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[缩窄性心包炎的心音图检查]

[Phonomechanocardiography of constrictive pericarditis].

作者信息

Guadalajara J F, Márquez M, Fishleder B L, Olvera Sarabia E, Friedland C

出版信息

Arch Inst Cardiol Mex. 1979 May-Jun;49(3):384-403.

PMID:475497
Abstract

There were studied 19 constrictive pericarditis cases demonstrated by anatomist study. It was evident, at all of them, systemic veiny hypertension's syndrome. "Extinguished" cardiac noises and "quiet" heart only appeared at the 42% of the cases. 73% of patients were found with important incapacity. Lyan's pericardic protodiastolic crack was registered at the 75% of the cases and only at 2 cases (10.9%) it was found reinforcement of pulmonary noise II. It is agree with the haemodynamic discovery of pulmonary pression's light elevation. Characteristically, precordiogrammes showed great "A" wave, and it was agree with telediastolic pression's elevation of the two ventricles obtained by catheterism. Phlebogramme was characteristic of systemic veiny hypertension by impediment of ventricular filled at all the studied cases. Measurement of cardiac cycle's phases showed diminution at PE, Blumberger's intrasystolic quotient, left expulsion fraction (Carrard's method) and ventricular pression's elevation middle velocity (VPEMV). By the contrary Weissler's index was found elevated. Eventhough found ciphers could be considered like bordering normal values, there is a difference statistically significance in relation with the values that were found in sane subjects. These discoveries were interpreted in the base that the patient's heart with constrictive pericarditis acts at the curve's ascendent part of the ventricular function because it has incapacity to utilize Starling's mechanism. Process' chronicity produces myocardic atrophy by "discuss" and, by this, ventricular function's improvement can be no immediate to pericardiectomy. Apexcardiogramme shows the impedement to ventricular filled with its diastolic morphology which is very similar to intracavitary pression's curve ("square root's image"). It is postuled the hypothesis that these sicks do not develop important pulmonary hypertension, because right ventricle's poor diastolic distension impides generation of major expense and systolic pression and, by other side, the impedement to ventricular filled has repercussion over right auricle and systemic veiny territory much more distensible, with the known clinical consequences.

摘要

对19例经解剖学研究证实的缩窄性心包炎病例进行了研究。在所有这些病例中,均出现了体静脉高压综合征。“消失”的心音和“安静”的心仅在42%的病例中出现。73%的患者存在严重功能障碍。75%的病例记录到利恩心包舒张早期杂音,仅2例(10.9%)发现肺动脉第二心音增强。这与肺压轻度升高的血流动力学发现相符。特征性地,心前区心电图显示巨大“A”波,这与通过心导管检查获得的两个心室舒张末期压力升高相符。静脉造影显示,在所有研究病例中,由于心室充盈受阻,具有体静脉高压的特征。心动周期各时相的测量显示,心包叩击音、布伦伯格收缩期内商、左室射血分数(卡拉德法)和心室压力升高平均速度降低。相反,魏斯勒指数升高。尽管所发现的数值可被认为接近正常范围,但与健康受试者所发现的值相比,仍存在统计学上的显著差异。这些发现的解释是,患有缩窄性心包炎的患者心脏在心室功能曲线的上升部分起作用,因为它无法利用斯塔林机制。病程的慢性化通过“耗竭”导致心肌萎缩,因此,心包切除术后心室功能的改善不会立即出现。心尖心电图显示心室充盈受阻,其舒张期形态与心腔内压力曲线非常相似(“平方根征”)。有人提出这样的假说,即这些患者不会发生严重的肺动脉高压,因为右心室舒张期扩张不良阻碍了大量血流的产生和收缩压的形成,另一方面,心室充盈受阻对右心房和更易扩张的体静脉区域产生影响,从而产生已知的临床后果。

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