心包疾病PPT课件.ppt
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1、心包疾病心包疾病General characteristics(Normal Pericardial Anatomy and Normal Pericardial Anatomy and PhysiologyPhysiology)1.Pericardium is the membranous sac surrounding the heart.2.The pericardium consists of two layers:visceral layer and parietal layer.3.There is about 50ml pericardial fluid in the peric
2、ardial cavity.The normal functions of the pericardiumMaintaining an optimal cardiac shape.Reducing friction between the beating heart and adjacent structures.Protecting the heart from other diseases which are caused by the neighboring organs:inflammation,TB,cancer etc.Preventing the overfilling of t
3、he heart.Classification of Pericardial DiseasesCongenital defectPericarditisacute pericarditisacute pericarditispericardial effusionpericardial effusion constrictive pericaditis constrictive pericaditis.Pericardial neoplasmPericardial cystsAcute pericarditisDefinition Acute pericarditis is an inflam
4、mation of the pericardium.Etiology The disease may be idiopathic or secondary to The disease may be idiopathic or secondary to other diseases,for exampleother diseases,for exampleViral infection:Viral infection:coxsackieviruscoxsackievirus B,CMV B,CMVBacterial infection:Staphylococcus sp,Bacterial i
5、nfection:Staphylococcus sp,Streptococcus sp,tubercle bacillusStreptococcus sp,tubercle bacillusPost-MI complicationsPost-MI complicationsDrugsDrugsMalignancy Malignancy Collagen vascular diseaseCollagen vascular diseasePathology Early stageEarly stage:fibrous protein pericarditisfibrous protein peri
6、carditis Progressive stageProgressive stage:Rapid effusive pericarditis acute cardiac tamponade Rapid effusive pericarditis acute cardiac tamponade Chronic accumulation is accommodated by the expanding Chronic accumulation is accommodated by the expanding pericardiumpericardium myopericarditis myope
7、ricarditis Final resultFinal result:The exudate was completely dissolved and absorbed The exudate was completely dissolved and absorbed Organization Organization calcification of pericardium constrictive calcification of pericardium constrictive pericarditispericarditispathophysiologyAcute pericardi
8、al effusionAcute pericardial effusion The pressure of the pericardial cavityThe pressure of the pericardial cavity FV(filling volume)of the ventricular diastoleFV(filling volume)of the ventricular diastole SV(stroke-volume)SV(stroke-volume)BPBP Clinical Manifestations -fibrous protein pericarditis C
9、hest pain Chest pain(Symptoms)(Symptoms)Position Position:retrosternal or retrosternal or precordium,midsectionprecordium,midsection CharacterCharacter:sharp pain,dull pain,sharp pain,dull pain,compressioncompression WorsenWorsen deep breathing,cough,deep breathing,cough,and lying down.and lying dow
10、n.Relieved Relieved sitting and leaning sitting and leaning forward.forward.Pericardial friction rub Pericardial friction rub (Signs)(Signs)Both systole and Both systole and diastolediastole This finding is This finding is diagnosticdiagnosticClinical Manifestations -Pericardial effusion Symptoms Sy
11、mptoms DispneaDispnea Pressure symptomsPressure symptoms:dry cough(bronchus)dry cough(bronchus)hoarseness(laryngeal hoarseness(laryngeal nerve)nerve)dysphagia dysphagia(esophagesophagus)us)Signs Signs physical sign of the heart physical sign of the heart tachycardia,tachycardia,indistinct heart indi
12、stinct heart soundssounds Ewart signEwart sign(consolidation of (consolidation of lower lobe of left lung)lower lobe of left lung)Hypotension Hypotension SBPSBP,pulse pressurepulse pressure even even paradoxical pulseparadoxical pulse.Congestion of systemic Congestion of systemic circulationcirculat
13、ion distended jugular veindistended jugular vein edemaedemaClinical Manifestations -Cardiac tamponadeAcute:Becks trilogyHypotension or shockHypotension or shockDistended jugular veinDistended jugular veinIndistinct heart soundsIndistinct heart soundsSubacute or chronic:venous pressure venous pressur
14、e congestion of systemic circulationcongestion of systemic circulationKussmaul sign(dilation of jugular vein Kussmaul sign(dilation of jugular vein during inspiration)during inspiration)Laboratory findings -ECGStage I:Stage I:ST segment elevationST segment elevation(concave upward not (concave upwar
15、d not convex)in all leads except avR and V1 without convex)in all leads except avR and V1 without reciprocal ST segment depression(which occurs in reciprocal ST segment depression(which occurs in MI)(Several hours later).MI)(Several hours later).Stage IIStage II:ST segments return to baseline,the:ST
16、 segments return to baseline,the initially upright T waves flatten(several days later)initially upright T waves flatten(several days later)Stage III:Stage III:T waves invert(weeks later)T waves invert(weeks later)Stage IV:Stage IV:T waves revert to normal(weeks or T waves revert to normal(weeks or m
17、onths later)months later)Other changes:Large effusion can cause both Other changes:Large effusion can cause both reduced voltage and electrical alternans.reduced voltage and electrical alternans.EKG of Acute pericarditis(Stage I)Acute inferior myocardial infarctionLaboratory findings -Chest x-ray fi
18、lmCardiac shadow has Cardiac shadow has an enlarged an enlarged“water-bottle”“water-bottle”appearance.appearance.Clear lung field.Clear lung field.Cardiac shadow Cardiac shadow changes with changes with postures.postures.Laboratory findings -Echocardiography This is the best This is the best noninva
19、sive noninvasive investigation investigation for confirming for confirming diagnosis of a diagnosis of a pericardial pericardial effusioneffusionLaboratory findings -Pericardiocentesis 1.Pericardiocentesis can help to make1.Pericardiocentesis can help to make diagnosis diagnosis.Fluid should be sent
20、 for culture and assayFluid should be sent for culture and assay Protein,glucose and LDH assaysProtein,glucose and LDH assays:LDH,glucose and:LDH,glucose and protein determine if fluid is a transudate or exudate;protein determine if fluid is a transudate or exudate;Cytology and tumor markerCytology
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