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1、ACUTEPERICARDITISAcutepericarditisisasyndromeduetoinflammationofthepericardiumcharacterizedbychestpain,apericardialfrictionrub,andaserialelectrocardio-graphicabnormalitiesTheincidence:rangesfrom2-6%(severalautopsyseries).men>woman1.themostcommoncauses:idiopathic,viralpericarditis,ure
2、mia,bacterialinfection,acutemyocardialinfarction,pericardiotomy,tuberculosis,neoplasm,andtrauma…2.pathologicalchanges:presenceofpolymorphnuclearleukocytes,increasedpericardialvascularityanddepositionoffibrin.3.History①.Chestpainisthechiefcomplaint,itsqualityandlocationarevariable.Com
3、monlocations:retrosternalandleftprecardialregions.Radiatestothetrapeziusridgeandneck.Painaggravatedbylyingsupine,coughing,deepinspirationandswallowing,paineasedbysittingup,leanedforward.IschemicpainPericardialpainLocationretosternal,leftshoulder,armprecardium:lefttrepeziusridgeQualit
4、ypressure,burning,buildupsharp,dull,pleuriticThoracicmotionnoeffectincreasedbybreathingDurationangina:1or2to15minhoursordaysunstable:1/2hrtohoursEffortangina:usuallynorelationunstable:usuallynotPosturenoeffect;maysit,belch,useleaningforwardforreliefvalsalvaknee-chestpositionaggravate
5、dbyrecumbencyforrelief②Dyspneaisaggravatedbyfever,largepericardialeffusion ③Additionalsymptoms:cough,sputumproduction,weightloss. Inelderlypatientsthechestpainanddyspneaaresubtle.4.PhysicalexaminationThefrictionrub:ascratching,grating,high-pitchedsound,thesoundisbelievedtoarisefromfr
6、ictionbetweentheroughenedpericardialandepicardialsurfaces.EwartsignThepericardialfrictionrubisclassicallydescribedashavingthreecomponentsthatarerelatedtocardiacmotionduringatrialsystole(presystole),ventricularsystoleandrapidventricularfillinginearlydiastole.Location:lowerleftsternalb
7、order.Importantfeature:oftenevanescentandchangeinqualityDetectionofrub:stethoscopeappliedfirmlytothechestatthelowerleftsternalborderduringinspirationandfullexpirationwiththepatientsittingupandleanforward.12.Cardiactamponade:①elevationofintracardiacpressure②progressivelimitationofvent
8、riculardiast
