复旦大学：《内科学》课程教学资源（PPT课件讲稿）（周京敏）心包疾病

心包疾病 中山医院周京敏

心 包 疾 病 中山医院 周京敏

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

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

Chest pain Inflammation of visceral and parietal cardiac sac resolved fibrous Surgery fluid effusion Effusion Chronic restrictive pericarditis dyspnea Cardiac tam pomade Heart Failure Dyspnea, JV distension, BP+

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￬

Etiology Acute pericarditis C-Constr-Peric Non-specific ++++ +++ Tumor +++ TB ++ ++++ Radiation therapy ++ System disease Physical and chemical factors

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 Fe ever + fatigue +++ ascites ++ wasting +

Clinical Manifestation --- Symptoms Acute pericarditis C-Constr-Peric Chest pain + + + + fibrous Pleurotic, Postural － Dyspnea + --- +++ fluid Fast and thin + + + + General Fever －--- + + － fatigue － + + + ascites － + + + wasting － + +

Clinical Manifestation -- Signs Acute pericarditis C-Constr-Peric Friction rub ++++ transient Enlargement on ++ percussion Edema. ascites + +++ Pulsus paradoxus +++ (10mmHg) Jugular vein +++ + distension

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 He hepatic norm impaIr CK-Mb or :m myocardium normal CTNT Injury

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 Non-specific in avR (VI) Arrhythmia Sinus tachycardia Afib. A-v block

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 E cho fluid p Normal. rarely calcification Chest X-ray Enlarged shadow orma Bottle-like Small and straight Calcification ct or MRI Fluid Pericardium thickening Etiology diagnosis

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 Restrictive Pericarditis · normal

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