西安交通大学医学院循环系统疾病课件 Acute Pericarditis.pptVIP

Acute Pericarditis 一、Etiology Idiopathic(non-specific) Infectious: virus, bacterium, fungi, other infectious Neoplastic Autoimmunity Pericarditis following AMI Uremic pericarditis Radiation pericarditis Delayed postmyocardial-pericardial injury syndromes 二、Pathology two types: fibrinous adhesion pericardial effusion 三、Manifestations Symptoms: chest pain dyspnea additional symptoms Chest Pain Quality: sharp, or dull, oppressive Location: precordium, left trapezius ridge Radiation: neck and trapezius ridge, left arm Aggravation: lying supine, coughing, deep inspiration, and swallowing; eased by sitting up and leaning forward Frequently in idiopathic and infectious pericarditis Dyspnea Most characteristic symptom breathe shallowly to avoid pericardio- pleuritic chest pain caused by large pericardial effusion: (1) compresses adjacent bronchi and pulmonary parenchyma (2) pulmonary edema Physical Examination Pericardial friction rub Pericardial effusion Pericardial friction rub Scratching, grating, high-pitched sound Arise from friction between the roughened pericardial and epicardial surface Detected by deep inspiration, sitting up and leaning forward Classically have three components: atrial systole, ventricle systole, and ventricle diastole Pericardial effusion ① Cardiac sign: ② Ewart’s sign: compression of the left lung ③ Cardiac tamponade: Acute cardiac tamponade Chronic pericardial effusion without cardiac tamponade Electrocardiogram Four stages of abnormal of the ST-segment and T-waves: Stage Ⅰ: ST-segment elevation, T-waves upright Stage Ⅱ : ST-segment isoelectric, T-waves flat Stage Ⅲ : T-waves inversion Stage Ⅳ: T-wave changes to normal Reduction in QRS voltage, no Q-wave Chest X-ray Echocardiography Pericardiocentesis ① For di