心包疾病

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1、PericardialdiaeseKaijunCuiAssociatedprofessorSichuanUniversityCLASSIFICATIONacutepericarditispericardialeffusioncardiactamponadeconstrictivepericarditiscongenitallyabsentpericardium(uncommon)pericardialcysts(uncommon)MANIFESTATIONcharacteristicchestpain(Theche

2、stpainofacutepericarditisisusuallysuddeninonset,retrosternal,andpleuriticinthatitisexacerbatedbyinspiration.Thechestpaincanbeaffectedbypositionaspatientsmaynotelesseningofthepainwhentheyleanforwardorareintheuprightposition.)(2)pericardialfrictionrub(3)suggesti

3、veelectrocardiographic(ECG)changes(4)neworworseningpericardialeffusionElectrocardiographicabnormalitiesinacutepericarditis.Diffuseup-slopingSTsegmentelevationisseeninleadsI,II,aVF,andV1toV6.ThePRsegmentiselevatedintheaVRlead(arrows)andsubtlydepressedinleadsI,I

4、I,aVF,andV2toV6(arrowheads).ReciprocalST-segmentdepressionisseenintheaVRlead.Two-dimensionaltransthoracicechocardiogramshowingtheparasternallong-axisviewinapatientdiagnosedashavingacutepericarditis.Amoderate-sizedpericardialeffusion(PE)ispresentposteriorly.LA=

5、leftatrium;LV=leftventricle;RV=rightventricle.Short-axiscardiacmagneticresonanceimagingwithdelayedgadoliniumenhancementinapatientwithacutepericarditis.Thebrightlyenhancedpericardium(arrowheads)issuggestiveofinflammationinapatientwithacutepericarditis.TREATMENT

6、NonsteroidalAnti-inflammatoryDrugsColchicineCorticosteroidsOverviewofthediagnosisandmanagementofacutepericarditisNSAID=nonsteroidalanti-inflammatorydrug.*CorticosteroidsshouldnotberoutinelyusedinitiallyunlessthereisarheumatologicetiologyorNSAIDsandcolchicinear

7、econtraindicated.CARDIACTAMPONADECardiactamponadeischaracterizedbytheaccumulationofpericardialfluidunderpressure.Asthepericardialeffusionincreases,themovementoftheparietalpericardiumdecreases.Tamponadeoccurswhenallcardiacchambersarecompressedasaresultofincreas

8、edintrapericardialpressuretothepointofcompromisingsystemicvenousreturntotherightatrium(RA).Increasedintrapericardialpressurereducesthemyocardialtransmuralpressure,andthecardiaccham