心包疾病课件_4.ppt

心脏压塞征 静脉淤血的症状 颈静脉怒张： 静脉压显著升高； Kussmaul征：慢性心包填塞时，静脉淤 血征象明显，颈静脉怒张 但搏动不显著，且在吸气 期更明显； 肝颈静脉回流征：阳性； 肝脏肿大：伴压痛； 腹水 下肢浮肿 * Case Report A female patient, 47 years of age, was admitted to the service of the Medical Clinic of the Clinics Hospital of the Federal University of Paraná. She complained about shortness of breath, weakness, and edema, with dyspnea after light and heavy exertion starting 2 years earlier. The patient also reported asthenia and lower limb, facial, and abdominal edema, but denied the existence of any other health problem except depression (untreated for the last few months). She was previously hospitalized for dyspnea. Her symptoms had been treated but her clinical picture had never been investigated. She did not have a family history of morbidity; the patient was not a smoker or alcohol consumer, and at the time was not using any medication. Systemic examination revealed intestinal constipation and palpitation. No family history of importance (including tuberculosis) was reported. On physical examination, she had a regular general condition, hypocoloration, and eupnea. Her arterial pressure was 120/90 mmHg, pulse 90bpm, respiratory frequency 16rpm, and she had a 36.5o C temperature. On segmental examination, she had engorged jugulars, crepitating stertors on pulmonary bases, hypophonetic yet rhythmic cardiac murmurs, slight lower limb edema, and slowed, deep tendinous reflexes. Complementary examinations (performed on the first 3 days of hospitalization) showed, on thoracic radiography, a marked increase in the volume of the cardiac silhouette and slow right-side pleural effusion (Figure 1), and on electrocardiography, sinus rhythm, low voltage on the frontal plane, and diffuse alteration of ventricle repolarization. The laboratory examination hemogram showed the following: hematocrit, 39.5%; hemoglobin, 13.2g/dL; mean corpuscle volume, 100 fL; leukocytes, 6,100 (5% rod