Hoit Brian D
Physiology and Biophysics, Case Western Reserve University, Cleveland, OH; University Hospitals Cleveland Medical Center, Cleveland, OH.
Prog Cardiovasc Dis. 2017 Jan-Feb;59(4):341-348. doi: 10.1016/j.pcad.2016.11.001. Epub 2016 Dec 1.
Pericardial heart disease includes pericarditis, (an acute, subacute, or chronic fibrinous, noneffusive, or exudative process), and its complications, constriction, (an acute, subacute, or chronic adhesive or fibrocalcific response), and cardiac tamponade. The pathophysiology of cardiac tamponade and constrictive pericarditis readily explains their respective findings on clinical examination, Doppler echocardiography, and at cardiac catheterization. The primary abnormality of cardiac tamponade is pan-cyclic compression of the cardiac chambers by increased pericardial fluid requiring that cardiac chambers compete for a fixed intrapericardial volume. Features responsible for the pathophysiology include transmission of thoracic pressure through the pericardium and heightened ventricular interdependence. Constrictive pericarditis is a condition in which the pericardium limits diastolic filling and causes dissociation of intracardiac and intrathoracic pressures, and heightened ventricular interdependence. Both conditions result in diastolic dysfunction, elevated and equal venous and ventricular diastolic pressure, respiratory variation in ventricular filling, and ultimately, reduced cardiac output.
心包疾病包括心包炎（一种急性、亚急性或慢性纤维性、无渗出或渗出性病变）及其并发症，如缩窄（一种急性、亚急性或慢性粘连或纤维钙化反应）和心脏压塞。心脏压塞和缩窄性心包炎的病理生理学很容易解释它们在临床检查、多普勒超声心动图和心导管检查中的各自表现。心脏压塞的主要异常是心包积液增加导致心腔全周期受压，使得心腔争夺固定的心包内容积。导致病理生理学改变的特征包括胸内压力通过心包传递以及心室相互依赖增强。缩窄性心包炎是一种心包限制舒张期充盈并导致心内压与胸内压分离以及心室相互依赖增强的疾病。这两种情况都会导致舒张功能障碍、静脉压和心室舒张压升高且相等、心室充盈的呼吸变化，最终导致心输出量减少。
