心包疾病-讲座.pptVIP

Associated professor Sichuan University CLASSIFICATION acute pericarditis pericardial effusion cardiac tamponade constrictive pericarditis congenitally absent pericardium (uncommon) pericardial cysts (uncommon) MANIFESTATION characteristic chest pain (The chest pain of acute pericarditis is usually sudden in onset, retrosternal, and pleuritic in that it is exacerbated by inspiration. The chest pain can be affected by position as patients may note lessening of the pain when they lean forward or are in the upright position.) (2) pericardial friction rub (3) suggestive electrocardiographic (ECG) changes (4) new or worsening pericardial effusion Electrocardiographic abnormalities in acute pericarditis. Diffuse up-sloping ST segment elevation is seen in leads I, II, aVF, and V1 to V6. The PR segment is elevated in the aVR lead (arrows) and subtly depressed in leads I, II, aVF, and V2 to V6 (arrowheads). Reciprocal ST-segment depression is seen in the aVR lead. Two-dimensional transthoracic echocardiogram showing the parasternal long-axis view in a patient diagnosed as having acute pericarditis. A moderate-sized pericardial effusion (PE) is present posteriorly. LA = left atrium; LV = left ventricle; RV = right ventricle. Short-axis cardiac magnetic resonance imaging with delayed gadolinium enhancement in a patient with acute pericarditis. The brightly enhanced pericardium (arrowheads) is suggestive of inflammation in a patient with acute pericarditis. TREATMENT Nonsteroidal Anti-inflammatory Drugs Colchicine Corticosteroids Overview of the diagnosis and management of acute pericarditis NSAID = nonsteroidal anti-inflammatory drug. *Corticosteroids should not be routinely used initially unless there is a rheumatologic etiology or NSAIDs and colchicine are contraindicated. CARDIAC TAMPONADE Cardiac tamponade is characterized by the accumulation of pericardial fluid under pressure. As the pericardial effusion increases, the movement of the parietal pericardium decreases. Ta