tailieunhanh - Ebook The ESC textbook of cardiovascular medicine: Part 2

(BQ) Part 2 book "The ESC textbook of cardiovascular medicine" presents the following contents: Pericardial diseases, tumours of the heart, congenital heart disease in children and adults, pregnancy and heart disease, infective endocarditis, cardiac rehabilitation, pulmonary hypertension, ventricular tachycardia,. | Pericardial Diseases Bernhard Maisch Jordi Soler-Soler Liv Hatle and Arsen D. Ristic Summary The diagnosis of acute pericarditis is based on the clinical presentation chest pain pericardial friction rub and typical ECG changes. Echocardiography is essential for the detection of pericardial effusion and for the determination of its physiological significance signs of constriction concomitant heart disease or paracardial pathology. A substantial proportion of patients classified as having idiopathic pericarditis have disease that is the result of either viral or autoreactive pericarditis. To establish the aetiology pericardiocentesis pericardioscopy and pericardial epicardial biopsy may be necessary in these cases. Polymerase chain reaction or in situ hybridization in the pericardial effusion and or pericardial epicardial tissue are diagnostic for viral pericarditis but in routine clinical management these tests are applied infrequently. A diagnosis of tuberculous pericarditis can be established by conventional culture or polymerase chain reaction identification of Mycobacterium tuberculosis in the pericardial fluid or tissue or elsewhere. Pericardiocentesis is indicated for cardiac tamponade is helpful for the diagnosis of suspected purulent tuberculous or neoplastic pericarditis and in patients with large effusions without overt tamponade 20 mm in echocardiography in diastole . Electrical alternans and pulsus paradoxus are signs of an advanced stage of cardiac tamponade and indicate the need for prompt drainage. Aortic dissection is a major contraindication for pericardiocentesis. Relative contraindications include uncorrected coagulopathy anticoagulant therapy thrombocytopenia 50 000 mm3 and posterior and loculated effusions. In cardiac wounds postinfarction myocardial rupture or dissecting aortic haematoma cardiac surgery is life-saving. Loculated effusions may require open surgery or thoracoscopic drainage. Intrapericardial instillation of antineoplastic and or