[end-clinical]

¹  The exciting functions of orange peel are documented at length in academic literature – for instance, did you know that the juice from orange peel is highly flammable?

90,000 Heart disease and oral health

I It is increasingly heard that oral health is essential to maintaining overall health. At the same time, a larger proportion of the population of developed countries suffers from periodontal or gum disease, which often remain undiagnosed. This fact may be due to the fact that in the absence of pain in the teeth, the patient does not seek to visit the dentist, and the therapist rarely pays attention to the health of the oral cavity.

However, according to Delta Dental, there are now two specific links between oral health and heart disease. First, recent studies have shown that if you have moderate to advanced gum disease, you are at a higher risk of developing heart disease than people with healthy gums. And secondly, the state of health of the oral cavity can warn the doctor about the presence of various diseases and abnormalities, including disorders of the heart.

How are these two types of diseases related?

Oral health and heart disease are linked through the spread of bacteria from the mouth to other areas of the body through the bloodstream. If bacteria reach the heart, they can attach to vulnerable areas and cause inflammation. All this can lead to the development of diseases such as endocarditis or, in other words, an infection of the inner lining of the heart, which is confirmed by the data of the Mayo Clinic.The development of other cardiovascular diseases such as atherosclerosis (narrowing of the arteries) and stroke, according to the Cleveland Clinic, may increase the risk of heart disease and stroke

Symptoms and signs

According to the American Association of Periodontics (AAP), you can have gum disease, even at an early stage, if you have any of the following:

• Redness, swelling of the gums and soreness when touched;

90,019 gums bleed while eating, brushing or flossing;

• You notice purulent blisters or other signs of infection around your gums and teeth;
• gums seem to “slide” along the surface of the tooth;
• You often notice bad breath or bad taste in your mouth;
• Some teeth are loose or move away from other teeth.

Preventive measures

Good hygiene practices and regular dental check-ups are the best way to prevent gum disease. The American Dental Association (ADA) guidelines on the Mouth Healthy website suggest that you brush your teeth twice a day with a comfortable, soft bristled toothbrush that will reach the surface of each tooth. ADA also recommends using its approved toothpastes such as Colgate Total®, which has been proven to promote gum health.You should also brush your teeth daily with dental floss and have regular professional oral hygiene with your dentist.

By taking care of the health of the oral cavity in advance, you can protect yourself from the development of heart diseases associated with weakened oral health, as well as maintain a healthy smile, snow-white and beautiful for the rest of your life.

90,000 Causes and treatment of fluid in the heart | Cash kaleidoscope. ru

Fluid accumulates in the heart as a result of inflammation of the heart membrane.

This disease is quite serious, with chronic forms of the disease, the development of heart failure is possible.

Tamponade, or rapid accumulation of fluid in the pericardium, leads to cardiac arrest. In this case, only urgent assistance will help.

In order not to start the disease, you should recognize it in time and start treatment in a timely manner.

The two-layer membrane of the heart, consisting of connective tissue, protects the main organ from abrasion. According to some assumptions, the pericardium is a source of various biologically active elements that are involved in the regulation of the heart.The inner layer of the shell is securely attached to the heart muscle. Between the layers of the bursa there is a serous, colorless liquid, which allows the sheets of the membrane to slide without friction. Normally, it should be no more than 30 ml.

If the amount of fluid has increased significantly, this indicates the formation of pericarditis. Pericarditis can manifest itself not only in an increase in the amount of fluid, but also in the appearance of adhesions, inflammatory changes in the membrane.

Causes

Pericarditis appears as a result of complications of the underlying disease.There are various reasons for the development of the disease:

• Viral, bacterial and fungal infections, as well as the effect of parasites, leads to inflammatory processes in the pericardium.
• Rheumatoid arthritis, dermatomyositis, scleroderma or systemic lupus erythematosus contribute to the development of the disease.
• Myocardial infarction or lung disease leads to pericarditis after a few days.
• Metabolic disorders can stimulate the onset of heart disease.
• Penetrating chest trauma contributes to the formation of traumatic pericarditis.
• Radiation and oncological diseases, surgical interventions, including coronary artery bypass grafting, lead to pericarditis. If the cause is not established, then the resulting pericarditis is idiopathic.

Inflammation requires compulsory treatment, in the absence of which protein and calcifications will begin to be deposited between the layers of the heart membrane. This will lead to adhesion of layers and disruption of the functionality of the entire pericardium; it will not be able to protect the heart muscle from abrasion.The consequence will be a limitation of the amplitude of heart contractions, which ultimately will contribute to the growth of heart failure.

Types of pericarditis

The disease, depending on the nature of the fluid, is classified into:

• dry – the volume of serous fluid in the membrane does not change or becomes less;
• fibrinous – characterized by a slight increase in fluid volume and the presence of a large amount of protein;
• exudative – characterized by a large volume of accumulated fluid.

Pericarditis can be acute, lasting no more than 2 months, and chronic, lasting more than six months.

Due to the fact that inflammation of the pericardium rarely occurs separately from other diseases, this disease goes unnoticed.

Symptoms can be expressed in varying degrees, their effect depends on the volume of fluid in the pericardium, on the speed of its accumulation, on the severity of the underlying disease. The onset of the disease can be characterized by fever, severe general weakness, muscle pain and headaches.The primary signs of the disease may be absent or mild. Many do not even associate these signs with the problems of the main organ, so the cardiologist has to treat an already advanced disease.

Excess fluid gradually increases pressure on the heart, resulting in the following symptoms:

• chest pain;
• Difficulty breathing;
• persistent dry cough;
• the occurrence of pain in the scapula, neck or left arm;
• increased pain during exertion;
• Difficulty swallowing;
• attacks of palpitations.

When fluid builds up quickly, cardiac tamponade forms, which further compresses it, preventing it from contracting. Signs of tamponade are:

• severe pain in the chest;
• persistent shortness of breath;
• feeling of anxiety;
• feeling of lack of air;
• inability to alleviate the condition in any position of the body.

The appearance of these symptoms indicates the need for urgent medical attention due to the likelihood of cardiac arrest.

Diagnostics

In order to detect an ailment, complex procedures are carried out to determine the level of work of the heart muscle and the state of the pericardium:

• auscultation allows you to hear the friction noise of the membrane, which may be absent at an early stage of the disease;
• an electrocardiogram shows all the specific changes, with its help it is possible to identify myocarditis;
• An echocardiogram can detect even small changes in fluid;
• X-ray of the chest organs makes it possible to see the heart enlarged as a result of the accumulation of fluid, and also to determine the severity of the disease;
• Ultrasound of the heart allows you to detect an increase in the volume of serous fluid, inflammatory processes, to determine functional failures of the heart;
• Computed tomography makes it possible to find out the exact volume of fluid in the shell and other data.

Treatment

To get rid of pericarditis, you must first determine the cause.

Having cured the underlying disease, the complication can also be eliminated.

For optimal and correct treatment, the patient must be hospitalized for observation.

If the disease is not cured in a timely manner, then it turns into a chronic stage, posing a great danger to the patient’s life.

Treatment of acute pericarditis:

• taking medications for the treatment of the underlying disease;
• taking non-steroidal anti-inflammatory drugs and corticosteroids;
• Injection of corticosteroids into the cardiac sheath;
• Pericardial puncture is sometimes performed for therapeutic or diagnostic purposes.

If tamponade or purulent pericarditis was found, then in this case pericarditis is treated with surgical methods:

• aspiration of excess fluid with a needle, its analysis and the appointment of further treatment;
• removal of part of the thickened layer of the pericardium;
• pericardiectomy.

Proper treatment and implementation of all recommendations after heart surgery will help the body to rehabilitate with the least health complications.

source

COVID-19 – heart disease? The main thing about the pandemic from foreign media

COVID-19 most often gives complications to the lungs, but it is known that the disease-causing SARS-CoV-2 virus directly or indirectly damages other organs, including the heart. Recently, a lot of data has accumulated that indicate that heart damage is not uncommon, even in those who have been ill with mild or no symptoms. Scientific American writes about this.

The article begins with the stories of American athletes who developed heart problems after COVID-19.Usually it is myocarditis – inflammation of the heart muscle. In half of all cases (not only with COVID-19), myocarditis passes without consequences, but sometimes arrhythmia occurs because of it, and someone dies.

On this topic

According to one estimate, myocarditis is the cause of 7% of deaths of those infected with the new coronavirus. True, some doctors and scientists consider this number to be overestimated. In another study, which examined health workers who had recovered, ten weeks after the onset of symptoms, 37% were diagnosed with myocarditis or myopericarditis (this is when both the muscle and the lining of the heart are inflamed).True, the article with the results has not yet been reviewed by independent scientists. A study in Germany showed that 78% of those who had recovered after two months have abnormalities in the work of the heart, 60% have myocarditis. Most of them had mild to moderate COVID-19.

Even severe myocarditis often goes away on its own, you just need to be observed by a doctor, sometimes – to take medications. But this is not always the case, and athletes are especially at risk. It is better for them to give up competition for three to six months in order not to get arrhythmias or die.

Disturbing news from Europe

More and more new cases of COVID-19 are being registered in Europe. In Spain and France, the count is again in the thousands, in some places there are daily “records”. Science says what has changed since spring and what experts are proposing.

The new statistics should be carefully compared to the April peaks. Now they test much more often (in most countries, positive results are less than 3%), it is easy to get masks (at first they were not even advised to wear them), mobile applications for tracking contacts have appeared (although many of them are far from perfect, but about the best ones it is difficult say how good they are), and now they treat better.Nevertheless, new cases suggest that the authorities of European countries lifted too many restrictions too early.

Outbreaks occur in offices, and COVID-19 is “younger” because people go to parties as if nothing had happened. Newly opened schools can add even more problems. Until the death rate has jumped, but it is a matter of time before the elderly start to get sick.

Different countries have their own restrictions, but within one country the rules are either toughened up, then softened, then again toughened up.It would be nice to establish uniform requirements for all, but the European Union does not have such powers.

On this topic

Compared to spring, more is known about the virus, and therefore the measures to combat its spread have changed. Hand washing is not considered that important because dirty surfaces do not play a significant role. In the spring, in some places it was not even possible to run down the street, but now attention is paid to what is happening in the premises.

Experts believe that the most important thing is to identify disease clusters and cases of “super-spread”: according to some estimates, 10% of those infected provide 80% of new infections.One should look not only for those whom a person could infect, but also those from whom he could get the virus. One expert interviewed by Science suggests quarantining only possible participants in the “superproliferation” along with those who have found the virus. But this should be done immediately, and after five days these people should be tested. Then resources will be used in the best possible way and it will be possible to better understand how clusters generally arise.

Probably, all this will not be enough, and at some point there will be so many patients again that stricter restrictions will have to be introduced.But, perhaps, this time it will be possible to avoid complete lockdowns.

The unfortunate flight in China

An example of “superproliferation” is the case in China, reported in the scientific journal JAMA Internal Medicine and retold in The New York Times.

On January 19, a group of Buddhists went to the ceremony in the city of Ningbo, which is located almost a thousand kilometers from Wuhan. The pilgrims traveled by bus. In one of them was a woman who had dined with friends from Hubei province two days earlier.It is in Hubei, Wuhan, where an outbreak of a strange disease now known as COVID-19 occurred shortly before.

Within a few days, 23 passengers on the bus also fell ill. Chinese scientists have found out the circumstances of the incident. Even those who were sitting in the last row, that is, seven rows from that woman, were infected. The only thing that could somehow help was open windows or a place near the doors.

On this topic

It is also known that 68 people were traveling on the bus, all were without masks, an air conditioner was installed inside, and a one-way trip took 50 minutes.There was also a second bus with 60 passengers, but no one got sick there. An article in JAMA Internal Medicine says the woman had no symptoms, and a preprint of the same article, published in China, said that the day before, the woman felt unwell, took medication, but did not go to the doctor.

This case serves as further confirmation that SARS-CoV-2 is transmitted not only with relatively large droplets of mucus, but also through the air with tiny particles. In addition to the passengers of one of the buses, seven more participants in the ceremony in the temple fell ill.All of them had close contact with an infected woman. The ceremony lasted 2.5 hours, then the people dined together in a spacious but unventilated room. Then those who got there by buses took the same places and went back.

With the approach of cold weather, people will increasingly find themselves in similar situations. If possible, large crowds should be avoided in poorly ventilated areas where masks are not worn.

Prepared by Marat Kuzaev

90,000 Heart sounds: cardiologist of the FTsVMT Pavel Zolotukhin talks about heart murmurs in adults

Heart murmur in adults

Sometimes, when listening (auscultation) of the heart, doctors talk about the presence of some kind of “noise”.What are these sounds? Are they dangerous to health? Are there signs of heart disease? Let’s try to figure it out.

The article was published in the new issue of the journal of the Center for High Medical Technologies.

Read entire issue

The work of the heart is always accompanied by sounds. In the overwhelming majority of cases, there are two of them. They are called the first and second heart sounds because they follow each other and make up the heart cycle together. Tones are associated with vibrations of various structures of the heart, as well as the muscles and walls of blood vessels during the movement of blood.The cardiac cycle consists of two large phases. The first phase, which begins with the first tone, is systole, when blood is expelled from the heart by the force of muscle contraction into large vessels (aorta and pulmonary artery). Therefore, the first heart sound is also called systolic. The second phase begins with the second tone and is called diastole. At this time, the heart muscle relaxes, and the chambers of the heart are filled with a new portion of blood. Another name for the second tone is diastolic. Heart sounds have certain signs that characterize their duration, sonority, time of occurrence.

All other sounds that occur while listening to the heart are called “noises”. The characteristics of the noise depend on the general condition of the person, his constitution, the frequency of the rhythm and many other factors. It is important to understand that any sound outside the normal two-tone cardiac cycle requires compulsory comprehensive assessment and attention.

Noises are divided into two large groups: organic and functional.

The first group – organic murmurs – occurs with various structural changes in the heart.This means that they are based on heart defects – congenital or acquired. The noise may indicate, for example, damage to the heart valves – valve stenosis, valvular insufficiency, or their simultaneous combination. Organic noise also appears with cardiomyopathy (enlargement of the cavity of the heart chambers or hypertrophy (thickening) of the myocardium), endocarditis (inflammation of the inner lining of the heart (endocardium), acute pericarditis (inflammation of the pericardial sheets lining the heart outside).All of these pathologies are very serious and life-threatening conditions that require urgent medical attention. Therefore, the presence of “murmur” in the heart is an important signal for additional diagnostics and detection of the disease.

The second group of murmurs, the so-called functional murmurs, are either not associated with the heart, or are based on abnormalities that do not affect its work. The causes of functional noise are different. They can occur due to vegetative-vascular dystonia, as well as during the period of rapid growth in children and adolescents.Also, sometimes they testify to some features of the structure of the human heart that arose during intrauterine development. In this case, a systolic murmur can accompany a person throughout his life. In addition, functional murmurs can be caused by the anatomical features of large bronchi located next to the aorta and pulmonary artery, which simply “squeeze” these vessels with accelerated blood flow through their valves. Prolonged overstrain, both mental and mental, and physical, can contribute to the appearance of noise.One of the common causes of sound phenomena is pregnancy, during which there is an increase in the volume of circulating blood in the mother’s body for optimal blood supply to the fetus. In this regard, during pregnancy, changes in intracardiac blood flow also occur with listening to systolic murmur. In some cases, functional murmurs, although not associated with problems in the heart itself, often indicate other, sometimes serious diseases. Functional noises can also appear against the background of metabolic disorders.For example, with anemia (a decrease in hemoglobin in the blood), thyrotoxicosis (an excess of thyroid hormones) or with fever.

Very often the patient does not even suspect about the presence of heart murmurs, and even more so, about the type and cause of their occurrence. A heart murmur can be diagnosed by a doctor while listening to it. You need to see a doctor if you have any of the following symptoms:

Symptoms of a murmur in the heart:

• Rapid heart rate at rest and light exertion.
• Shortness of breath. Pay attention to your health if even walking makes you short of breath.
• Chest pain that worsens after exercise.
• Blue lips and fingertips from brisk walking or running.
• Swelling of the extremities.

The presence of one or more of the above symptoms is a reason to see a doctor. And remember – heart murmur is not always caused by a serious illness.But all the same, you should undergo an examination on time in order to exclude such a disease or, if it is detected, to start treatment in a timely manner.

Pericarditis: diagnosis and treatment of heart inflammation in Odessa

Types of pericarditis

Distinguish between dry and exudative pericarditis.

At dry pericarditis there is almost no fluid, and the pericardial sheets rub against each other. Because of this, there is a very strong constant pain, aggravated by breathing.

At exudative pericardium , on the contrary, a huge amount of fluid accumulates between the leaves of the heart sac. It compresses the chambers of the heart, and the heart cannot cope with its function. The patient develops heart failure, and in the most severe cases, a tamponade: the heart cannot contract and the person dies.

If pericarditis is left untreated, pericardial tissue may degenerate and acute pericarditis becomes chronic.

Over time, the fluid dissolves, the walls of the pericardium thicken, the cavity is overgrown and the so-called constrictive pericarditis occurs.It is also called the “carapace heart”: the pericardium forms a hard carapace around the heart, which prevents the heart from contracting. It beats inside, but cannot fully fill with blood and throw it out.

Causes of pericarditis

Most often, it is impossible to determine the exact cause of pericarditis. It almost always develops as a complication of other diseases or injuries. If pericarditis is not treated, it quickly becomes the main problem – not only because inflammation is accompanied by severe pain in the heart, but also because its consequences are much more dangerous than most diseases that led to inflammation.

The main causes of pericarditis include:

• infections and viruses are the most common cause;
• diseases caused by bacteria, including rheumatism and tuberculosis;
• fungal diseases: often they are latent, and pericarditis develops already in the late stages;
• pericardial injuries: gunshot wounds, stab and cutting injuries, injuries from impacts, traffic accidents or falls from a height;
• radiation sickness, as well as radiation therapy for tumors in the chest cavity;
• myocardial infarction;
• heart surgery;
• systemic connective tissue diseases and other autoimmune processes: systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma, sarcoidosis, vasculitis;
• endocrinological disorders, in particular, hypothyroidism, gout;
• renal failure;
• allergic diseases;
• malignant tumors, especially in the breast.

Symptoms of pericarditis

Acute pericarditis is more dangerous, as it develops rapidly – within a week or two. Due to inflammation, the pericardium quickly fills with fluid or, conversely, dries out, due to which its walls stick together.

This is the main symptom of pericarditis – severe pain and heaviness behind the breastbone and in the heart area already in the first hours after the onset of inflammation. The localization of pain varies depending on the position of the body and intensifies in the supine position, when food is swallowed (the liquid can be swallowed practically without pain), coughing and deep breathing.

Other symptoms of pericarditis include:

• temperature rise,
• weakness, loss of appetite, weight loss,
• shortness of breath, feeling short of breath,
• cough,
• dizziness,
• swelling of the legs and abdomen,
• arrhythmia.

Chronic pericarditis can be symptom-free for a long time.

Diagnostics

Pericarditis, which develops against the background of other chronic diseases, can be difficult to detect even in a hospital setting.This requires a comprehensive diagnosis, which will help to distinguish the signs of pericarditis from the manifestations of concomitant diseases.

The basis for suspicion of pericarditis may be the results of the initial examination of the patient by a cardiologist – noises when listening with a stethoscope, similar to crackling, creaking, rustling of sheets of paper, rhythmic rustles. These signs appear literally an hour after the onset of inflammation and persist at all stages of the disease.

To clarify the diagnosis, the doctor prescribes the following studies:

• Electrocardiography – gives an idea of ​​the heart rate and abnormalities in the work of the pericardium,
• chest x-ray or EchoCG – allows you to see how fluid is distributed in the pericardium,
• general and biochemical blood test,
• Additional tests to clarify the cause of inflammation, such as pericardial biopsy or pericardial fluid analysis.

Pericarditis treatment

To cure pericarditis, first of all, it is necessary to cure the disease that caused the inflammation of the pericardium.

If pericarditis is caused by an infection, antibiotics are prescribed. Pericarditis caused by viral diseases is treated symptomatically with the use of antiviral drugs.

Pericarditis diagnosed in time, with proper treatment, rarely gives complications. But nevertheless, sometimes against the background of inflammation of the pericardium, heart failure, cardiac tamponade, pathological deposition of salts in the heart can develop.

Rarely, surgery is required for pericarditis. In particular, the operation is indicated for constrictive pericarditis, in which the pericardium compresses the heart. In this case, pericardectomy is performed – removal of the cardiac membrane.

90,000 Epidural analgesia in adults with heart surgery with or without a heart-lung machine

Review Question

We decided to study the effect of epidural pain relief on the number of postoperative deaths and the risk of cardiac, pulmonary, and neurological complications in adult heart surgery based on the results of randomized clinical trials.

This review was first published in 2013 and updated in 2019.

Relevance

For epidural pain relief, a local anesthetic, opioid, or a mixture of these drugs is injected through a catheter into the epidural space, which is located on the outside of the membrane that surrounds the spinal cord. Epidural pain relief could reduce the risk of complications after surgery, such as lung infections, including pneumonia, difficulty breathing (respiratory distress), heart attack, and irregular heart rhythm caused by atrial fibrillation.The concern is that during heart surgery, blood must be thinned to reduce clotting. And it can increase the chances of bleeding around the spinal cord. The accumulation of blood puts pressure on the spinal cord and can lead to permanent nerve damage and disability.

Research characteristics

We included randomized controlled clinical trials in adults who underwent any cardiac surgery under general anesthesia with or without cardiopulmonary bypass, and in which investigators compared epidural pain relief in the perioperative period (period “around” the operation – before, during, after surgery) with other forms of pain relief.Surgeries performed included coronary artery bypass grafting, heart valve surgery and congenital heart disease. The average age of the participants was from 43 to 75 years. Outcomes were measured within a year after surgery.

We included 69 studies with 4860 participants. Where indicated, research was funded by public funds (five studies), philanthropy (eight), institutional funds (23) and, in part, by industry (two).Overall, 31 trials did not indicate a funding source. The evidence is current to November 2018.

Key Outcomes

When the researchers compared epidural pain relief with systemic pain relief (for example, by injecting pain reliever directly into a vein), they found no difference in the number of deaths in the first 30 days after surgery (38 studies, 3418 participants). There may be differences in the number of people who have had heart attacks (26 studies, 2713 participants).These findings are supported by low quality evidence. We found a small reduction in the risk of respiratory depression with epidural pain relief (21 studies, 1736 participants), but not in the risk of pneumonia (10 studies, 1107 participants) (low to moderate quality evidence). The reduction in the risk of respiratory depression was more evident with cardiopulmonary bypass surgery. Epidural analgesia reduced the risk of atrial fibrillation and atrial flutter early in recovery, in the first two weeks after surgery (18 studies, 2431 participants; moderate-quality evidence).There were no clear differences in the number of cerebrovascular events (18 studies, 2232 participants), and there were no reports of long-term neurological complications or epidural hematomas (53 studies, 3982 participants; very low or low-quality evidence). Although epidural analgesia may have shortened the duration of tracheal intubation, this was noted mainly in older studies and clinical practice has changed since then (40 studies, 3353 participants; moderate-quality evidence).

We found only six studies comparing epidural analgesia with local anesthetic on the body surface to create blocks of peripheral nerves, directly into the space around the lungs (intrapleural analgesia) and into a surgical wound (wound infiltration). These studies provided low to very low quality evidence and did not report many of the outcomes of this review. The study authors reported no heart attacks or epidural hematomas.

Quality of evidence

We rated the quality of the evidence as moderate, low, or very low. There are too few participants in our review to argue that there is no difference in the number of deaths of patients who received epidural or systemic analgesia, and there is no increase in the risk of epidural hematoma formation.

Pericarditis in dogs and cats

Maintenance

1. Symptoms
2. Predisposition to pericarditis
3. Diagnosis
4. Treatment

Perhaps many have never heard of this disease in animals touch on this topic.Very often this diagnosis remains undetermined, which means that the animal does not receive proper treatment, and sometimes it loses its life due to “something with the heart”. But knowing the features of this disease, the owner can render a great service to his pet.

Pericarditis in dogs and cats is an inflammation of the outer lining of the heart. The pericardium covers the heart and great vessels, normally contains from 1-15 ml of liquid rich in phospholipids, which provides sliding without additional friction.

Symptoms

The most common complaints from owners of dogs with pericarditis are lethargy, exercise tolerance, lack of appetite, collapse or fainting, bloating and shortness of breath, mucosal pallor, bluish mucous membranes.The intensity of the clinical manifestations of pericarditis, directly, depends on whether the process is acute or chronic and on the volume of free fluid in the pericardial cavity.

If your pet has pericarditis or the symptoms described above, please contact one of our veterinary centers at +7 499 110 66 86 (24 hours a day).

Predisposition to pericarditis

Pericarditis, according to various sources, occurs in middle-aged and elderly dogs and makes up from 3.5 to 0.4% of all dogs examined by a cardiologist.These are mainly dogs of large and medium breeds, over 5 years old, more often males, there is a breed predisposition (Labradors, Golden Retrievers, German Shepherds, Great Danes).

There are no statistics on pericarditis in cats, but on average the figure does not exceed 1-5% and is mainly associated with infectious peritonitis, less often it is a consequence of congestive heart failure.

According to various sources, neoplasms cause pericarditis from 30% to 80%, which is nevertheless a low percentage of the total number of neoplasms (only about 0.19%).In cats, the figure is even lower, it is only 0.03% and almost always lymphomas.

Diagnostics

The diagnosis is based on the data of physical examination, X-ray, ECHOkg of the heart, blood tests, ECG.

Examination of an animal with suspicion of pericarditis should be carried out efficiently, but with some caution. Often the patient comes to the doctor’s office in a serious condition, with severe symptoms of right-sided heart failure, as a result of cardiac tamponade, sometimes such symptoms can develop during the day.At the same time, weakness, shortness of breath are expressed, cardiac impulse is reduced, pulse is weak or not felt at all, jugular veins are dilated, mucous membranes are pale, SNK is more than 3-5 s. Abdominal enlargement due to ascites and wheezing due to developing pulmonary edema and chest effusion may also be observed. Such patients should not be thoroughly diagnosed; it is enough to make sure of the presence of free fluid with the help of ECHO and carry it through a skin puncture of the pericardium.

If the patient’s condition is more stable, a thorough examination should be performed.X-ray examination reveals the rounded contours of the heart. Also, the method allows you to determine the metastasis of the lung tissue.

On ECG , R-wave alteration is diagnosed, sometimes a decrease in voltage and depression of the ST segment.

The gold standard for diagnosing pericarditis is cardiac echocardiography, this method also allows you to assess hemodynamics, the presence of chest effusion, and sometimes to identify neoplasms (the right atrium is most often affected).The presence of fluid in the pericardial cavity is defined in all projections as an echo-negative space bounded by the pericardial layers; abnormal (from side to side) movement of the heart is also observed.

Blood tests are required for differential diagnosis. Sometimes they may not have serious abnormalities, but leukocytosis, increased urea and creatinine, anemia are common.

Analysis of the pericardial fluid is used for differential diagnosis.The resulting material is examined to identify the causative agent of the infection, exclude a purulent process. The resulting fluid is sent for cytological examination to exclude the tumor genesis of the disease

Treatment

Depends on the rate of development of the process and the cause of the disease, and is mainly reduced to three components:

– pericardial puncture and fluid removal.

– antibiotic therapy and heart failure control.

– pericardiotomy.

Conservative treatment. If it was possible to identify the pathogen is selected individually, routine antibiotic prescription is recommended for all patients to prevent complications. Diuretics and ACE inhibitors are also indicated, but with caution so as not to provoke a decrease in blood pressure. It is important to control the work of the kidneys, as they primarily suffer from sudden changes in pressure. With severe anemia, iron and folic acid preparations are recommended, in acute cases – blood transfusion.It is also possible to use drugs with antihypoxic and antioxidant properties.

In cats, conservative treatment is more effective, and almost always proceeds with the appointment of steroids. Surgical treatment is ineffective because in severe cases, unlike dogs, pulmonary edema often develops.

It is better to prepare a wide surgical field from 2 to 8 intercostal space, the puncture is performed in the thoracic position or in the lateral position. On the right side to reduce the risk of injury to the left coronary artery.To do this, use guides from under intravenous catheters, the catheters themselves or spinal needles, depending on the size of the patient. Before puncture, sedation is necessary (nalbuphine 0.4 mg / kg + propofol 6 mg / kg if necessary), most patients, due to the severity of the condition, behave calmly. It is also important to provide venous access, a resuscitation kit and control of the electrical activity of the heart and pressure.

The injection site can be infiltrated with a 1% lidocaine solution, usually the injection is performed in 4-5 intercostal spaces, slightly above the junction of the ribs with the sternum, an ultrasound sensor can also be used to select a site.Due to the fact that the pericardium is overstretched, it is not always possible to feel resistance when it is punctured, so you can focus on the free movement of the needle tip, the depth of needle insertion, and the presence of fluid freely flowing under pressure. If the fluid is serous or purulent, it is important not to confuse it with the contents of the chest, and hemorrhagic exudate with blood from the chambers of the heart. To clarify the location of the needle, you can use an ultrasound sensor, also when the myocardium is injured, as a result of a puncture or touching with a needle, ventricular extrasystoles often appear on the ECG.

In response to fluid removal, the patient’s condition improves rapidly, primarily due to an increase in cardiac output. After aspiration of fluid, it is necessary to carry out replacement therapy with colloidal and crystalloid solutions and leave the patients for observation for at least 6-12 hours.

Often a single puncture is not enough, you have to repeat them 3-4 times or resort to pericardiotomy. It is important to inform the owner of this so that he is prepared for possible deterioration and constantly keeps in touch with the attending physician.According to some reports, timely surgical treatment can significantly increase the duration and quality of life. For patients with idiopathic pericarditis, it can also have a therapeutic effect and does not allow the development of concentric pericarditis, with tumor pericarditis, this will avoid tamponades, improve the quality of life and obtain material for histological examination, which means the possibility of chemotherapy. As for excision of neoplasms, opinions differ here.Surgical excision of angiosarcoma will have a poor prognosis, given that micrometastases are usually already present, the average survival rate is about four months. With other types of neoplasms, the survival rate is slightly higher up to 5-8 months. After performing pericardiotomy, the survival rate increases (according to some reports, up to 3 years).

Conclusion: Males are more prone to pericarditis, the average age is 5-12 years, the Labrador Retriever is a more susceptible breed.Echocardiography is the most sensitive diagnostic tool for pericarditis, in particular, it makes it possible to differentiate between various acquired heart diseases that cause cardiomegaly on radiographs.