心包疾病.ppt

心包疾病
中山医院周京敏
General
Incidence: low
-6%
急性心包炎
慢性缩窄性心包炎
慢性心包积液
粘连性心包炎
Inflammation of visceral
and parietal cardiac sac
Effusion
Chronic restrictive
pericarditis
Cardiac
tamponade
fluid
dyspnea
Chest pain
resolved
fibrous
Surgery
Heart Failure
effusion
Dyspnea, JV distension, BP￬
Acute pericarditis
C-Constr-Peric
Non-specific
+ + + +
+ + +
Tumor
+ + +
+
TB
+ +
+ + + +
Radiation therapy
-
+ + +
System disease
+
+
Physical and chemical factors
+
+
Etiology
Clinical Manifestation --- Symptoms
Acute pericarditis
C-Constr-Peric
Chest pain
+ + + + fibrous
Pleurotic, Postural
-
Dyspnea
+ --- +++ fluid
Fast and thin
+ + + +
General
Fever
---- + +
-
fatigue
-
+ + +
ascites
-
+ + +
wasting
-
+ +
Acute pericarditis
C-Constr-Peric
Friction rub
+ + + +
transient
-
Enlargement on percussion
-----+ + +
-
Edema, ascites
---- + +
---- + + + +
Pulsus paradoxus
(>10mmHg)
---- + + +
---- +
Jugular vein distension
---- + + +
---- + +
Clinical Manifestation --- Signs
Acute Pericarditis
C-Constr Peric
Lab findings
Blood
WBC increase
anemia
Ascites
rarely
Leak-out
Hepatic:
normal
impair
CK-Mb or cTNT
↑: myocardium
injury
normal
Acute Peric
C-Constr Peric
Electrocardiology
P wave
Normal
50%: notch
Abnormal q wave
No
Widespread calcification
QRS Voltage
↓
↓
ST-T
Convex ↑except
in avR (V1)
Non-specific
Arrhythmia
Sinus tachycardia
Afib, A-V block
Acute Peric
C-Constr Peric
Echo
fluid
Normal, rarely calcification
Chest X-ray
Enlarged shadow
Bottle-like
Normal,
Small and straight,
Calcification
CT or MRI
Fluid
Pericardium thickening
Etiology diagnosis
Echocardiography
Acute Pericarditis:
Most important, useful, sensitive
Confirm the diagnosis
Semi-quantity the volume
Assess the efficacy of management
Guide the pericardiocentesis
Chronic Restrinctive Pericarditis
normal