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1、ACUTEPERICARDITISAcutepericarditisisasyndromeduetoinflammationofthepericardiumcharacterizedbychestpain,apericardialfrictionrub,andaserialelectrocardio-graphicabnormalitiesTheincidence:rangesfrom2-6%(severalautopsyseries).men>woman1.themostcommoncauses:idiopathic,viralpericar
2、ditis,uremia,bacterialinfection,acutemyocardialinfarction,pericardiotomy,tuberculosis,neoplasm,andtrauma…2.pathologicalchanges:presenceofpolymorphnuclearleukocytes,increasedpericardialvascularityanddepositionoffibrin.3.History①.Chestpainisthechiefcomplaint,itsqualityandlocat
3、ionarevariable.Commonlocations:retrosternalandleftprecardialregions.Radiatestothetrapeziusridgeandneck.Painaggravatedbylyingsupine,coughing,deepinspirationandswallowing,paineasedbysittingup,leanedforward.IschemicpainPericardialpainLocationretosternal,leftshoulder,armprecardi
4、um:lefttrepeziusridgeQualitypressure,burning,buildupsharp,dull,pleuriticThoracicmotionnoeffectincreasedbybreathingDurationangina:1or2to15minhoursordaysunstable:1/2hrtohoursEffortangina:usuallynorelationunstable:usuallynotPosturenoeffect;maysit,belch,useleaningforwardforrelie
5、fvalsalvaknee-chestpositionaggravatedbyrecumbencyforrelief②Dyspneaisaggravatedbyfever,largepericardialeffusion ③Additionalsymptoms:cough,sputumproduction,weightloss. Inelderlypatientsthechestpainanddyspneaaresubtle.4.PhysicalexaminationThefrictionrub:ascratching,grating,high
6、-pitchedsound,thesoundisbelievedtoarisefromfrictionbetweentheroughenedpericardialandepicardialsurfaces.EwartsignThepericardialfrictionrubisclassicallydescribedashavingthreecomponentsthatarerelatedtocardiacmotionduringatrialsystole(presystole),ventricularsystoleandrapidventri
7、cularfillinginearlydiastole.Location:lowerleftsternalborder.Importantfeature:oftenevanescentandchangeinqualityDetectionofrub:stethoscopeappliedfirmlytothechestatthelowerleftsternalborderduringinspirationandfullexpirationwiththepatientsittingupandleanforward.12.Cardiactampona
8、de:①elevationofintracardiacpressure②progressivelimitationofventriculardiast
