周京敏-心包疾病.ppt

心包疾病,General,Incidence: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,Inflammationofvisceralandparietalcardiacsac,Effusion,Chronicrestrictivepericarditis,Cardiactamponade,fluid,dyspnea,Chestpain,resolved,fibrous,Surgery,HeartFailure,effusion,Dyspnea,JVdistension,BP,Etiology,ClinicalManifestation-Symptoms,ClinicalManifestation-Signs,Echocardiography,AcutePericarditis:Mostimportant,useful,sensitiveConfirmthediagnosisSemi-quantitythevolumeAssesstheefficacyofmanagementGuidethepericardiocentesisChronicRestrinctivePericarditisnormal,PE,12-LeadECGfromaPatientwithAcutePericarditis,DemonstratingWidespreadST-SegmentElevationandPR-SegmentDepression.,CardiacTamponade,ChronicConstrictivePericarditis,DiagnosisandDifferentialDiagnosis,ManagementandPrognosis,AcutePericarditis:Specific,InterestingCase,A64-year-oldmanwithprogressivelyworseningedemaofthelegsPE:Jugularvenousdistention,anenlargedliver,pittingedema,ECG:low-voltageandAT,Chestfilm:thickenedpericardium,CT:dilatedSVC,anormalaorticarch(AA)andDA,andathickenedpericardium.,Simultaneousrightandleftcatheter:diastolicLV=RVRightheartcatheter:indiastole:RA=RV=PA=PCWP,pericardialstripping:markedpericardialthickening(P),Histologicanalysis:nocausewasidentifiedEdemadecreasedmarkedlyafterpericardialstripping,60ysmale,hypertensionfor30ysEdema4-5yearsECG,ChestX-ray,Echcardiography:normalWhatisthediagnosis?,Hypertension,HeartFailure,NYHA