急性心包炎ppt课件_2.pptVIP

ACUTE PERICARDITIS Acute pericarditis is a syndrome due to inflammation of the pericardium characterized by chest pain ,a pericardial friction rub ,and a serial electrocardio-graphic abnormalities The incidence :ranges from 2-6%(several autopsy series). menwoman 1.the most common causes: idiopathic ,viral pericarditis,uremia,bacterial infection ,acute myocardial infarction, pericardiotomy, tuberculosis,neoplasm, and trauma … 2.pathological changes: presence of polymorphnuclear leukocytes, increased pericardial vascularity and deposition of fibrin. 3.History ①.Chest pain is the chief complaint,its quality and location are variable. Common locations:retrosternal and left precardial regions. Radiates to the trapezius ridge and neck. Pain aggravated by lying supine,coughing,deep inspiration and swallowing,pain eased by sitting up,leaned forward. 4.Physical examination The friction rub:a scratching,grating,high-pitched sound ,the sound is believed to arise from friction between the roughened pericardial and epicardial surfaces. Ewart sign Detection of rub: stethoscope applied firmly to the chest at the lower left sternal border during inspiration and full expiration with the patient sitting up and lean forward. 12.Cardiac tamponade: ①elevation of intracardiac pressure ②progressive limitation of ventricular diastolic filling ③reduction of stroke volume and cardiac output. Clinic manifestation: ①a decline in systemic arterial pressure ②elevation of systemic venous pressure ③a small, quiet heart. Jugular venous distention, tachypnea, tachycardia , pulsus paradoxus, hypatomegaly. pulsus paradoxus:an inspiratory decrease in the amplitude of palpated pulse in the femoral or carotid arteries. Laboratory studies: ECG: electrical alternans UCG 5.Electrocardiagram: four stages Stage Ι:comprise ST segment elevation is concave upward and present in all leads except avR and V1. T waves are upright. Stage Ⅱ: ST segments return to basel