Pericarditi ricorrenti
Table of Contents
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 esserepericarditi autoimmunitrattati con terapia antinfiammatoria o steroidea a dosaggi troppo bassi o di durata insufficiente.Pericarditi viralitrattate 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 lapericardite acuta, sono caratterizzate dadolore toracico precordialespesso con componentepleuritica, associato afebbre,sfregamenti pericardici, dispnea,aumento della VESealterazioni ECGtipiche.
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.
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