病毒性心肌-炎课件

13-yr-oldfemaleC/O:Vomiting(呕吐)HPC:Suddenonsetofvomiting6hoursago,vomitfoodonlyAssociatedfeatures:exhausted;pallorcomplexion;limbscoldandsweating.(疲倦乏力,面色苍白,肢冷汗多)O/ECVS:BP:105/70mmhg,HR:123/min,nomurmursGIT:soft,nomess,nopalpableliverandspleen;(腹软,肝脾不大)RS,CNS:normalInvestigation:bloodsodiumandpotassiumslightlyfall(低钠,低钾血症)Diagnosis:Gastritis,moderatedehydration(急性胃炎,中度脱水)Treatment:Rehydration.(补液治疗)Result:deterioratedanddied13-yr-oldfemale1病毒性心肌炎(viralmyocarditis,VMC)PediatricAcademicGroupSally病毒性心肌炎2月的与要求(objectiveandrequirement)1、掌握中医辨证论治与西医治疗原则Master:selectionoftreatmentbaseondifferentialofsyndromesintraditionalChinesemedicineandtherapeuticprincipleofWesternmedicine2、熟悉病因病理。Familiar:diagnosis,pathogenicandpathologys3、了解概念,研究进展。Understand:definitionandresearchprogress.i月的与要求(objectiveand3概述(summarization)1.定义:病毒侵犯心脏所致的,以心肌的局限性或弥漫性炎性病变为主要表现的疾病Definition:inflammationofmyocardiumcausebyviralinfection(pericardiumorendocardium)2.典型症状:神疲乏力,面色苍白,心悸气短,肢冷多汗。Typicalsymptom:exhausted,pallorcomplexion,palpitations,shortnessofbreath,limbscoldandexcessivesweating.3中医属温病、怔忡、胸痹、虚劳等范畴。Seasonalfebriledisease,severepalpitation,chestbi-tsyndromeandconsumptivedisease.概述(summarization)4概述(merization)4中医文献论述(referent)(1)《小儿药证直决脉证治法》:“心主惊虚则卧而悸动不安。”(2)《张氏医通神志门》:“夫悸之症状不齐,总不外乎心伤而火动,火郁而生涎也。若夫虚实之分,气血之辨,痰与饮,寒与热,外感六淫,内伤七情,在临证辨之。”(3)《伤寒论辨太阳病脉证并治》:“伤寒脉结:代,心动悸,炙甘草汤主之概述(merization)5中医病因病机(aetiologyandpathogenesis)风热侵心气阴受损正气袭肺卫邪毒心血瘀滞内舍痰瘀互结不足湿热困于心心阳虚衰阻脾胃水湿内停病因是风热、湿热wnd-heat,dampnesshea之入侵:病机是邪毒内损于心,心脉痹阻(stagnationofheartmeridian)。瘀血,痰浊(stagnationofblood,phlegm)是病理产物中医病因病机(aetiologyand6病因和发病机制PathogenicandpathogenesisC因pathogenic):肠道和呼吸道病毒。最常见Morethan20kindsofvirus,includingrespiratoryvirusandintestinalvirus,themostcommoniscoxsackievirus二、发病pathogenesis)病毒→血循环心肌自身免疫(ity毒素细胞补体参与(complement)细胞因子(cytokine)神经体液(nerveandhumor)脂质过氧化物(lipidperoxide病因和发病机制7病因和发病机制(pathogenicanapathogenesis三、病理(pathologic):炎症细胞没润、心肌细胞变性坏死、心肌纤维化、瘢痕形成病因和发病机制(pathogenic8c细伤严国时。回导线死漫线。8镜下息分心以后。使机组织不人伤细胞发生了德8的。现象。细的Whenthereismarkedcellularinjury,thereiscelldeath.ThismicroscopicappearanceofmyocardiumisamessbecausesomanycellshavediedthatthetissueisnotrecognizableManynucleihavebecomepyknotic(shrunkenanddark)andhavethenundergonekarorrhexis(fragmentation)andkaryolysis(dissolution).Thecytoplasmandcellbordersarenotrecognizablec9临床表现(clinicalsymptom):前驱感染:二周内有呼吸道或肠道感染Prodrome:RespiratoryandIntestinalinfectionin2weeks二、心脏受累表现:心悸、气短、乏力、头晕、面色苍白、多汗、胸闷胸痛。重者心力衰竭,心源性休克,心脑综合征Serious(complication):Cardiacfailure,Cardiacshock,CardiacandEncephalicsyndrome.三、体征:心尖区第一音低钝,部分有奔马律。一般无器质性杂音。可闻及早搏Sign:Heartsoundreduceandarrhythmia.临床表现(clinicalsymptom):10病毒性心肌-炎课件11病毒性心肌-炎课件12病毒性心肌-炎课件13病毒性心肌-炎课件14病毒性心肌-炎课件15病毒性心肌-炎课件16病毒性心肌-炎课件17病毒性心肌-炎课件18病毒性心肌-炎课件19病毒性心肌-炎课件20病毒性心肌-炎课件21病毒性心肌-炎课件22病毒性心肌-炎课件23病毒性心肌-炎课件24病毒性心肌-炎课件25病毒性心肌-炎课件26病毒