心 包 疾 病
中山医院 周京敏
General
? Incidence,low
? 1.5-6%
? 急性心包炎
? 慢性缩窄性心包炎
? 慢性心包积液
? 粘连性心包炎
Inflammation of visceral
and parietal cardiac sac
Effusion Chronic restrictive pericarditis
Cardiac
tamponade
fluid
dyspnea
Chest pain
resolved
fibrous Surgery
Heart Failure
effusion
Dyspnea,JV distension,BP?
Acute pericarditis C-Constr-Peric
Non-specific + + + + + + +
Tumor + + + +
TB + + + + + +
Radiation therapy - + + +
System disease + +
Physical and
chemical factors
+ +
Etiology
Clinical Manifestation --- Symptoms
Acute pericarditis C-Constr-Peric
Chest pain + + + + fibrous
Pleurotic,Postural
－
Dyspnea + --- +++ fluid
Fast and thin
+ + + +
General
Fever － --- + + －
fatigue － + + +
ascites － + + +
wasting － + +
Acute pericarditis C-Constr-Peric
Friction rub + + + +
transient
－
Enlargement on
percussion
－ ----+ + + －
Edema,ascites － --- + + － --- + + + +
Pulsus paradoxus
(>10mmHg)
－ --- + + + － --- +
Jugular vein
distension
－ --- + + + － --- + +
Clinical Manifestation --- Signs
Acute Pericarditis C-Constr Peric
Lab findings
Blood WBC increase anemia
Ascites rarely Leak-out
Hepatic,normal impair
CK-Mb or
cTNT
↑,myocardium
injury
normal
Acute Peric C-Constr Peric
Electrocardiology
P wave Normal 50%,notch
Abnormal q wave No Widespread
calcification
QRS Voltage ↓ ↓
ST-T Convex ↑except
in avR (V1)
Non-specific
Arrhythmia Sinus tachycardia Afib,A-V block
Acute Peric C-Constr Peric
Echo fluid
Normal,rarely
calcification
Chest X-ray Enlarged shadow
Bottle-like
Normal,
Small and straight,
Calcification
CT or MRI Fluid
Pericardium thickening
Etiology diagnosis
Echocardiography
Acute Pericarditis,
? Most important,useful,sensitive
? Confirm the diagnosis
? Semi-quantity the volume
? Assess the efficacy of management
? Guide the pericardiocentesis
Chronic Restrinctive Pericarditis
? normal
PE
12-Lead ECG from a Patient with Acute Pericarditis,Demonstrating
Widespread ST-Segment Elevation and PR-Segment Depression,
Cardiac Tamponade
Chronic Constrictive Pericarditis
Acute Pericarditis C-Constr Peric
Pericardiocentesis Etiology diagnosis
Relief symptoms
__
Catheterization __ Pressure curve
change
心包镜 Etiology diagnosis hard
Diagnosis and Differential Diagnosis
Acute Pericarditis C-Constr Peric
Diagnosis Chest pain + dyspnea +
friction rub
Ascites + jugular
vein distension
Differential
Diagnosis
MI
Acute Abdomen
Restrictive CM
Liver disease
Management and Prognosis
Acute Pericarditis C-Constr Peric
Management
?Diuretics ?Diuretics
?Pericardiocentesis
?Prudent to choose
?Surgery
?As early as possible
Prognosis ?Completely resolved
?Chronic Cons-Peric
?Completely resolved
?Heart failure
Acute Pericarditis,Specific
Forms Features
Viral Following upper respiratory infection
Tuberculosis Night sweats,Anti-TB effective
Bacterial Toxic ill
Neoplastic Cytologic exam,nearby tumor
Others
systematic diseases
Dressler’s Syndrome
Radiation
Uremic
Interesting Case
? A 64-year-old man with progressively worsening
edema of the legs
? PE,Jugular venous distention,an enlarged liver,
pitting edema
ECG,low-voltage and AT
Chest film,thickened pericardium
CT,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 =PCWP
pericardial stripping,
marked pericardial thickening (P)
? Histologic analysis,no cause was identified
? Edema decreased markedly after pericardial
stripping
? 60ys male,hypertension for 30ys
? Edema 4-5years
? ECG,Chest X-ray,Echcardiography,
normal
? What is the diagnosis?
Hypertension,Heart Failure,NYHA III
? CT,thickening of the Pericardium
? Anti-TB,3 months
? Pericardial Stripping,TB