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发布时间:2013-10-06 14:30:52  


Acute pericarditis is a syndrome due to inflammation of the pericardium characterized by chest pain ,a pericardial friction rub ,and a serial electrocardiographic abnormalities


The incidence :ranges from 2-6%(several autopsy series). men>woman

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.

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.

Ischemic pain
Location retosternal , left shoulder,arm Quality pressure, burning, buildup Thoracic motion no effect Duration angina: 1 or 2 to 15 min unstable: 1/2hr to hours Effort angina:usually unstable:usually not Posture no effect; may sit,belch,use valsalva knee-chest position for relief

Pericardial pain
precardium:left trepezius ridge sharp, dull, pleuritic increased by breathing hours or days no relation leaning forward for relief aggravated by recumbency

②Dyspnea is aggravated by fever,large
pericardial effusion ③Additional symptoms:cough, sputum production,weight loss. In elderly patients the chest pain and

dyspnea are subtle.

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

Ewart sign

The pericardial friction rub is classically described as having three components that are related to cardiac motion during atrial systole(presystole),ventricular systole and rapid ventricular filling in early diastole. Location: lower left sternal border. Important feature: often evanescent and change in quality

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

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


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 baseline, T wave flattening. Sta

ge Ⅲ: T waves in normal Stage IV: reversion of T wave changes to normal Others: isolated,PR-segment depression,sinus tachycardia, atrial arrhythemias. Echocardiogram: is the most sensitive and accurate tool in the detection and quantification of pericardial fluid.


6.Blood test :

leukcytosis and elevation of the sedimentation.

7. The chest roentgenogam: for a large pericardial effusion,the X-ray show both enlargement and changes in configuration of

the cardiac sihouette provide clues to the
underlying cause of the pericarditis.

8.Pericardicentesis and biopsy.

The chest roentgenogam

①detect an underling disease that requires specific therapy ②pain relief:nonsteroidal anti-inflammatory agents:aspirin,indomethicia or corticosteroids. ③antibiotics: purulent pericarditis

10.Natural history: viral, idiopathic,
post-myocardial infarction percarditis or post-pericardiotomy syndrome are

usually self-limited.

11.Recurrent pericarditis:20-28%

急性非特异性 病因 症状 病毒 急起 心前区 结核性 结核杆菌 发烧及结核 肿瘤性 转移癌 渐进性呼吸 化脓性 葡萄球菌 G+ 高热毒血症

体症 心包摩擦音 少量积液


大量积液 中大量积液

积液性质 浆液纤维蛋白 浆液纤维蛋白 治疗 皮质激素 抗痨

血性 治疗原发病

化脓性 抗生素及引流术





Constrictive pericarditis
CP is present when a fibrotic,thickened,and

adherent pericardium restricts diastolic filling
of the heart.Calcium deposition may contribute

to thickening and stiffing of the pericardium.



Tuberculosis is the leading cause

3.clinical factures

S3 gallop Pericardial knock Palpable systolic apical impulse Pericardial calcification may be present Equal RV and LV diastolic pressure usually present Rate of LV filling 80% in first half of diastole CAT SCAN ECHO MRI thickened pericardium

Constrictive pericarditis absent may be present absent

restrictrve cardiomyopathy may be present absent may be preset
absent LV>RV 40% in first half of diastole normal pericardium

Management :
Judicious use of diet and diuretics Beta-blockers and calcium channel blockers slow the HR


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