Acute Pericarditis - Harvard University：急性心包炎-哈佛大学.ppt

Acute Pericarditis and Pericardial Effusion Meghan York September 9, 2009 Outline Anatomy of pericardium Overview of pericardial disease Etiology Clinical presentation Ancillary diagnostics 6) Echocardiography in evaluation Anatomy Normal amount of pericardial fluid: 15-50 cc Two layers: Outer layer is the parietal pericardium and consists of layers of fibrous and serous tissue Inner layer is visceral pericardium and consists of serous tissue only Pericardium Fibroelastic sac consisting of 2 layers Visceral at epicardial side Parietal at mediastinal side Pericardial fluid formed from ultrafiltrate of plasma Diseases of the Pericardium Acute Fibrinous Pericarditis Pericardial Effusion Cardiac tamponade Recurrent Pericarditis Constrictive Pericarditis Epidemiology of Acute Pericarditis 0.1% of hospitalized patients 5% of patients admitted to Emergency Department for non-acute myocardial infarction chest pain Findings on Echo Pericardial effusion If present, possibility of tamponade physiology needs to be considered Pericardial thickening Increased echogenicity of pericardial reflection and as multiple parallel reflections posterior to the LV on M-mode If present, evidence of constrictive physiology should be considered Tamponade: 2D Pericardial thickening on Echo Findings on CT Chest X ray Normal in patients with acute pericarditis unless pericardial effusion is present Enlarged cardiac silhouette Requires 200cc of fluid Chest X Ray Major Causes of Pericardial Disease 1)Infection 2)Radiation 3)Neoplasm 4)Myocardial intrinisic disease 5)Trauma 6)Autoimmune 7)Drugs 8)Metabolic *viral, autoreactive/autoimmune, and neoplastic most common diagnosis Etiology of Acute Pericarditis: Infectious Viral -adenovirus -enterovirus -cytomegalovirus -influenza -hepatitis B -herpes simplex -echovirus -mumps Mycoplasma Fungal Parasitic Bacterial -staphylococcus -streptococcus -pneumococcus -haemophilus -neisseria -chlamydia -legionella -tubercu