Recurrent 心包炎

What is recurrent 心包炎?

Recurrent 心包炎 is when you develop 心包炎 for a second time after having no symptoms for at least four weeks.

心包炎 is inflammation of the pericardium, a sac-like organ with two thin layers of tissue that surround the heart. The pericardium holds the heart in place, protects it from infection, and keeps it from filling with too much blood. It also cushions the heart from outside pressure. 少量的液体使这两层保持分离，并在心脏跳动时减少它们之间的摩擦. 但在一些患有这种疾病的人身上，这些组织会变得肿胀和发炎. 这可能会引起剧烈的胸痛，并可能导致心脏周围的液体积聚，从而引起不适. 在大多数情况下，心包炎是轻微的，无需治疗即可自行好转.

Among those treated for acute 心包炎, 15%至30%的人如果不使用秋水仙碱治疗，可能会复发性心包炎. 心包炎最常见于16至65岁的男性，但它可以影响任何年龄的任何人. 在急诊科寻求胸痛治疗的人中，约有5%患有急性心包炎.

Other types of 心包炎 include:

• Acute 心包炎 lasts less than four to six weeks.
• 持续的心包炎症状持续超过4至6周，但即使治疗也不到3个月.
• Chronic 心包炎 lasts for more than three months. 

What are the symptoms of recurrent 心包炎?

Symptoms of recurrent 心包炎 include:

• Chest pain is almost always present. 它可能感觉像一种尖锐的刺痛，辐射到手臂、颈部、肩膀、背部或腹部. Some people mistake the pain for a 心脏病. The pain gets worse when coughing, taking deep breaths or lying down. The pain may improve by sitting up and leaning forward.
• Shortness of breath or difficulty breathing
• Heart palpitations or a faster than normal heartbeat
• Low-grade fever, chills or sweating
• 干咳
• Swollen abdomen, legs or feet
• 低血压症状，如头晕、眩晕或昏厥

What causes recurrent 心包炎?

在大多数患者中，复发性心包炎的原因是特发性的或未知的. While there’s no single cause for recurrent 心包炎, 它通常发生在最初的心包炎没有得到充分治疗的人身上.

病毒性疾病, 比如疱疹, 流感, 腺病毒, 肠病毒或爱泼斯坦巴尔病毒也可引起复发性心包炎.

Other potential causes include:

• 自身免疫性疾病，如狼疮、硬皮病和类风湿性关节炎
• 并发症 心脏病 or 心脏手术
• Health problems, such as kidney failure or cancer
• 细菌、真菌和寄生虫感染(最常见于免疫系统受损的人群)
• Radiation to the chest
• 胸部创伤
• 某些药物, 比如苯妥英(一种抗癫痫药)和普鲁卡因胺(治疗心律不齐) 

How is recurrent 心包炎 diagnosed?

Depending on your age and medical conditions, a primary care doctor, 心脏病专家, rheumatologist or infectious disease specialist may treat you.

If your doctor believes you may have 心包炎, 他们会听你的心脏摩擦的声音，这种声音经常出现在患有这种疾病的人身上. 以下一项或多项检查可用于确诊:

• Blood test: May reveal elevations in the white blood cell count, erythrocyte sedimentation rate, 血清c反应蛋白浓度和其他炎症迹象.
• 心电图 (心电图):测量你的心电活动，某些结果可能提示心包炎.
• 胸部x光片:对心脏、肺和胸腔内的血管拍照. x光片能显示心脏是否因心包积液过多而增大. 它也可能显示感染，结节病或恶性肿瘤的迹象，可能导致心包炎.
• 超声心动图声波可以显示你的心脏的大小、形状和工作原理. This can reveal fluid buildup in the pericardium.
• 心脏CT 计算机断层扫描:一种能清晰、详细地拍摄心脏图像的x射线.
• 心脏核磁共振 (magnetic resonance imaging): Also called CMR, 这种测试使用磁铁和无线电波来创建你的器官和组织的详细图像. This can reveal changes in the pericardium.

How is recurrent 心包炎 treated?

复发性心包炎通常用抗炎药秋水仙碱治疗 阿斯匹林 and non-steroidal anti-inflammatory drugs (NSAIDS).

When NSAIDs and colchicine don’t lead to a complete resolution, low to moderate doses of corticosteroids, such as prednisone may also be prescribed. Because steroids have been linked with a higher risk of recurrence, 它们通常用于不能耐受非甾体抗炎药或秋水仙碱的人，或孕妇或患有自身免疫性疾病等疾病的人.

免疫抑制剂, anti-inflammatory and interleukin 1 blockers, which neutralize pro-inflammatory molecules, 也可以开给对药物没有反应的病人，以达到更好的症状控制.

你的医生可能会进行心包穿刺，将多余的液体从心包中排出. 最后，心包可能部分或全部切除. This is called a pericardiectomy.

前景

对于大多数人来说，复发性心包炎可在家中安全处理，很少导致死亡. But it can cause potentially life-threatening complications, 如心包弹性丧失(缩窄性心包炎)和心包积液(心包填塞). Some people with 心包炎 may also have pericardial thickening.

Seek medical treatment if you have continued symptoms of 心包炎.

如果你感到任何类型的胸痛，立即拨打911，因为这可能是心脏病发作的征兆. If you have recurrent 心包炎, 一定要和你的医生谈谈你的症状和治疗方案.