周京敏心包疾病.pptVIP

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 Effusion Chronic restrictive pericarditis Cardiac tamponade fluid dyspnea Chest pain resolved fibrous Surgery Heart Failure effusion Dyspnea, JV distension, BP ? Acute pericarditis C-Constr-Peric Non-specific + + + + + + + Tumor + + + + TB + + + + + + Radiation therapy - + + + System disease + + Physical and chemical factors + + Etiology Clinical Manifestation --- Symptoms Acute pericarditis C-Constr-Peric Chest pain + + + + fibrous Pleurotic, Postural － Dyspnea + --- +++ fluid Fast and thin + + + + General Fever － --- + + － fatigue － + + + ascites － + + + wasting － + + Acute pericarditis C-Constr-Peric Friction rub + + + + transient － Enlargement on percussion － ----+ + + － Edema, ascites － --- + + － --- + + + + Pulsus paradoxus (10mmHg) － --- + + + － --- + Jugular vein distension － --- + + + － --- + + Clinical Manifestation --- Signs Acute Pericarditis C-Constr Peric Lab findings Blood WBC increase anemia Ascites rarely Leak-out Hepatic: normal impair CK-Mb or cTNT ↑: myocardium injury normal Acute Peric C-Constr Peric Electrocardiology P wave Normal 50%: notch Abnormal q wave No Widespread calcification QRS Voltage ↓ ↓ ST-T Convex ↑except in avR (V1) Non-specific Arrhythmia Sinus tachycardia Afib, A-V block Acute Peric C-Constr Peric Echo fluid Normal, rarely calcification Chest X-ray Enlarged shadow Bottle-like Normal, Small and straight, Calcification CT or MRI Fluid Pericardium thickening Etiology diagnosis Echocardiography Acute Pericarditis: ? Most important, useful, sensitive ? Confirm the diagnosis ? Semi-quantity the volume ? Assess the efficacy of management ? Guide the pericardiocentesis Chronic Restrinctive Perica