复旦大学附属中山医院：《内科学》课程教学资源（PPT课件讲稿）心包疾病

心包疾病 中山医晚周京敏

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 Pleuritic Postural Dyspnea ++ fluid ++++ Fast and thin General F 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 b fin ab lindings Blood WBC increase 1a anemia Ascites rarely Leak-out Hepatic normal ImpaIr CK-Mb or↑: myocardium norma CTNT Ir

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 g wave No Widespread calcification ORS Voltage ST-T Convex↑ except on-specific in avR(V1) 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 Normal. rarely calcitication Chest X-ray Enlarged shadow Normal 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