TUBERCULOUS PERICARDITIS

Tuberculous pericarditis may complicate pulmonary tuberculosis but may also be the first manifestation of the infection. In Africa, a tuberculous pericardial effusion is a common feature of AIDS. The condition typically presents with chronic malaise, weight loss and a low-grade fever. An effusion usually develops and the pericardium may become thick and unyielding, leading to pericardial constriction or tamponade. An associated pleural effusion is often present.

SYMPTOMS

• Pericardial effusion is the most common clinical manifestation.
• Pericardial pain is referred to the scapular ridge, presumably owing to irritation of the phrenic nerves, which pass adjacent to the pericardium.
• The chest pain of acute pericarditis must be differentiated from pulmonary embolism and myocardial ischemia or infarction.
• Cough, chest pain, dyspnea, orthopnea, pedal edema, and night sweats are the most frequent symptoms.
• Fever is present in 73% to 97% of patients.
• Signs of pericardial disease with cardiomegaly, tachycardia, pulsus paradoxus, muffled heart sounds, hepatomegaly, jugular venous distention, ascites, and peripheral edema occur in 34% to 84% of cases.

DIAGNOSIS

The diagnosis may be difficult to confirm. Sputum samples can be examined when pulmonary lesions are present; however, these are absent in many cases. Pericardiocentesis usually reveals an exudative fluid. Direct AFB smears of pericardial fluid are rarely positive and the yield on culture is 50% to 59%. Pericardial biopsy with histologic examination and culture of the affected tissue has a higher diagnostic yield of 70% to 83%.

COMPLICATIONS

Healing by fibrosis can result in pericardial calcification and constrictive pericarditis, the most serious complication.

HOMOEOPATHIC TREATMENT

Homoeopathic treatment requires a deep constitutional analysis. The history of the disease, the family medical history, physical and mental characteristics of the patient, the likes and dislikes, medication details are all taken into consideration. This approach stands in consonance with the homoeopathic convention: Well selected Homoeopathic remedies are effective for tuberculous pericarditis treatment.

APIS MELLIFICA:  Sudden pain just below the heart, soon extending toward right chest, with suffocation. Very feeble action of the heart; violent beats, shaking the whole body; intermittent beats. Region of heart sensitive to least pressure; rasping sounds of systole and diastole unmistakably audible. Palpitation of heart from scanty secretion of urine, heart from scanty secretion of urine, perfectly cured by establishing the natural quantity. Pulse almost imperceptible at wrist: accelerated and full; very frequent and hard; wiry; irregular and slow pulse; intermittent.

ARSENIC ALBA: Violent and insupportable throbbings of the heart, chiefly when lying on the back, and esp. at night.─Irregular beatings of the heart, sometimes with anguish.─Cramp in the heart.─Heart-beats irritable.─Palpitation with anguish, cannot lie on back; < going upstairs.─Palpitation and trembling weakness after stool; must lie down.─Palpitation after suppressed herpes or foot-sweat

DIGITALIS: Acceleration of the movements of the heart, with palpitations that can be heard (with slow pulse), anguish, and contraction in the sternum.─Very slow pulse.─On rising up in bed pulse becomes much more frequent and irregular.─Irregular and intermittent pulse.─Dull uneasiness in various parts of heart region, with sensation of weakness in forearm.─Feeling of slight confusion of heart, esp. on moving, with painful sensation of weakness in wrist and forearms.─Sudden sensation as though heart stood still, with great anxiety and necessity for holding breath, after dinner; must keep perfectly still.

LACHESIS: Palpitation of heart, with (fainting and) anxiety, sometimes excited by cramp-like pains, with cough, and fit of suffocation.─Palpitation of heart and choking from slightest anxiety.─Feels as if heart hanging by a thread and every beat would tear it off.─Irregularity of beats.─Constrictive sensation in region of heart.─Spasms in heart (with aneurism of r. carotid) and disagreeable pulsation in ears.─As if heart too large for containing cavity.─Stitches in region of heart, with shortness of breath, fainting fits and cold sweat.─Faint feeling about heart, with heats up spine and flushings of face.─Faintings, giddiness, and palpitation constantly recurring.

LYCOPODIUM: Palpitation of the heart, esp. during digestion, or in bed in evening, sometimes attended with anxiety and trembling. Accelerated pulse, with cold face and feet. Palpitation of the heart with flapping of the wings of the nose; enlargement of the heart; hypertrophy in general. Cramp and constriction, dyspnœa, stitches beneath short ribs, extending to small of back and shoulders; sharp pains shooting into heart, sensation of stoppage of circulation at night, with fright and then sweat, pulse quick and unsteady.

COLCHICUM: Violent palpitation of the heart. Pressure and oppression in the region of the heart, as if an attack of apoplexy threatened; > by walking. Anxiety in region of heart. Impulse not felt. Pericarditis, with severe pain, oppression and dyspnśa, pulse threadlike. Sound of heart become weaker, pulse of low tension.

SULPHUR: Sharp pain at heart goes through to between shoulders; esp. with dyspeptic symptoms.Cutting pains about heart, as with knives, which decrease or increase, last a few hours, with redness of face, followed by general coldness; attacks only when waking up. Violent congestion of blood towards chest and heart, sometimes with ebullition in chest, uneasiness, faintness, and trembling of arms. Sensation of emptiness in the cardiac region, or pressure and sensation as if the heart had not room enough.Affections in general of heart; also external chest. Sensation as if heart were enlarged. Frequent palpitation of the heart, sometimes even visible, and with anxiety; at night; in bed; on failing asleep; when going up an ascent.