心包疾病讲座专家讲座

心包疾病中山医院周京敏心包疾病讲座第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心包疾病讲座第2页InflammationofvisceralandparietalcardiacsacEffusionChronicrestrictivepericarditisCardiactamponadefluiddyspneaChestpainresolvedfibrousSurgeryHeartFailureeffusionDyspnea,JVdistension,BP￬心包疾病讲座第3页AcutepericarditisC-Constr-PericNon-specific+++++++Tumor++++TB++++++

Radiationtherapy-+++Systemdisease++Physicalandchemicalfactors++Etiology心包疾病讲座第4页ClinicalManifestation---SymptomsAcutepericarditisC-Constr-PericChestpain++++fibrousPleurotic,Postural－

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

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