急性心包炎ppt課件

1、ACUTE PERICARDITIS,,Acute pericarditis is a syndrome due to inflammation of the pericardium characterized by chest pain ,a pericardial friction rub ,and a serial electrocardio-graphic abnormalities,,The incidence :ranges

2、 from 2-6%(several autopsy series). men>woman1.the most common causes: idiopathic ,viral pericarditis,uremia,bacterial infection ,acute myocardial infarction, pericardiotomy, tuberculosis,neoplasm, and trauma

3、…2.pathological changes: presence of polymorphnuclear leukocytes, increased pericardial vascularity and deposition of fibrin.,3.History,①.Chest pain is the chief complaint,its quality and location are variable.Comm

4、on locations:retrosternal and left precardial regions. Radiates to the trapezius ridge and neck.Pain aggravated by lying supine,coughing,deep inspiration and swallowing,pain eased by sitting up,leaned forward.,Ischemic

5、 pain Pericardial pain Location retosternal , left shoulder,arm precardium:left trepezius ridge

6、 Quality pressure, burning, buildup sharp, dull, pleuritic Thora

7、cic motion no effect increased by breathing Duration angina: 1 or 2 to 15 min hours or days unstable: 1/2hr to hoursEffort angina:usu

8、ally no relation unstable:usually not Posture no effect; may sit,belch,use leaning forward for relief valsalv

9、a knee-chest position aggravated by recumbency for relief,②Dyspnea is aggravated by fever,large pericardial effusion③Additional symptoms:cough, sputum production,weight loss.In elderly patien

10、ts the chest pain and dyspnea are subtle.,4.Physical examinationThe friction rub:a scratching,grating,high-pitched sound ,the sound is believed to arise from friction between the roughened pericardial and epicardial s

11、urfaces.Ewart sign,The pericardial friction rub is classically described as having three components that are related to cardiac motion during atrial systole(presystole),ventricular systole and rapid ventricular filling

12、 in early diastole.Location: lower left sternal border.Important feature: often evanescent and change in quality,Detection of rub: stethoscope applied firmly to the chest at the lower left sternal border during in

13、spiration and full expiration with the patient sitting up and lean forward.,12.Cardiac tamponade:①elevation of intracardiac pressure ②progressive limitation of ventricular diastolic filling ③reduction of stroke volum

14、e and cardiac output.,Clinic manifestation:①a decline in systemic arterial pressure②elevation of systemic venous pressure③a small, quiet heart.,Jugular venous distention, tachypnea, tachycardia , pulsus pa

15、radoxus, hypatomegaly. pulsus paradoxus:an inspiratory decrease in the amplitude of palpated pulse in the femoral or carotid arteries.Laboratory studies:ECG: electrical alternansUCG,5.Electrocardiagram: four stage

16、s,Stage Ι:comprise ST segment elevation is concave upward and present in all leads except avR and V1. T waves are upright.Stage Ⅱ: ST segments return to baseline, T wave flattening.Stage Ⅲ: T waves in normalStage IV:

17、reversion of T wave changes to normal Others: isolated,PR-segment depression,sinus tachycardia, atrial arrhythemias.Echocardiogram: is the most sensitive and accurate tool in the detection and quantificatio

18、n of pericardial fluid.,.Electrocardiagram,6.Blood test : leukcytosis and elevation of the sedimentation.,7. The chest roentgenogam: for a large pericardial effusion,the X-ray show both enlargement and changes in

19、configuration of the cardiac sihouette provide clues to the underlying cause of the pericarditis. 8.Pericardicentesis and biopsy.,The chest roentgenogam,9.Management:①detect an underling disease that requires specifi

20、c therapy②pain relief:nonsteroidal anti-inflammatory agents:aspirin,indomethicia or corticosteroids.③antibiotics: purulent pericarditis,10.Natural history: viral, idiopathic, post-myocardial infarction percarditis o

21、r post-pericardiotomy syndrome are usually self-limited.11.Recurrent pericarditis:20-28%,診斷要點不同類型心包炎的臨床特點 急性非特異性 結核性 腫瘤性 化膿性病因 病毒 結核桿菌 轉移癌 葡萄球菌 G+癥狀 急起 心前區(qū) 發(fā)燒及結核

22、 漸進性呼吸 高熱毒血癥 劇痛，發(fā)燒 中毒癥狀 困難體癥 心包摩擦音 中大量積液 大量積液 中大量積液 少量積液積液性質 漿液纖維蛋白 漿液纖維蛋白 血性 化膿性治療 皮質激素 抗癆 治療原發(fā)病 抗生素及引流術預后 好，易反復 易縮窄

23、 差 較好,,,,Constrictive pericarditis,CP is present when a fibrotic,thickened,and adherent pericardium restricts diastolic filling of the heart.Calcium deposition may contribute to thickening and stiffing

24、of the pericardium.1.Pathophysiology2.Etiology Tuberculosis is the leading cause3.clinical factures,Constrictive restrictrve pericarditis

25、 cardiomyopathyS3 gallop absent may be presentPericardial knock may be present absent Palpable systolic absent

26、 may be preset apical impulse Pericardial calcification may be present absent Equal RV and LVdiastolic pressure

27、usually present LV>RVRate of LV filling 80% in first half 40% in first half of diastole of diastoleCAT SCANECH