【物理】心包疾病.pptVIP

心 包 疾 病 General Incidence: low 1.5-6% 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 Etiology Clinical Manifestation --- Symptoms Clinical Manifestation --- Signs 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 Cardiac Tamponade Chronic Constrictive Pericarditis Diagnosis and Differential Diagnosis Management and Prognosis Acute Pericarditis: Specific Interesting Case A 64-year-old man with progressively worsening edema of the legs PE: Jugular venous distention, an enlarged liver, pitting edema Simultaneous right and left catheter: diastolic LV = RV Right heart catheter: in diastole: RA = RV = PA =PCWP Histologic analysis: no cause was identified Edema decreased markedly after pericardial stripping 60ys male, hypertension for 30ys Edema 4-5years ECG, Chest X-ray, Echcardiography: normal What is the diagnosis? * 中山医院 周京敏 Effusion Chronic restrictive pericarditis Cardiac tamponade fluid dyspnea Chest pain resolved fibrous Surgery Heart Failure effusion Dyspnea, JV distension, BP? + + + - Radiation therapy + + System disease + + Physical and chemical factors + + + + + + TB + + + + Tumor + + + + + + + Non-specific C-Constr-Peric Acute pericarditis + + + － ascites wasting fatigue Fever + + － + + + － － －--- + + General + + + + + --- +++ fluid Fast and thin Dyspnea － + + + + fibrous Pleurotic, Postural Chest pain C-Constr-Peric Acute pericarditis －--- + + －--- + + + Jugular vein distension －--- + －--- + + + Pulsus paradoxus (10mmHg) －--- + + + + －--- + + Edema, ascites － －----+ + + Enlargement on percussion － + + + + transient Friction rub C-Constr-Peric Acute pericarditis Lab findings CK-Mb or cTNT Hepatic: Ascites Blood normal ↑: myocardium injury impair normal Leak-out rarely anemia WBC increase C-Constr Peric Acute Perica