Pericarditi ricorrenti
Definizione
Le pericarditi ricorrenti sono caratterizzate da un’infiammazione ricorrente del pericardio. Per pericardite si intende un’ infiammazione del pericardio con formazione di un essudato fibrinoso o sieroso- fibrinoso, talvolta emorragico​. Questo quadro infiammatorio può presentarsi come un singolo episodio, ma anche con 2 o più episodi.
Epidemiologia
Le pericarditi ricorrenti si verificano nel 15-30% dei pazienti affetti da pericardite acuta. I fattori di rischio per le recidive sono rappresentati da terapia steroidea condotta erroneamente, da mancata risposta alla terapia antinfiammatoria iniziale e dal sesso femminile.
Fisiopatologia
Sono stati proposti diversi meccanismi per spiegare la patogenesi di queste forme. Possono essere pericarditi autoimmuni trattati con terapia antinfiammatoria o steroidea a dosaggi troppo bassi o di durata insufficiente. Pericarditi virali trattate con terapia corticosteroidea troppo precoci che favoriscono la replicazione del genoma virale all’interno del tessuto pericardico e allungano il tempo di esposizione agli agenti virali. Talvolta possono essere causate da infezioni o esacerbazione di processi autoimmuni​.
Sintomi
Come per la pericardite acuta, Â sono caratterizzate da dolore toracico precordiale spesso con componente pleuritica, associato a febbre, sfregamenti pericardici, dispnea, aumento della VES e alterazioni ECG tipiche.
Terapia
Il trattamento sintomatico di queste forme si basa sul riposo e sugli stessi farmaci utilizzati nella pericardite acuta: antinfiammatori e corticosteroidi. La colchicina è efficace nelle pericarditi ricorrenti, quando gli antinfiammatori e gli steroidi non sono in grado di prevenire le recidive​.
Ti potrebbero interessare:
Che cos’è il pericardio?
Il pericardio è un sacco fibroso che avviluppa il cuore e l’origine dei grossi vasi che partono dal cuore.
Forma
Il pericardio ha la forma di un cono cavo leggermente appiattito in senso antero-posteriore, la cui base, aderente al diaframma, è diretta in basso, mentre l’apice, diretto in alto corrisponde ai grossi vasi.
Come le altre sierose, il pericardio presenta due foglietti:
- Foglietto viscerale, sottilissimo, che tappezza maggiormente la superficie del cuore dall’apice alla base e che si prolunga in parte sui grossi vasi, dove si riflette per continuarsi con il foglietto parietale.
- Foglietto parietale (sacco fibroso del pericardio), molto robusto perché è rinforzato da una lamina fibrosa, la quale costituisce con esso una formazione unica; questo foglietto parietale o pericardio propriamente detto, per il suo aspetto fibroso di colore bianco o opaco si distingue dalle pleure che lo circondano, le quali sono molto sottili o translucide. Fra i due foglietti del pericardio si trova una cavità , la cavità pericardica, la quale, come tutte le cavità sierose, nello stato normale è virtuale, poiché il foglietto parietale è strettamente addossato al cuore e lo segue nei suoi movimenti di espansione e di contrazione; ma, al pari di tutte le cavità sierose, può diventare reale per il prodursi di versamenti sierosi o emorragici.
Good content, With thanks.
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