myocarditis and cardiogenic shock the 急性心肌炎心源性休克课件

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1、CARDIOGENICSHOCKAdityaBadheka,PL-1EtiologyPumpFailureDuctaldependentlesionsMyocardialfailuremyocarditiscardiomyopathyelectrolyteabnormalitiesischemiaRestrictive:TamponadeAbnormalitiesinheartratePHYSIOLOGICPRINCIPLESFrank-StarlingPhenomenonCardiacOutputOxygendeliveryandutilizationFrank-StarlingPheno

2、menon“Inthenormalheart,thediastolicvolume(preload)istheprincipalforcethatgovernsthestrengthofventricularcontraction.”OttoFrankandErnestStarlingCardiogenicShockCardiacoutputisinadequatetomeettissuedemandsPhases:Early,compensatedLate,uncompensatedHypotensionandbradycardiaarethesignsC.O.=Strokevolumex

3、HeartrateStrokevolume:PreloadMyocardialcontractilityAfterload:systemicandpulmonaryresistancebloodviscosityHeartRateBradycardiaSustainedtachycardiaAcuteMyocarditis-DefinitionAprocesscharacterizedbyinflammatoryinfiltratesofthemyocardium,withnecrosisand/ordegenerationofmyocyteswhichisverydifferentfrom

4、theischemicdamageobservedinischemicheartdisease.CAUSESOFMYOCARDITISInfectious:Viral:adenovirus(2&5),enterovirus,CMV,RSVBacterial:meningococcus,TB,Legionella,LeptospiraRickettsialProtozoal:T.cruziNon-infectious:toxic,drugs,hypersensitivity/autoimmuneAcuteViralMyocarditisHeartFailureCompleteRecoveryN

5、oSymptomsChronicDilatedCardiomyopathyDysrhythmias/ConductionDisordersSuddenDeathClinicalPresentationofMyocarditisPATHOPHYSIOLOGYOFMYOCARDITISTHEDOMINOEFFECTViralInfectionInflammationandInjuryDecreasedMyocardialContractilityHeartEnlarges:LVEDVCardiacOutputSympatheticToneCHFLAPPulm.edemaScarringD

6、ysrhythmiasIschemicHeartDiseaseinChildrenALCAPAAnomalousLeftCoronaryArteryarisingfromthePulmonaryArteryKawasakiDiseaseAneurysmsOthervasculitisElectrolyte/MetabolicAbnormalitiesHyperkalemiaHypocalcemiaHypermagnesemiaHypoxiaMetabolicAcidosisVENTRICULARFUNCTIONCURVESNORMALANDFAILINGLVCardiogenicShock

7、-ArrhythmiasCheckpulses:rapidCheckEKGSVTCardiogenicShockHighAfterloadTamponade:pulsusparadoxusPulmonaryhypertensionmassivePEHighorlowSystemicVascularResistanceSepticshockLVfailurefromchronichypertensionSign