Rheumatic pericarditis-1

X-ray examination of the heart shadow size with the accumulation of fluid are rapidly increasing, taking the characteristic triangular or round shape. Ripple contours weakens. Rentgenokimograficheski been a sharp decrease in the amplitude of the heart. With a large effusion can be displayed atelectasis of the lower lobe of the left lung.
ECG changes in pericarditis detected even before the pericardial friction noise and have a characteristic dynamics. In the first phase, which lasts about a week, found arcuate deformation and displacement of the ST segment up with a simultaneous increase of the T wave in all leads. In the second phase (late 1st – 2nd week) ST shifted to contour, T waves, flattened into two phases and becomes negative. With a large effusion detected voltage reduction of the complex QRS. In the following, to the extent of recovery, the normalization changes. Unlike coronary disorders Q wave in pericarditis is not expressed, and R wave in the precordial leads almost always remains.
More commonly seen worn clinical and electrocardiographic signs of pericarditis which appear only in the dynamic study. According to VA Shanina (1968), with spikes plevroperikardialnye Rheumatic tend to regress.
Consequently, the doctor, the experience of the clinical and laboratory diagnostic tool, can detect active rheumatoid process in any of the membranes of the heart. But it is well known, and others: isolated involvement of individual heart membranes with systemic disease such as rheumatism, is less common than the combined. It should be reiterated that the consistent involvement of rheumatic heart disease tend shells – myocardium, pericardium, endocardium. This does not necessarily having all the triads, can be affected by any two shells, but myocarditis is an integral part of this process.
Rheumatic heart disease has long been divided into focal, diffuse and pancarditis. The first two forms reflect the pathologic features of the process rather than clinical. Therefore more clinically justified proposal AI Nesterov (1967, 1973) to allocate clear rheumatic heart disease (severe), to some extent coincides with the morphological definition of "diffuse" (pancarditis, endomiokardit, mioperikardit), "moderate" (Moderate) – Multifocal in morphological terms (mainly myocarditis or endomiokardit) and "weak" (poorly defined) – mostly focal, granulomatous process in the myocardium, and (or) endocardium.
Such differentiation is necessary to individualize patient understanding, because there is no strict parallelism between the severity of carditis and the degree of activity of rheumatic fever as a whole. Thus, for II and III degree of activity can be detected weakly expressed carditis, and all clinical and laboratory manifestations of the high activity of rheumatic process will be determined by extracardiac syndromes. In addition, in patients with chronic heart failure synthetic liver function disorders are often the cause of inadequate detection of low activity in laboratory parameters in patients with severe manifestations of inflammatory lesions of the heart. Illustration of this can serve as shown in Table. 7 Data Zvereva K. (1972).

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