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Pericardite acuta

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Cardiac diagnosis Pericarditis. Medical form report with written diagnosis of Pericarditis lying on the table in doctor cabinet, surrounded by stethoscope, manometer and ecg. Concept for cardiology - Foto stock royalty-free di Pericardite

Definizione

Per pericardite acuta si intende un’ infiammazione del pericardio con formazione di un essudato fibrinoso o sieroso- fibrinoso, talvolta emorragico​.

Epidemiologia

L’incidenza generale della pericardite acuta non può essere determinata a causa dell’elevato numero di casi che non vengono diagnosticati. Si stima che rappresenti circa l’ 1% delle cause di ospedalizzazione. Una delle diagnosi più frequente nei  reparti di Emergenza P. S. costituendo fino al 5% dei casi di dolore toracico.

 


 

Eziologia

Il prototipo è rappresentato dalla pericardite davirus, ma nella maggior parte dei casi l’eziologia rimane indeterminata. Molti casi di pericardite virale, infatti, vengono classificati come “pericardite acuta idiopatica“. La pericardite idiopatica costituisce circa l’ 80- 90% dei casi di pericardite acuta, con prevalenze che variano in base alle caratteristiche demografiche della popolazione e alle variazioni stagionali delle infezioni virali. La tubercolosi potrebbe anche essere la causa di alcune di queste pericarditi definite idiopatiche. Più frequenti sono lepericarditi epistenocardiche, che insorgono 24-72 ore dopo un infarto miocardico per irritazione dei foglietti sovrastanti l’area infartuata. La loro incidenza si è nettamente ridotta dopo l’introduzione di tecniche che consentono la precoce rivascolarizzazione (trombolisi,rivascolarizzazione miocardica chirurgica e percutanea.

 

Sintomi

La pericardite acuta esordisce quasi sempre con undolore toracico.Il dolore pericarditico insorge spesso in modobrusco e improvviso, di tipo trafittivo e simil-pleuritico(si accentua con il respiro, con la rotazione del tronco, con la tosse). Alcune volte può essere sordo e oppressivo, simile a quello dell’ infarto miocardico.

Viene localizzato al torace anteriore in sede precordiale retrosternale, ma può irradiarsi al collo, alla spalla sinistra, ai due arti inferiori, al dorso.

Il dolore pericarditico è spesso attenuato dalla posizione seduta con il busto inclinato in avanti ed è accentuato in clinostatismo.

Altri sintomi associati sono:

  • Astenia
  • Tachicardia
  • Dispnea
  • Tossenon produttiva e a voltesinghiozzo.

Altri sintomi sono caratterizzati da:

  • Febbrecon brivido scuotente (solitamente con temperature < 39 C)
  • Malessere generale
  • Mialgie

I soggetti anziani tuttavia, possono essere apiretici. I pochi casi di pericardite acuta in cui vi è assenza di dolore vengono diagnosticati sulla base dei sintomi associati o in corso di accertamenti per malattie sistemiche.

 


 

Diagnosi

il quadro clinico, in presenza di dolore tipo pericardico o di sfregamento pericardico, permette di sospettare la presenza di un’ infiammazione del pericardio.

Elettrocardiogramma

  • Caratteristicamente si osserva unsopraslivellamento del tratto ST con concavità verso l’alto in tutte le derivazioni. Infatti, al contrario della sindrome coronarica acuta in cui alterazioni del tratto ST sono circoscritte alla zona interessata dall’ ischemia miocardica, nella pericardite acuta il sopraslivellamento del tratto ST coinvolge tutte le derivazioni. Nei giorni successivi si normalizza il tratto ST e successivamente si negativizza l’onda T.

-Sottoslivellamento del PR (segno più specifico)

-Diminuzione del voltaggio del QRS.

Radiografia toracica

Cardiomegalia globale, con perdita della normale silhouette cardiaca. Se il versamento pericardico è significativo l’ombra cardiaca assume la caratteristica forma “a fiasco”.

Ecocardiogramma

E’ l’esame più utilizzato ed efficace per valutare la presenza di versamento pericardico. In presenza di cardiomegalia alla radiografia, permette di capire se essa sia dovuta ala dilatazione delle camere cardiache o alla presenza di versamento. In quest’ultimo caso permette anche di stimare la quantità del versamento.

Esami di laboratorio

Può essere presente unaumento delCPKe a volte anche delletroponine, in presenza di coinvolgimento del miocardio sottostante​.

 

Decorso e prognosi

Nel 70-90% dei casi è una patologia che non va incontro a complicanze nè recidive; di conseguenza, la prognosi della pericardite acuta è di solito buona e non richiede l’ospedalizzazione. Il ricovero ospedaliero è indicato solo quando insorgano complicanze, quando non vi è risposta al trattamento iniziale oppure quando si sospetta una determinata eziologia che richiede un approfondimento diagnostico di tipo laboratoristico e strumentale.


 

Terapia

La terapia delle pericarditi infettive dovrebbe essere causale, ma ciò è possibile solo in pochi casi (pericardite tubercolare, pericarditi da piogeni). Nellepericarditi viralila terapia è solo sintomatica, conaspirinaad alte dosi o antinfiammatori non steroidi impiegati per ridurre il dolore e l’irritazione flogistica. Molti pazienti presentano un beneficio clinico già dopo le prime somministrazioni. Quando il dolore persiste nonostante la terapia antinfiammatoria è indicato aggiungere analgesici. Lacolchicinapuò essere utilizzata in aggiunta ai farmaci antinfiammatori o come monoterapia, nelle fasi iniziali della patologia e per la profilassi delle recidive.​

 

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