1、pathophysiologicInflammation of visceral and parietal cardiac sacEffusion pChronic constrictive pericarditisCardiac tamponadefluid dyspneaChest pain resolvedA Fibrous pSurgery Heart Failurewasting Pericardial effusion Dyspnea, JV distension, BP Acute pericarditisC-Constr-PericVirus+ + + + +Non-speci
2、fic+ + + + + +Tumor + + + +TB+ + + + + + Radiation therapy- + + + System disease+Physical and chemical factors+EtiologyClinical Manifestation - SymptomsAcute pericarditisC-Constr-PericChest pain+ + + + fibrousPostural Dyspnea+ - + fluidFast and thin+ + + +GeneralFever- + + fatigue+ + +ascites+ + +wa
3、sting+ +Acute pericarditisC-Constr-PericFriction rub + + + + transientEnlargement on percussion-+ + +Ewart,Rotch,Edema, ascites- + +- + + + +Pulsus paradoxus(10mmHg)BP- + + +- + Jugular vein distension- + + +- + +Clinical Manifestation - SignsAcute PericarditisC-Constr PericLab findingsBloodWBC incr
4、easeanemiaAscitesrarelyLeak-outHepaticnormalimpairCK-Mb or cTNT: myocardium injurynormalAcute PericC-Constr PericElectrocardiologyP waveNormal50%: notchAbnormal q waveNoNoQRS VoltageNormal or ST-T (Convex ) exceptin avR (V1)Non-specificArrhythmiaSinus tachycardiaAfib, A-V blockAcute PericC-Constr Pe
5、ricEchofluidNormal, rarely calcificationChest X-rayEnlarged shadowBottle-likeNormal,Small and straight,CalcificationCT or MRIFluidPericardium thickeningEtiology diagnosisParameterExudateTransudateAppearanceTurbid, purulent, or bloodyClear, or amberTotal protein30 g/L200 IU/L45 mg/dL45 mg/dLCellsMany
6、 (leukocytes, lymphocytes, neoplasic)Few (usually mesothelial)MicroorganismsPresent in cases of infectious originAbsentDistinction Between Exudative and Transudative Pericardial Fluid19 y Female after 1 wk in hospital with Acute Pericarditis12-Lead ECG from a Patient with Acute Pericarditis, Demonst
7、rating Widespread ST-Segment Elevation and PR-Segment Depression. EchocardiographyAcute Pericarditis: Most important, useful, sensitive Confirm the diagnosis Semi-quantity the volume Assess the efficacy of management Guide the pericardiocentesisChronic Constrictive Pericarditis normalCardiac Tampona
8、deAcute Pericarditis C-Constr PericPericardiocentesisEtiology diagnosisRelief symptoms_Catheterization_Pressure curve change心包镜Etiology diagnosishardDiagnosis and Differential Diagnosis Acute PericarditisC-Constr PericDiagnosisChest pain + dyspnea + friction rubAscites + jugular vein distensionDiffe
9、rential Diagnosis MIAcute AbdomenRestrictive CMLiver diseaseManagement and PrognosisAcute PericarditisC-Constr PericManagementDiureticsDiureticsPericardiocentesis Prudent to chooseSurgery As early as possiblePrognosisCompletely resolvedChronic Cons-PericCompletely resolvedHeart failureInteresting Ca
10、se A 64-year-old man with progressively worsening edema of the legs PE: Jugular venous distention, an enlarged liver, pitting edemaECG: low-voltage and ATChest film: thickened pericardiumCT: dilated SVC, a normal aortic arch (AA) and DA, and a thickened pericardium. Simultaneous right and left catheter: diastolic LV = RV Right heart catheter: in diastole: RA = RV = PA =PCWPpericardial stripping: marked pericardial thickening (P)
