內(nèi)科學教學課件：心肌病心包炎

Cardiomyopathy

DefinitionThecardiomyopathiesarediseasethatinvolvethemyocardiumprimarilyandarenottheresultofhypertensionorcongenital,valvular,coronary,arterialorpericardialabnormalitiesEtiologyclassificationofCMWHO/ISFC19951.Thedefinitionofcardiomyopathy:aprimarytype,consistingofmyocardialdiseaseofunknowncause

Etiologyclassification2.Classificationofcardiomyopathy:(1)DCM–dilatedCM(2)HCM–hypertrophicCM(3)RCM–restrictiveCM(4)ARVD/C–arrhythmogenicrightventricularCM

Dilatedcardiomyopathycharacter:

leftand/orrightventricularsystolicpumpfunctionisimpaired,leadingtocardiacenlargementandoftenproducingsymptomsofcongestiveheartfailure.

Clinicalmanifestation1.symptoms

(1)early:asymptom(2)late:symptomsofleftandright-sidedcongestivefailure,manifestedbydyspnea,peripheraledemaandpalpitation,hepatomegaly,thromboembolism,suddendeath.Clinicalmanifestation2.Signs:(1)heartenlarge(2)diastolic3rdsoundgallop(3)allkindsofarrhythmiaExamanation1.X-ray:heart/chest>50%,ventricularenlargement,pulmonaryeffusion2.ECG:Arrhythmiasuchasatrialfibrillation,block.ST-segmentandT-waveabnormalities3.Echocardiography:Leftatrialandventriculardilationwithnormalorthinnedwallsandsystolicdysfunction,ejectionfractionreducing

Examanation

4.radionuclidescintigraphy5.cardiacpipeinspectionandangiogram6.endocardialbiopsy

Treat1.Drugs:themethodsoftherapyistocontrolcongestiveheartfailureandarrhythmia.2.Artificalcardiacpacing(cadiacresynchronization,CRT),ICD.3.Surgicaltherapy,cardiactransplantationHypertrophiccardiomyopathyCharacter:1.disproportionateleft/rightventricularhypertrophy,involvingseptum.2.diastolicdysfunction

Classification：

accordingtoobstructionofleftventricularoutflowtract

1.obstructiveHCM2.non-obstructiveHCMApicalhypertrophy(APH)Clinicalmanifestation1.Symptoms:suddendeath,dyspnea,anginapectoris,fatigue,syncope2.Signs:(1)slightcardiacenlargement(2)thefourthsound

(3)systolicmurmuratthelowleftsternalborderaswellasatthe3rd-4thintercostalspace.

Incaseswithoutflowobstruction,aloudsystolicmurmurispresentthatincreaseswithuprightposture,

nitroglycin，positiveinotropicdrugs

orValsalva’smaneuveranddecreasewithsquatting,.β-blockers。Examanation：

1.X-ray:mildtomoderatecardiacenlargement2.ECG:leftventricularhypertrophy,ST-Tabnormalities,abnormalQwaves3.echocardiogram:(1)asymmetricseptalhypertrophy(ASM)(2)septalhypertrophyand≥1.3thicknessofLVposteriorwall(3)systolicanteriormotion(SAM)ofthemitralvalve

Treat：1.B-blockers,calciumantagonists2.DDDartificalcardiacpacing:maypreventtheprogressionofhypertrophyandobstruction.3.Nonsurgicalseptalablationhasbeenperformedbyinjectionofalcoholintoseptalbranchesoftheleftcoronaryartery.4.SurgicaltherapySpecificCM

asecondarytype,consistingofmyocardialdiseaseofknowncauseorassociatedwithadiseaseinvolvingotherorgansystems.

Forexample:(1)alcoholcardiomyopathy(2)peripartumcardiomyopathy(3)Keshan’sDisease(4)drug-inducedcardiomyopathyPericardialDiseaseClassification1.acutepericarditis2.chronicpericarditis3.adherentpericarditis4.subacuteexudativeconstrictivepericarditis5.chronicconstrictivepericarditis

AcutepericarditisEtiology1.acutenonspecificpericarditis2.infectivepericarditis:virus,bacteriaandsoon3.autoimmunity:rheumapyra,connectivetissuedisease(CTD),postheartdamagessyndrome(postinfarctionsyndrome)

4.carcinomalpericarditis5.metabolicdisease:gout6.physicalcause:injureandradiation7.diseasesofnearorgan:AMI,aortic

dissection

Pathology:

fibroproteinousorexudativepericarditis

Clinicalmanifestation1.Fibroproteinouspericarditis

(1)symptoms:precardialpain:asharp,dullsensativeradiatetoneckandshoulder,deepinspirationandcoughwillprecipitatethepain(2)signs:apericarditisfrictionrub------characteristicsignthethirdorfourthleftintercostalspace2.exudativepericarditis

(1)symptoms:dyspnea–outstandingsymptom(2)signs:①thecardiacdullness↑②theapicalimpulseweaken

ordisappear③heartsoundfaint,far④Ewart’ssign⑤distensionofjugularvein,hepatomegaly,ascitescardiactamponade

(1)tachycardia,distensionofjugularvein,venouspressure↑(2)①jugularvenousdistension↑②Bp↓SBp↓DBp(±)….shock③paradoxicalpulse④signsofpericarditiseffusionLabexam1.Laboratorytest:infectivepericarditis–WBC↑ESR↑

2.X-ray:exudativepericarditis–heartenlargeobviouslywithoutcongestionoflung------Thisisastrongevidenceofpericarditiseffusion.3.ECG:acutestage:ST↑,butnotincludingaVR4.echocardiogram:

5.pericardiocentesis(心包穿刺)mainindications:cardiactamponade,exudativepericarditisunknowncauseConstrictivepericarditisClinicalmanifestation