose the condition or when the character of the fluid is to be studied for determining the aetiology and as an emergency for decompression of heart in cardiac tamponade.

CHRONIC ADHESIVE PERICARDITIS

Site of puncture

  1. Just outside the apex beat-commonly done and this is a safe procedure.
  2. In between the ensiform cartilage and left costal arch.
  3. Parasternal line-just outside the surface marking of internal mammary artery.
  4. In the scapular line along the inferior angle of the scapula. In tuberculous pericardial effusion anti-tuberculous regime should be continued. Steroids are helpful.

In Pyogenic pericarditis apart from appropriate antibiotics surgical drainage should be considered early. Whenever necessary, surgical treatment should be undertaken. This is particularly indicated when there is oedema and exercise intolerance. Sometimes the operation is very difficult and cardiopulmonary by-pass is of value.

Chronic Constrictive and Adhesive Pericarditis

After preoperative treatment with proper antibiotics surgical Areatment (Pericardiactomy) should be undertaken.

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