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The Heart Connection to TB: What is Tubercular Pericarditis? How dangerous is this for us? Know everything about it

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  • What Is Tubercular Pericarditis? How Dangerous Is This For Us? Know Everything About It

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Case – 1

45-year-old Sanjay (name changed) was suffering from shortness of breath for the past few days. One day suddenly the pain increased a lot and was admitted to the hospital. On examination here, it was found that the size of his heart has increased significantly. The heart was filled with water in large quantities. Along with this, there was swelling in the walls of the heart. He was immediately taken to the cath lab and his water was removed, then he felt relieved. Later on it was found out that he had TB.

Case – 2

Manjubala (name changed) of Satna was complaining of cough and fever 2 months back. Upon examination, TB disease was detected. A few days after the treatment was stopped midway, he complained of severe chest pain as well as increased heart rate. On admission, it was found that he had TB of the membrane of the heart, as well as water around the heart.

According to an estimate, 26% of the total TB cases in the world i.e. every fourth patient of TB is Indian. The World Health Organization has set a target of freeing the world from TB in 2030 and the Government of India had set a target of TB elimination in India by 2025, but the situation changed after Corona. In 2019, a total of 90,000 people died in our country due to TB. While TB mainly affects the lungs, some other parts of the body also get its side effects, which is known as extra pulmonary TB.

How does TB affect the heart?

TB of the heart is often seen in the form of tubercular pericarditis. The structure of the heart consists of three layers – the endocardium, the myocardium, and the outermost layer or membrane that surrounds the heart is called the pericardium. Tubercular pericarditis is often characterized by inflammation of the membrane, which becomes a bit hard and thick, thereby obstructing the expansion and contraction of the heart. A kind of pressure starts on the heart. Also, a large amount of fluid accumulates around this membrane of the heart, which is called pericardial effusion. In the beginning, this liquid is similar to very thin water, which gradually becomes thick and webs also start forming in it. It is often seen that people who have low immunity (immunity) are more likely to get this disease.

Symptoms of Tubercular Pericarditis

Tubercular pericarditis often begins with fever. In about 75 percent of the cases, high fever first comes in the evening, along with the patient also sweats profusely. These symptoms can also be seen in TB of the lungs, but after that chest pain, heaviness, difficulty in breathing, cough, swelling of the legs are some of the symptoms that are often seen in tubercular pericarditis.

How is tuberculous pericarditis diagnosed?

It is often recognized by other symptoms of TB such as fever, often in the evening, loss of appetite, and weight loss. Tubercular pericarditis can also occur at times during TB of the lungs. Sometimes only tubercular pericarditis occurs. Chest X-ray is the most important test for its diagnosis. In this, if the size of the heart is enlarged or if some fluid is seen around the heart, then tubercular pericarditis may occur. After this, in the examination of echocardiography of the heart, it is found out whether the pericardium of the heart has become rough and thick, the amount of fluid that has accumulated around the pericardium, whether the pressure on the heart is too high. Apart from these, other tests of TB such as sputum test, fluid collected around the heart, blood tests like ADA, PCR etc. are also done.

There may be complications

It is often seen that in the absence of timely diagnosis, the patient suffers from tubercular pericarditis for a long time. By the time it is detected, the pericardium, that is, the outermost membrane of the heart, has become very thick and hard, which adversely affects the contractile ability of the heart. This is called constrictive pericarditis.

Due to the accumulation of more than a certain amount of fluid, the pressure on the chambers on the right side of the heart increases significantly. This condition is called cardiac tamponade. This is a serious condition in which if this pressure is not reduced in time, then the patient can also die.

How is this disease treated?

American College of Cardiology Fellow and Cardiologist Dr. Hemant Chaturvedi says that tubercular pericarditis is a disease in which there is pressure on the heart and its ability to contract is affected. Therefore, treatment should be started immediately after its detection in the investigation. The main treatment is done for the main disease ie TB. Under the Revised National TB Programme, anti-tubercular drugs are given in the prescribed dosage and duration depending on the category the patient belongs to.

If there is an excessive amount of fluid that has accumulated around the pericardium of the heart, which is affecting the function of the heart, then that fluid is first removed with the help of fluoro imaging. This is called pericardiocentensis. By doing this there is a possibility of saving the life of the patient. Apart from this, in the case of constrictive pericarditis, through cardiac surgery, the stripping of the pericardium, the outermost membrane, which becomes hard and rough, is removed, so that the contractile capacity of the heart can be restored again. Therefore, it is very important that this disease is recognized early, so that complications can be avoided by starting anti-tubercular medicine immediately.

Dr. Priyanka Rohatgi, Chief Nutritionist, Apollo Hospital, New Delhi, tells that due to tuberculosis, fever remains for a long time, there is a lot of weakness in the body. Therefore, at this time we should focus on such a diet which can be easily digested. Eat high-calorie, protein-rich foods such as pulses, foods containing B complex such as spinach and other green leafy vegetables, lentils, seasonal fruits containing vitamins A, C, guava, orange apple, potato bukhara etc. This keeps immunity good. Avoid processed and packaged foods like refined sugar, refined flour, sauces, excessive tea and coffee. This can cause problems like indigestion, nausea.

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