急性心包炎课件_5.pptVIP

Acute PericarditisECG conference Pericardium Visceral / serous Direct contact with epicardium (ST elev) single layer mesothelial cells Parietal / fibrous mesothelial and fibrous layer Pericardial Anatomy Etiology – Acute Pericarditis Infectious Viral : Coxsackie, Echo, EBV, Influenza, HIV Bacterial: TB, staph, hemophillus, pneumococcal, salmonella Fungal/other: histo/blasto/coccidio, rickettsia Rheumatologic SLE, Sarcoid, RA, Dermatomyositis, Ankylosing Spondylitis, Scleroderma, PAN Neoplastic Primary: angiosarcoma, mesothelioma Metastatic: breast, lung, lymphoma, melanoma, leukemia Immunologic Celiac sprue, Inflammatory Bowel Disease Drug Hydralizine, Procainamide Other MI, Dressler’s, Post Pericardiotomy, Chest Trauma, Aortic dissection Uremic, Post Radiation IDIOPATHIC Acute Pericarditis – Clinical History preceding viral illness, etc Symptoms Chest pain Signs Friction Rub ECG early: PR / ST changes late: isoelectric ST/ T inv History Often preceding viral illness 1-2wk prior Chest Pain Sudden, sharp,pleuritic, constant worse supine/ L lat decub, relief sitting up radiation: back, trapezius ridge symptoms usually resolve by 2 weeks, ECG abnormalities may persist for months Auscultory – Rub(s) Endopericardial (classic) “triphasic”: atrial sys, ventricular sys, early diastole may only hear 2 phase (afib or tachycardia) or 1 loudest LSB, raised extremities/increased venous return Pleuropericardial “exopericardial”, extension into adjacent structures marked resp variation, musical quality Conus dilation of pulm conus in hyperactive heart PE, thyroid storm, acute beriberi Pneumohydropericardium air/gas overlying pcard fluid metallic tinkle (small amt) ; churning/splashing “mill-wheel sound” (lg) ECG PR depression ST elevation concave up, ST/T V6 .25, no reciprocal DDx: Acute MI Early Repolarization Myocarditis Aneurysm other: Brugada, BBB ECG Acute Pericarditis - Stages Stage I first few days ? 2 weeks ST elev, PR depression up