內(nèi)科學(xué)教學(xué)課件：心肌病心包炎

1、Cardiomyopathy,Definition,The cardiomyopathies are disease that involve the myocardium primarily and are not the result of hypertension or congenital, valvular, coronary, arterial or pericardial abnormalities,Etiology classification of CM,WHO/ISFC1995 1. The definition of cardiomyopathy : a primary

2、type, consisting of myocardial disease of unknown cause,Etiology classification,2. Classification of cardiomyopathy: (1) DCMdilated CM (2) HCM hypertrophic CM (3) RCM restrictive CM (4) ARVD/C arrhythmogenic right ventricular CM,Dilated cardiomyopathy,character: left and/or right ventricular systoli

3、c pump function is impaired, leading to cardiac enlargement and often producing symptoms of congestive heart failure,Clinical manifestation 1. symptoms (1) early: asymptom (2) late: symptoms of left and right-sided congestive failure, manifested by dyspnea, peripheral edema and palpitation, hepatome

4、galy, thromboembolism, sudden death,Clinical manifestation,2. Signs: (1) heart enlarge (2) diastolic 3rd sound gallop (3) all kinds of arrhythmia,Examanation,1. X-ray: heart/chest 50%, ventricular enlargement, pulmonary effusion 2. ECG: Arrhythmia such as atrial fibrillation, block. ST-segment and T

5、-wave abnormalities 3. Echocardiography: Left atrial and ventricular dilation with normal or thinned walls and systolic dysfunction, ejection fraction reducing,Examanation,4. radionuclide scintigraphy 5.cardiac pipe inspection and angiogram 6. endocardial biopsy,Treat,1. Drugs: the methods of therap

6、y is to control congestive heart failure and arrhythmia. 2. Artifical cardiac pacing(cadiac resynchronization,CRT) ,ICD. 3. Surgical therapy, cardiac transplantation,Hypertrophic cardiomyopathy,Character: 1.disproportionate left/ right ventricular hypertrophy, involving septum. 2. diastolic dysfunct

7、ion,Classification： according to obstruction of left ventricular outflow tract 1. obstructive HCM 2. non-obstructive HCM Apical hypertrophy(APH,Clinical manifestation 1. Symptoms: sudden death, dyspnea, angina pectoris, fatigue, syncope 2. Signs: (1)slight cardiac enlargement (2)the fourth sound,3)s

8、ystolic murmur at the low left sternal border as well as at the 3rd-4th intercostal space. In cases with outflow obstruction, a loud systolic murmur is present that increases with upright posture, nitroglycin ，positive inotropic drugs or Valsalvas maneuver and decrease with squatting,. - blockers,Ex

9、amanation： 1. X-ray: mild to moderate cardiac enlargement 2. ECG: left ventricular hypertrophy, ST-T abnormalities, abnormal Q waves 3. echocardiogram: (1) asymmetric septal hypertrophy (ASM) (2) septal hypertrophy and 1.3 thickness of LV posterior wall (3) systolic anterior motion (SAM)of the mitra

10、l valve,Treat： 1. B-blockers, calcium antagonists 2. DDD artifical cardiac pacing: may prevent the progression of hypertrophy and obstruction. 3. Nonsurgical septal ablation has been performed by injection of alcohol into septal branches of the left coronary artery. 4. Surgical therapy,Specific CM,a

11、 secondary type, consisting of myocardial disease of known cause or associated with a disease involving other organ systems,For example: (1) alcohol cardiomyopathy (2) peripartum cardiomyopathy ( 3) Keshans Disease (4) drug-induced cardiomyopathy,Pericardial Disease,Classification,1.acute pericardit

12、is 2.chronic pericarditis 3.adherent pericarditis 4.subacute exudative constrictive pericarditis 5.chronic constrictive pericarditis,Acute pericarditis,Etiology 1. acute nonspecific pericarditis 2. infective pericarditis: virus, bacteria and so on 3. autoimmunity: rheumapyra, connective tissue disea

13、se(CTD), post heart damages syndrome ( postinfarction syndrome,4. carcinomal pericarditis 5. metabolic disease: gout 6. physical cause: injure and radiation 7. diseases of near organ: AMI, aortic dissection,Pathology: fibroproteinous or exudative pericarditis,Clinical manifestation,1. Fibroproteinou

14、s pericarditis (1) symptoms: precardial pain: a sharp, dull sensative radiate to neck and shoulder, deep inspiration and cough will precipitate the pain (2) signs: a pericarditis friction rub - - characteristic sign the third or fourth left intercostal space,2. exudative pericarditis (1) symptoms: d

15、yspnea outstanding symptom (2) signs: the cardiac dullness the apical impulse weaken or disappear heart sound faint, far Ewarts sign distension of jugular vein, hepatomegaly, ascites,cardiac tamponade (1) tachycardia, distension of jugular vein, venous pressure (2) jugular venous distension Bp SBp D

16、Bp( ).shock paradoxical pulse signs of pericarditis effusion,Lab exam,1. Laboratory test: infective pericarditis WBC ESR 2. X-ray: exudative pericarditis heart enlarge obviously without congestion of lung - -This is a strong evidence of pericarditis effusion. 3. ECG: acute stage :ST , but not includ

17、ing aVR,4. echocardiogram,5. pericardiocentesis (心包穿刺) main indications: cardiac tamponade, exudative pericarditis unknown cause,Constrictive pericarditis,Clinical manifestation 1. Symptoms: acute fatigue, weakness, weigh loss, exertional dyspnea, abdominal swelling, ankle edema,2.signs: jugular vein distention, hepatomegaly, ascites, heart sound or disappear, the cardiac dullness normal, apical impluse,pericardial knock 50%(+), H