心包疾病講座專家講座

心包疾病中山醫(yī)院周京敏心包疾病講座第1頁GeneralIncidence:low1.5-6%急性心包炎慢性縮窄性心包炎慢性心包積液粘連性心包炎心包疾病講座第2頁InflammationofvisceralandparietalcardiacsacEffusionChronicrestrictivepericarditisCardiactamponadefluiddyspneaChestpainresolvedfibrousSurgeryHeartFailureeffusionDyspnea,JVdistension,BP?心包疾病講座第3頁AcutepericarditisC-Constr-PericNon-specific+++++++Tumor++++TB++++++

Radiationtherapy-+++Systemdisease++Physicalandchemicalfactors++Etiology心包疾病講座第4頁ClinicalManifestation---SymptomsAcutepericarditisC-Constr-PericChestpain++++fibrousPleurotic,Postural－

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

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