心包疾病讲座

心包疾病中山医院周京敏第1页GeneralIncidence:low1.5-6%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第2页InflammationofvisceralandparietalcardiacsacEffusionChronicrestrictivepericarditisCardiactamponadefluiddyspneaChestpainresolvedfibrousSurgeryHeartFailureeffusionDyspnea,JVdistension,BP￬第3页AcutepericarditisC-Constr-PericNon-specific+++++++Tumor++++TB++++++

Radiationtherapy-+++Systemdisease++Physicalandchemicalfactors++Etiology第4页ClinicalManifestation---SymptomsAcutepericarditisC-Constr-PericChestpain++++fibrousPleurotic,Postural－

Dyspnea+---+++fluidFastandthin++++GeneralFever－---++－fatigue－+++ascites－+++wasting－++第5页AcutepericarditisC-Constr-PericFrictionrub++++transient－Enlargementonpercussion－----+++－Edema,ascites－---++－---++++Pulsusparadoxus(>10mmHg)－---+++－---+Jugularveindistension－---+++－---++ClinicalManifestation---Signs第6页AcutePericarditisC-ConstrPericLabfindingsBloodWBCincreaseanemiaAscitesrarelyLeak-outHepatic:normalimpairCK-MborcTNT↑:myocardiuminjurynormal第7页AcutePericC-ConstrPericElectrocardiologyPwaveNormal50%:notchAbnormalqwaveNoWidespreadcalcificationQRSVoltage↓↓ST-TConvex↑exceptinavR(V1)Non-specificArrhythmiaSinustachycardiaAfib,A-Vblock第8页AcutePericC-ConstrPericEchofluidNormal,rarelycalcificationChestX-rayEnlargedshadowBottle-likeNormal,Smallandstraight,CalcificationCTorMRIFluidPericardiumthickeningEtiologydiagnosis第9页EchocardiographyAcutePericarditis:Mostimportant,useful,sensitiveConfirmthediagnosisSemi-quantitythevolumeAssesstheefficacyofmanagementGuidethepericardiocentesisChronicRestrinctivePericarditisnormal第10页第11页PE第12页第13页12-LeadECGfromaPatientwithAcutePericarditis,DemonstratingWidespreadST-SegmentElevationandPR-SegmentDepression.第14页第15页CardiacTamponade第16页ChronicConstrictivePericarditis第17页AcutePericarditisC-ConstrPericPericardiocentesisEtiologydiagnosisReliefsymptoms__Catheterization__Pressurecurvechange心包镜Etiologydiagnosishard第18页DiagnosisandDifferentialDiagnosisAcutePericarditisC-ConstrPericDiagnosisChestpain+dyspnea+frictionrubAscites+jugularveindistensionDifferentialDiagnosisMIAcuteAbdomenRestrictiveCMLiverdisease第19页ManagementandPrognosisAcutePericarditisC-ConstrPericManagementDiureticsDiureticsPericardiocentesisPrudenttochooseSurgeryAsearlyaspossiblePrognosisCompletelyresolvedChronicCons-PericCompletelyresolvedHeartfailure第20页AcutePericarditis:SpecificFormsFeaturesViralFollowingupperrespiratoryinfectionTuberculosisNightsweats,Anti-TBeffectiveBacterialToxicillNeoplasticCytologicexam,nearbytumorOthers

systematicdiseasesDressler’sSyndromeRadiationUremic第21页InterestingCaseA64-year-oldmanwithprogressivelyworseningedemaofthelegsPE:Jugularvenousdistention,anenlargedliver,pittingedemaECG:low-voltageandATChestfilm:thickenedpericardiumCT:dilatedSVC,anormalaorticarch(AA)andDA,andathickenedpericardium.第22页Simultaneousrightandleftcatheter:diastolicLV=RVRightheartcatheter:indiastole:RA=RV=PA=PCWP第23页pericardialstripping:markedpericardialthickening(P)第24页Histologicanalysis:nocausewasidentifiedEdemadecreasedmarkedlyafterpericardialstripping第25页60ysmale,hypertensionfor30ysEdema4-5yearsE