ʻO ka Myocarditis Acute, Pericarditis, a me ka hoʻāʻo ʻana i ka ʻeha o ka umauma kūlana¶

ʻO ka ʻeha o ka ʻeha o ka ʻeha waena-hema a ʻoi loa ka ʻeha i ka wā e moe palahalaha ana ma kou kua a i ʻole e hanu hohonu a ʻoi aku ka maikaʻi o ka manaʻo i ka wā e noho ana i luna a hilinaʻi i mua**, ʻoi aku hoʻi i nā lā a i ʻole mau pule ma hope o ka maʻi ʻana o ka hanu, ka maʻi maʻi, ka ʻōpū o ka ʻōpū (gastroenteritis), a i ʻole ka mRNA/maʻi maʻi viral, ʻo ia ka hōʻailona maʻamau o ka maʻi ʻelua o ka maʻi maʻi a puni. myopericarditis (ka ʻāhu hui ʻana o ka ʻeke puʻuwai a me ka ʻiʻo puʻuwai ponoʻī). ʻOiai e pane pinepine ka viral pericarditis paʻakikī i ka lāʻau anti-inflammatory i manaʻo ʻia, ** ʻo ka myocarditis i hoʻokaʻawale ʻia** (ka ʻā ʻana o ka pā ʻiʻo puʻuwai puʻuwai, ʻo ka myocardium) kekahi o nā kumu nui o ka ** hopu koke ʻana i ka naʻau i nā ʻōpio, nā keiki, a me nā mea pāʻani , hiki ke hoʻoulu i ka ventricular ventricular arrhythmia o ka ventricular arrhythmia. poloka puʻuwai holoʻokoʻa, a i ʻole ka puʻuwai cardiogenic wikiwiki (fulminant myocarditis). Eia kekahi, hiki i ka wai e hōʻiliʻili wikiwiki i loko o kahi ʻeke pericardial inflamed hiki ke hoʻopaʻa i nā keʻena puʻuwai e pani ʻia (puʻuwai puʻuwai). Ka loiloi pilikia koke (12-lead ECG, high-sensitivity cardiac troponin blood testing, and echocardiography), pono noho-mua i mua, e pale ana i ka aspirin/NSAIDs ina ua manaoia ka myocarditis ma mua o ka hookolokolo ana o ke kauka, a me ka ** 100 pakeneka o ka hooikaika kino kino hoopakele ola.

E hana i kēia i kēia manawa¶

1. Hoʻopau koke i nā hana kino āpau a hoʻonoho pololei i ke kanaka, e hilinaʻi iki i mua (\(30\text{ a i }45\text{ degrees}\) i mua ma luna o ka uluna ma ka papaʻaina a i ʻole ko lākou mau kuli).
2. No ke aha ka hilinaʻi ʻana i mua e hoʻomaha ai i ka ʻeha pericardial: Ke moe paʻa ke kanaka ma kona kua (supine), huki ka ʻumekaumaha i ka puʻuwai i hope a hoʻopololei i ka pericardium parietal inflamed e kū'ē i ka diaphragm a me ka pleura, e hōʻeha ana i ka ʻeha ʻeha me kēlā me kēia puʻuwai a me ka hanu. ʻO ka noho pololei ʻana a me ka hilinaʻi ʻana i mua (ke kūlana tripod/pillow-hug) e huki iki i ka puʻuwai i mua mai ka pleura māmā hope a me ka mediastinum hope, e hōʻemi koke ana i ka hoʻoheheʻe mechanical.
3. No ke aha ka hoʻoikaika kino ʻole e ola ai: Inā ʻaʻa ka ʻiʻo o ka puʻuwai (myocarditis), hoʻokuʻu ʻia ka adrenaline (catecholamines) ma ka hele ʻana i ke alapiʻi, ka lawe ʻana i nā meaʻai, a i ʻole ka hoʻomaʻamaʻa ʻana e hoʻoulu i nā pōkole uila make (ventricular fibrillation) i loko o nā ʻiʻo ʻiʻo o ka naʻau.
4. ** Hana i ka 60-Second "Myocarditis & Cardiac Tamponade Red Flag Screen" a kāhea koke iā 911 / 112 / 999:**
5. Kāhea iā 911 ma United States a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom, a i ʻole e ʻike i nā mea āpau. helu pilikia.
6. ** ʻO nā Hae ʻulaʻula Myocarditis (Puʻu ʻiʻo o ka naʻau):** ʻEha o ka ʻōpū a paʻa paha i hui pū ʻia me pōkole ʻole i wehewehe ʻia i ka wā hoʻomaha a i ka wā e hele ai ma waena o kahi lumi, ** hiki ʻole ke moe palahalaha me ka ʻole o ke ea (orthopnea)**, ** ka piʻi ʻana o ka naʻau hoʻomaha wikiwiki i ka like me ke kuni (sinus tachycardia $>10}0}\text{>10}0}\text palpitations/skipping beats, dizziness/while, or like flu e like me ka luhi, luaʻi, a me ka ʻeha o ka ʻōpū (ʻoi loa i nā keiki).
7. ** Nā Hae ʻulaʻula Tamponade Puʻuwai (Fluid Crushing the Heart):** ʻO ka pōkole o ka hanu ʻana, ** nā ʻāʻī ʻāʻī (jugular venous distension)** oiai e noho pololei ana, māmā i ka hanu ʻana i loko (pulsus paradoxus), a me ka puʻuwai nāwaliwali a wikiwiki.
8. Mai lawe makapō i ka Ibuprofen, Naproxen, a i ʻole Aspirin ma mua o ka hoʻāʻo ʻana i ke koko troponin lumi pilikia e hoʻoholo inā loaʻa iā ʻoe ka Pericarditis maʻemaʻe a i ʻole Myocarditis.
9. ** ʻOkoʻa Lapaʻau Koʻikoʻi:** ʻOiai ʻo nā NSAID kiʻekiʻe (e like me ka ibuprofen a i ʻole ka aspirin) a me ka colchicine ka lāʻau lapaʻau mua o ka haukapila no ** pericarditis maʻemaʻe ʻole ** (inā he 100% maʻamau ka hoʻāʻo ʻana o ka troponin muscle puʻuwai), ** ʻAʻole i kaupalena ʻia nā NSAID i ka maʻi MYOCARDITIS troponin maʻemaʻe ** i loko o ka puʻuwai maʻi maʻi. Hōʻike nā haʻawina Cardiology (European Society of Cardiology [ESC] a me American Heart Association [AHA]) ʻo ka lawe ʻana i nā NSAID i ka wā o ka myocarditis viral ikaika e hōʻemi i ka hoʻōla ʻana o ka myocardial, hoʻonui i ka hoʻopiʻi viral i loko o ka ʻiʻo puʻuwai, a ʻoi aku ka paʻakikī o ka puʻuwai. E kali a hiki i ka holo ʻana o nā kauka ulia pōpilikia i kahi ** hoʻāʻo troponin cardiac** (a i ʻole hāʻawi i hoʻokahi \(325\text{ mg}\) chewed aspirin wale inā he maʻi maʻi maʻi maʻi. maʻi hohola manaʻo nui ʻia e nā mea hoʻouna ulia pōpilikia i kahi makua makua).
10. E nānā i nā mea hōʻino hou, Autoimmune, a i ʻole nā ​​lāʻau lapaʻau (1 a 4 mau pule ma mua) a kākau iā lākou no ke kauka ER:
11. Ua loaʻa i ka mea maʻi he anu maʻamau, ʻeha ʻāʻī, COVID-19, influenza, maʻi lima-wāwae-a-waha (Coxsackievirus B), a i ʻole maʻi maʻi maʻi maʻi ʻōpū (diarrhea/vomiting) i nā pule he 1 a 4 i hala?
12. Ua loaʻa i ka mea maʻi i ka immunization (ʻoi loa i loko o nā lā 1 i hala aku nei i nā kāne ʻōpio a ʻōpio paha) a i ʻole i hoʻomaka i kahi ** immunotherapy maʻi maʻi (immune checkpoint inhibitor e like me pembrolizumab a i ʻole nivolumab)** a i ʻole lāʻau psychiatric (clozapine)?
13. Loaʻa i ka mea maʻi ka maʻi kīkī (uremia), lupus, rheumatoid arthritis, a i ʻole ka ʻoki puʻuwai hou/ka puʻuwai (Dressler syndrome)?
14. ** E mālama i kahi Defibrillator Kūwaho Automated (AED) kokoke inā loaʻa a hoʻomākaukau no CPR inā maule ka maʻi a i ʻole he palpitations.** No ka mea hiki i ka myocarditis acute ke hoʻoulu i ka ventricular fibrillation me ka ʻōlelo ʻole ʻole, mai ʻae i ka mea maʻi i manaʻo ʻia he myocarditis e hoʻokele iā lākou iho i ka haukapila a hele wāwae ʻole i ke kaʻa.

ʻO ka ʻeha o ka umauma kūlana, ka pericarditis, a me ka lāʻau hoʻoholo triage myocarditis¶

E hoʻohana i kēia palapala holo kaʻa no ka loiloi ʻana i ka ʻeha o ka umauma kūlana a me nā hōʻailona puʻuwai post-viral koke.

flowchart TD
    Start["ʻEha ʻeha o ka ʻūhā, ʻeha, a i ʻole pōkole o ka hanu<br/>(ʻoi loa me ka hoʻololi ʻana i ke kūlana a i ʻole ma hope o ka maʻi viral)"] --> RedFlags{"E nānā i nā Hae ʻulaʻula weliweli i ke ola:<br/>- Maule (syncope) a i ʻole ʻūlū nui<br/>- Pōkole hanu i ka hoʻomaha a i ʻole orthopnea<br/>- heihei / puʻupuʻu maʻamau a i ʻole palpitations<br/>- ʻO nā ʻāʻī ʻāʻī, ka hou anuanu, a i ʻole ka ʻeha ʻeha."}

    RedFlags -->|"ʻAe (Kekahi Hae ʻulaʻula)"| Call911["KOKE 911 / 112 / 999 KAHIKI:<br/>1. Hoʻopiʻi ʻia ʻo Fulminant Myocarditis, Tamponade, STEMI, a i ʻole PE<br/>2. E noho pololei me ka hilinaʻi iki i mua; ZERO hele wāwae<br/>3. Mai hāʻawi i nā Ibuprofen/NSAIDs (ʻino i ka myocarditis)<br/>4. E hoʻomākaukau i ka AED / CPR a hiki i nā poʻe lapaʻau"]

    RedFlags -->|"NO Hemodynamic hiki ole nae"| PainPattern{"E noʻonoʻo i ke ʻano ʻeha pololei<br/>a me ke ʻano kūlana"}

    PainPattern -->|"SHARP, PLEURITIC & POSITIONAL:<br/>- ʻOi aku ka maikaʻi o ka moe ʻana ma ke kua (supine) & hoʻoikaika hohonu<br/>- Hoʻomaha ʻia e ka noho ʻana i luna a hilinaʻi i mua<br/>- Hoʻomaka pinepine i ke kua o trapezius hema (poʻohiwi luna)"| PeriMyo["E HOOLOHE IA ACUTE PERICARDITIS A I OLE MYOPERICARDITIS:<br/>1. Pono ʻia ka Loiloi ʻana o ka Oihana Hoʻomaʻamaʻa i ka lā hoʻokahi<br/>2. Pono ʻo 12-Lead ECG (diffuse ST elevation + PR depression), <br/> High-Sensitivity Cardiac Troponin, CRP/ESR, & Echocardiogram"]

    PeriMyo --> TropSplit{"He aha ka mea i hōʻike ʻia e ka Hospital Troponin<br/>& Echocardiogram?"}

    TropSplit -->|"ʻO Troponin NORMAL + Pumping maʻamau:<br/>PURE ACUTE PERICARDITIS"| PurePeri["HOSPITAL / CARDIOLOGY PERICARDITIS PROTOCOL:<br/>1. NSAID/Aspirin taper kiʻekiʻe + Colchicine (3 mahina)<br/>2. Inā nui ka effusion / tamponade -> Pericardiocentesis<br/>3. Hoʻoikaika koʻikoʻi a hiki i ka CRP & ECG maʻamau"]

    TropSplit -->|"ʻO Troponin ELEVATED a i ʻole ka neʻe ʻana o ka paia / ʻano kani ʻano maʻamau:<br/>ACUTE MYOCARDITIS / MYOPERICARDITIS"| MyoProtocol["KA HOʻOPIʻI O KA HOPE MYOCARDITIS:<br/>1. Ka nānā 'ana i ka telemetry inpatient no ka arrhythmias/poka pu'uwai<br/>2. E HAʻEʻE i nā NSAID inā ʻoi aku ka nui o ka ʻeha o ka myocardial<br/>3. Cardiac MRI + Hoʻopaʻa 3 a 6 mau mahina ma nā haʻuki a pau"]

    PainPattern -->|"HEAVY PRESSURE / SQUEEZING:<br/>- ʻAʻole i hoʻomaikaʻi ʻia e ka hilinaʻi ʻana i mua<br/>- E ʻā ana i ka ʻāwae, ka ʻāʻī, a i ʻole ka lima hema."| ACS["SUSPECT ACUTE CORONARY SYNDROME (HEART ATTACK)<br/>A Iʻole PREDOMINANT MYOCARDITIS:<br/>E kelepona iā 911 / 112 / 999 koke."]

Anatomy & Pathophysiology: Pericardium vs. Myocardium¶

No ka hoʻomaopopo ʻana i ke kumu o ka pericarditis a me myocarditis ke kumu o nā pilikia like ʻole a koi aku i nā lula lāʻau kūʻē, e nānā i nā ʻāpana ʻekolu o ka pā puʻuwai kanaka:

1. Ka Pericardium (Ka ʻeke ʻelua-Layered Sac, Hoʻopilikia ʻia i Pericarditis):
2. Noho ka naʻau i loko o kahi ʻeke fibrous ʻoi aku ka paʻakikī (fibrous pericardium) i hoʻopaʻa ʻia e kahi membrane pālua ʻoluʻolu a pulu (ka visceral a me parietal serous pericardium).
3. ʻO ka mea maʻamau, aia ka ʻokoʻa ma waena o kēia mau membrane ʻelua \(15\text{ a }50\text{ milliliters}\) (\(1\text{ to }3\text{ tablespoons}\)) o ka wai lubricating paheʻe no laila e paʻi ka puʻuwai me ka ʻole o ka friction.
4. Ma Acute Pericarditis, viral, autoimmune, a i ʻole ka ʻeha ma hope o ka hōʻeha ʻana i nā ʻāpana pericardial ʻelua a ʻoʻoleʻa, pehu, a pipili e like me ʻelua mau ʻāpana pepa ʻeleʻele e hamo ana me kēlā me kēia puʻuwai (pericardial friction rub).
5. ** No ke aha e ʻā ai ka ʻeha i ka piko o ka poʻohiwi hema (ka Trapezius Ridge):** Hoʻokomo ʻia ka pericardium waena a me ka diaphragm e ka Phrenic Nerve, mai nā aʻa aʻa spinal C3, C4, a me C5 ma ka ʻāʻī. Ma muli o ka supraclavicular nerves e hāʻawi ana i ka ʻili ʻili ma luna o ka luna luna o ka poʻohiwi (trapezius muscle) no ka C3 a me C4, ua wehewehe ka lolo i ka ʻeha pericardial ma ke ʻano he ʻeha ʻoi loa ma ka trapezius ridge. (Momi maʻi: Hoʻomaka ka ʻeha o ka puʻuwai ma lalo o ka ** lima hema/biceps [T1-T4]* a i ʻole i loko o ka ʻāʻī, akā ʻo ** ʻeha e ʻā ana i ka piko trapezius luna o ka poʻohiwi he kikoʻī loa no ka pericarditis**.)*
6. Ka Myocardium (The Thick Muscular Pumping Wall, Pā'ia i Myocarditis):
7. Aia ma lalo o ka ʻeke pericardial lahilahi ka paia ʻiʻo mānoanoa o ka ventricle hema a me ka ʻākau (ka myocardium), kahi e noho ai ka ʻōnaehana uila uila o ka puʻuwai (ka His-Purkinje conduction fibers).
8. ʻO ka mea hoihoi, ʻaneʻane ʻaʻohe mea ʻeha "koi/kūlana" i ka ʻiʻo o ka puʻuwai, ke loaʻa ʻo Myocarditis (mai ka hoʻouka ʻia ʻana mai e ka Coxsackievirus B, Adenovirus, Parvovirus B19, Influenza, SARS-CoV-2, a i ʻole he autoimmune reaction) necrosis maʻi paʻi**.
9. Hoʻopuka kēia i ka ** ʻehaʻeha, kaumaha, puʻuwai e like me ka ʻeha o ka umauma** (a i ʻole ʻeha ʻeha o ka umauma.), ** hoʻokuʻu i ka protein troponin cardiac i loko o ke kahe koko**, hoʻonāwaliwali i ka puʻu ʻana o ka naʻau (acute systolic heart failure / cardiogenic shock), a hana i nā ʻōpala uila e hoʻomaka ai ** ventricular tachycardia puʻuwai.**
10. ** ʻO Myopericarditis a me Perimyocarditis (Ke hoʻā ʻia nā ʻāpana ʻelua):**
11. Ma muli o ka noho pono ʻana o ka pericardium visceral i loko ma luna o ka ʻiʻo o ka naʻau o waho, e kahe pinepine ka mumū ma ka palena:
12. Myopericarditis: ʻO ka pericarditis (ʻeha kūlana koʻikoʻi) me ka ʻaʻa ʻana o ka naʻau i loko o ka ʻiʻo o ka puʻuwai papa (no ka ** ho'āʻo troponin puʻuwai maikaʻi**, e hoʻopau i ka hana puʻuwai maʻamau ma ka echocardiogram).
13. Perimyocarditis: ʻO ka myocarditis pōʻino mua loa (ke kiʻekiʻe o ka troponin me ka hoʻonāwaliwali ʻana o ka puʻuwai puʻuwai / ka neʻe ʻana o ka paia ma ka echocardiogram) i hele pū ʻia me ka ʻeha pericardial.

Hoʻohālikelike piha: Pericarditis vs. Myocarditis vs. Heart Attack (STEMI) vs. Pulmonary Embolism¶

No ka lawe ʻana o nā kūlana ʻehā i nā maʻi i ke keʻena pilikia me ka ʻeha o ka umauma nui, e hoʻohana i kēia papa hoʻohālikelike lapaʻau e hoʻomaopopo i ke ʻano o ka ʻōlelo ʻana a nā kauka iā lākou.

Kūkākūkā Ola Ola: Pehea e ʻike ai i ka Myocarditis Fulminant i nā keiki, ʻōpio, a me nā mea pāʻani.¶

No ke aha i kuhi hewa pinepine ʻia ai ka Myocarditis e like me ka "Stomach Flu," "Asthma," a i ʻole "Anxiety"¶

I nā keiki, nā ʻōpio, a me nā ʻōpio ma lalo o ka makahiki 40, ʻo acute myocarditis kekahi o nā pahele diagnostic weliweli loa i ka lāʻau lapaʻau no ka mea ʻaʻole pinepine ka poʻe maʻi ʻōpio e hele i ka ʻōlelo ʻana, *"He ʻeha koʻu puʻuwai maʻamau."

1. ** ʻO ka mask "Gastrointestinal / Stomach Flu" (Maikaʻi i nā keiki a me nā ʻōpio):**
2. Ma luna o 50 pākēneka o nā maʻi myocarditis maʻi pediatric i loaʻa mua me ** ka ʻeha o ka ʻōpū, ka luaʻi, ka luaʻi pinepine ʻana, ka ʻai ʻole, a me ka luhi nui/letargy** ma mua o ka ʻeha o ka umauma.
3. No ke aha e ʻeha ai ka ʻōpū a me ka luaʻi ʻana o ka ʻeha o ka naʻau? Ke nāwaliwali koke ka ʻōpū hema a me ka ʻākau, e hoʻi pololei ke koko i loko o ka ** ate (acute hepatic congestion, stretching the liver capsule)** ʻoiai ke kahe koko haʻahaʻa e pōloli i ka ʻōpū (mesenteric ischemia).
4. Pehea e haʻi aku ai i ka myocarditis ma waho o ka ʻōpū ʻōpū maʻalahi: E nānā i ka **ka hoʻomaha o ka naʻau a me ka hanu ʻana o ke keiki. I loko o ka ʻōpū maʻamau, e iho ka puʻuwai o ke keiki i ka wā e loaʻa ai ka wai a me ka mea hoʻemi wela. I ka myocarditis, ua loaʻa i ke keiki ka persistent resting tachycardia (\(>120\text{ to }160\text{ beats per minute}\) i ka wā e hoʻomaha ai a hoʻomaha), ʻo ka hanu pāpaʻu wikiwiki (tachypnea) me ka haʻalulu ʻole, nā lima a me nā wāwae haʻalulu, a me ka luhi loa i kahi hiki ʻole iā lākou ke noho i luna a i ʻole ke hele wāwae ʻole.
5. Ka Makana "Asthma hou / Bronchitis":
6. Hoʻomaka koke ʻia kahi ʻōpio makua e hoʻi mai ana mai ke anu maʻi maʻi i ka ʻuʻu maloʻo, ʻūhū, a me ka pōkole nui o ka hanu ke moe ʻana i lalo i ka pō (orthopnea a me paroxysmal nocturnal dyspnea). ʻO nā keʻena mālama koʻikoʻi e kuhikuhi i kekahi manawa i kahi mea hoʻoinu albuterol no "bronchitis post-viral," ke hoʻopiha maoli ka māmā i ka wai (acute cardiogenic pulmonary edema) mai ka myocarditis. (E hoʻomaopopo: ʻO nā mea inhalers Beta-agonist e like me albuterol e hoʻolalelale i ka puʻuwai a hiki ke hoʻoulu i ka arrhythmias pōʻino i ka myocarditis.)
7. Ka "Arrhythmia / Syncope" Hōʻike:
8. Hōʻike ʻole ʻia maule (syncope), kokoke maule i ka wā o ka haʻahaʻa haʻahaʻa, a i ʻole ke kuʻi ʻana/kapeke ʻana o ka puʻuwai. Ma nā ʻano ʻokoʻa koʻikoʻi like ʻole e like me Giant Cell Myocarditis a i ʻole Cardiac Sarcoidosis, ʻo ka hōʻailona mua ʻo ** ka pau ʻana o ka puʻuwai atrioventricular (AV) hikiwawe** (ke hāʻule ana ka puʻupuʻu ma lalo o \(35\text{ bpm}\)) a i ʻole sustained ventricular tachycardia.
9. Ma hope o ka hoʻopaʻa ʻana a i ʻole ka Immune-Checkpoint Inhibitor Myopericarditis:
10. Ma hope o ka mRNA COVID-19 a i ʻole ka maʻi ʻaʻai liʻiliʻi ʻo Myopericarditis: Loaʻa ka nui i nā kāne ʻōpio a me nā ʻōpio makua (mau makahiki 12 a 29) i loko o 1 a 7 mau lā (Nā lā kiʻekiʻe 2 a hiki i 4) ma hope o ke kau ʻana ʻelua. Hōʻike pinepine ia me ka ʻeha o ka umauma, pōkole o ka hanu, a i ʻole palpitations, troponin kiʻekiʻe, a me nā loli ECG diffuse. ʻOiai ʻo ka hapa nui (>95%) o nā maʻi ma hope o ka maʻi kano he maʻalahi a hoʻoholo wikiwiki me ka nānā ʻana i ka haukapila, pono kēlā me kēia hihia i ke keʻena pilikia koke ECG, troponin, a me ka loiloi echocardiogram me kahi pāpā haʻuki manawaleʻa.
11. ** ʻO ka maʻi maʻi maʻi maʻi maʻi (Immune Checkpoint Inhibitor [ICI]) Myocarditis:** ʻO nā maʻi e loaʻa ana i nā antibodies PD-1, PD-L1, a i ʻole CTLA-4 (e like me pembrolizumab, nivolumab, atezolizumab, a ipilimumab) no ka maʻi kanesa e hoʻomohala ana i ka ʻeha o ka umauma, pōkole o ka hanu, hāʻule mua ʻana o ka ʻiʻo (** ka hāʻule ʻana o ka ʻiʻo. 1 a 3 mahina o ka lapaʻau ʻana i mua ICI-associated myocarditis, nona ka 30 a 50 pakeneka ka nui o ka make ke ʻole e mālama koke ʻia i loko o ka haukapila me high-dose intravenous methylprednisolone (\(1,000\text{ mg}\) IV/lā).

Makaʻala hoʻopiʻi: ʻO ka holomua mai ka Pericarditis i ka Cardiac Tamponade¶

I ka wā e ʻā ai ka ʻeke pericardial, hiki iā ia ke hoʻokahe i ka wai nui (pericardial effusion) i loko o ka wahi pani a puni ka puʻuwai. - Inā e hōʻiliʻili mālie ka wai i nā mahina, e holo mālie ka ʻeke fibrous a hiki i \(1\text{ liter}\) (\(33\text{ fluid aunces}\)) me ka ʻole o ka ʻeha ʻana i ka naʻau. - Eia nō naʻe, i loko o ka maʻi viral, bacteria (purulent), autoimmune, post-opera, a malignant pericarditis, inā ʻo \(150\text{ a i }250\text{ milliliters}\) (\(5\text{ a }8\text{ fluid aunces}\)) o ka wai e ninini ʻia i loko o ke kaomi ʻoʻoleʻa, ʻaʻole i kikoo ʻia ma luna o nā hola pericardial piha i nā hola. atrium a me ka ventricle akau. - Hi'i ka pu'uwai i loko i ka wā ho'omaha (diastole) no laila 'a'ole hiki i ka pu'uwai ke ho'opiha hou i ke koko: ʻO ka tamponade maʻi ʻeha.

E nānā i kēlā me kēia maʻi pericarditis no nā hōʻailona 4 o ka Cardiac Tamponade: - [ ] Nalo hoʻohālikelike ʻia o ka ʻeha o ka umauma ʻoi i hui pū ʻia me ka pōkole o ka hanu wikiwiki: No ke aha? I ka piha ʻana o ka wai i ka ʻeke, hoʻokuʻu ʻo ia i nā ʻāpana pepa ʻeleʻele ʻelua o ka pericardium * kaʻawale * no laila e hoʻōki lākou i ka hamo ʻana (e hoʻōki i ka ʻeha ʻoi), ʻoiai ka wai e ʻeha i ka puʻuwai i ka manawa like. - [ ] Nā ʻāʻī ʻāʻī i hoʻopaʻa ʻia (Jugular Venous Distension [JVD]): Ua ʻike ʻia nā aʻa ma ka ʻaoʻao o ka ʻāʻī inā e noho pololei ana ke kanaka i \(45\text{ a i }90\text{ degrees}\). - [ ] ** ʻO ka noʻonoʻo a i ʻole ka nawaliwali o ka puʻuwai i kēlā me kēia manawa a ke kanaka e hanu hohonu ai i loko (Pulsus Paradoxus):** I ka hanu hohonu ʻana, e hāʻule ke kahe koko ma mua o \(10\text{ mmHg}\) no ka mea, ʻo ka pehu akau ʻākau ma waena o ka septum a paʻi i ka ventricle hema i loko o ka ʻeke piha piha wai. - [ ] Ka hoʻomaha ʻole, ka huikau, ka ʻili haʻihaʻi, a me ka hāʻule ʻana o ke koko (Beck's Triad).

Ka hoʻomaopopoʻana i ka 4 ECG Stage of Acute Pericarditis vs. STEMI¶

I ka wā e hoʻopili ai nā mea lapaʻau a i ʻole nā ​​kauka lumi pilikia i ka mea maʻi me ka ʻeha o ka umauma a hiki i kahi 12-lead electrocardiogram (ECG), e hoʻokaʻawale i ka Stage 1 Acute Pericarditis mai kahi maʻi maʻi ST-Elevation Myocardial Infarction (STEMI / Heart Attack) he mea koʻikoʻi no ka hāʻawi ʻana i nā lāʻau lapaʻau intravenous clot-busting drugs (thrombolytic a i ʻole thrombolytic maʻi). hiki ke hoʻoulu i ka fatal hemorrhagic cardiac tamponade (ke koko i loko o ka ʻeke pericardial):

Nā ʻano like ʻole o ka Pericarditis kūikawā: Uremic, Purulent, a me Dressler Syndrome¶

1. Post-Cardiac Injury Syndrome (Dressler Syndrome): Hana ʻia 1 a 6 pule ma hope o ka hōʻeha ʻana o ka naʻau (myocardial infarction), ʻoki puʻuwai hāmama, hoʻokomo i ke alakaʻi pacemaker, a i ʻole ablation cardiac, ke kau ka ʻōnaehana immune i kahi hoʻouka autoimmune lohi i nā protein pericardial i hoʻokuʻu ʻia i ka wā o ka ʻeha mua. Hōʻike ʻia me ka ʻeha o ka umauma pleuritic, ke kuni, a me ka hoʻoheheʻe ʻana o pleural/pericardial.
2. Uremic Pericarditis (Kidney Failure Emergency): I nā poʻe maʻi me ka maʻi maʻi maʻi maʻi mau loa a i ʻole nā ​​​​hana dialysis i hala, hoʻoulu ʻia nā toxins nitrogenous i ka pericardium, e hoʻoulu ai i ka "bread-and-butter" exudate. (E hoʻomanaʻo: ʻAʻole pinepine ka Uremic pericarditis i ke kiʻekiʻe ST maʻamau ma ECG a he hōʻailona ia no ** hemodialysis wikiwiki ** me ka heparin e pale ai i ka hemorrhagic tamponade.)
3. Purulent (Bacterial) Pericarditis: ʻO nā fevers spiking kiʻekiʻe (\(>39^\circ\text{C}\) [\(102.2^\circ\text{F}\)]), ʻoʻoleʻa, a me nā ʻano mea ʻawaʻawa i loko o ka mea maʻi me ka maʻi pneumonia, empyema, ʻokiʻoki ʻana i ka umauma, a i ʻole sepsis e koi koke i ka hoʻokaʻawale ʻana i ka pericardial ulia pōpilikia.

Hoʻomaʻamaʻa Halemaʻi & No ke aha ka "3 a hiki i ka 6 mahina haʻuki pāʻani" hoʻopakele ola¶

1. Pehea e mālama ai nā halemai i ka maʻi maʻi maʻi maʻi ʻole (ESC Guidelines)¶

Ke hōʻoia nā kauka ulia pōpilikia pure acute pericarditis (troponin maʻamau, ʻaʻohe myocarditis, ʻaʻohe tamponade, a ʻaʻohe kumu bacteria/tuberculous): - Dual Anti-Inflammatory Therapy: Kiʻekiʻe Ibuprofen (\(600\text{ a hiki i }800\text{ mg}\) i kēlā me kēia 8 hola) a i ʻole ** Aspirin (\(750\text{ a i }1,000\text{ mg}\) i kēlā me kēia 8 hola)** i hui pū ʻia me ka ʻōpū-pale proton-dose paʻa, $5 mg hoʻokahi. a i ʻole ʻelua manawa i kēlā me kēia lā no 3 mahina piha). (No ke aha he mea nui ai ka Colchicine: Ua hōʻike ʻia nā hoʻāʻo hoʻāʻo ʻāina [COPE a me ICAP hoʻāʻo] ʻo ka hoʻohui ʻana i 3 mau mahina o ka colchicine e ʻoki i ka pilikia o ka pericarditis e ʻeha hou i ka hapalua, mai 37% a hiki i 16%.) - No ke aha e pale ʻia ai ka ʻOral Corticosteroids (Prednisone) i ka Laina Mua ma Viral Pericarditis: ʻO ka hāʻawi ʻana i ka prednisone waha no ka maʻi viral pericarditis maʻalahi e nalo ai ka ʻeha i loko o 24 mau hola, ** akā e hoʻonui i ka hoʻihoʻi hou ʻana i ka manawa i hoʻopaʻa ʻia ** no ka mea e hoʻoikaika nā steroid i ka hoʻomau i ka maʻi. Hoʻopaʻa ʻia nā Corticosteroids no ka pericarditis autoimmune, ka hana ʻole o ka renal, ka hāpai ʻana, a me nā hihia refractory.

2. No ke aha e pono ai i nā 'âlapa a me ka po'e 'eleu e ho'olohe i ka pāpā ho'oikaika kino¶

Inā he kanaka haʻuki hoʻokūkū paha ʻoe, he ʻōpio i nā haʻuki kula, he pūʻali koa, a i ʻole he jogger/gym-goer, nā alakaʻi alakaʻi cardiology honua (American Heart Association / American College of Cardiology [AHA/ACC] a me European Society of Cardiology [ESC]) hoʻokō i ka hoʻoikaika kino kino ma hope o ka pericarditis a i ʻole myocarditis. - Ma hope o Pure Acute Pericarditis: Hoʻopaʻa piha ʻia mai nā haʻuki hoʻokūkū a me ka hoʻoikaika ikaika (e mālama i ka helu o ka naʻau ma lalo o \(100\text{ bpm}\) / hele māmā wale nō) a hiki i ka ** i hoʻoholo ʻia nā hōʻailona a pau A me nā hōʻailona inflammatory koko (CRP/ESR), 12-lead ECG, a me ka echocardiogram ua hoʻi i ka 100 pakeneka 3 mau lā maʻamau** (ma ka liʻiliʻi 3 mau lā ). - Ma hope o ka Myocarditis Acute (a i ʻole Myopericarditis me ka Troponin Kiʻekiʻe): ** Hoʻopau i ka 100 pākēneka pāpā i nā haʻuki hoʻokūkū āpau, ka holo ʻana, ka hāpai kaumaha, a me ka hoʻomaʻamaʻa haʻahaʻa a me ka ikaika no 3 a 6 mau mahina. - No ke aha e make ai ka hoʻoikaika kino ʻana i ka puka makani: ʻOiai ma hope o ka nalo ʻana o ka ʻeha o ka umauma i nā lā 3, e mau ana nā ʻāpana microscopic o ka edema a me ka ʻiʻo ʻili hoʻōla i loko o ka ʻiʻo puʻuwai no 90 a 180 mau lā. Hiki i ka pi'i 'ana o ka adrenaline ho'oikaika kino ke ho'oulu i ka ** ventricular fibrillation (hopu koke i ka na'au)** ma ke kahua pâ'ani pôpeku a i 'ole ka treadmill. Ma mua o ka hoʻi ʻana i ka hoʻomaʻamaʻa ma 3 a 6 mau mahina, pono e hōʻoia ke kanaka cardiologist i ka troponin maʻamau, maʻamau echocardiogram/cardiac MRI, kahi ** 24-a-48-hola Holter nānā e hōʻike ana i nā arrhythmias weliweli **, a me kahi ** hoʻomaʻamaʻa koʻikoʻi koʻikoʻi maʻamau **.

Palapala kamaʻilio pololei no 911/112/999 a me ka hoʻāʻo ʻana i ka haukapila¶

E hoʻohana i kēia mau palapala hōʻoia no laila e hana koke nā mea hoʻouna ulia pōpilikia a me nā kahu hānai hoʻomaʻamaʻa i kahi 12-lead ECG a me ka hoʻāʻo troponin kiʻekiʻe.

• No ka ʻeha ʻeha o ka umauma i ke kūlana (Suspected Pericarditis / Myopericarditis):

  "Aia wau i ka hoʻokolokolo pilikia me kahi maʻi [makahiki] makahiki i loaʻa i ka ʻeha ʻeha o ka umauma hema hema a ʻoi loa ka ʻeha i ka wā e moe palahalaha a hanu hohonu a hoʻomaikaʻi i ka wā e noho ana a hilinaʻi i mua [me ka ʻeha e ʻā ana i ka poʻohiwi hema trapezius. 12-lead ECG, high-sensitivity cardiac troponin, a me ka ʻaoʻao moe echocardiogram e hoʻokuʻu i ka myocarditis acute a me ka pericardial effusion."

• No ka Myocarditis Acute Manaʻo (Post-Viral Shortness of Breath, Tachycardia, or Syncope):

  *"Makemake au i kahi kaʻa kaʻa pilikia ma [Exact Address]. ʻO ka mea maʻi he [Age]-makahiki e ho'ōla ana mai kahi maʻi viral i kēia manawa i loaʻa i kēia manawa [paʻi umauma / pōkole nui o ka hanu i ka wā e moe ana / ka puʻuwai hoʻomaha hoʻomaha ʻole o ___ bpm / palpitations / maule. Ke manaʻo nei mākou i ka Acute Viral Myocarditis a pono e lawe koke i ke keʻena hoʻihoʻi cardiac. "

Nīnau pinepine¶

No ke aha e ʻeha nui ai ka pericarditis i ka wā e moe palahalaha ana ma kou kua, a no ke aha e ʻoi aku ka maikaʻi o ka hilinaʻi ʻana i mua?¶

Ke moe ʻoe ma kou kua, huki ka ʻumekaumaha i ka puʻuwai i hope i ka iwi kuamoʻo a hohola i ka ʻeke pericardial waho i ʻeha i ka diaphragm a me ka lining o ka māmā (pleura), ʻoiai ka hoʻonui ʻana o ke koko venous mai kou mau wāwae e hoʻonui i nā keʻena naʻau i ka ʻeke maka me kēlā me kēia kuʻi. ʻO ka noho pololei ʻana a me ka hilinaʻi ʻana i mua ma kahi kihi 30-45-degere e hoʻoneʻe i ka puʻuwai i mua mai ka pleura māmā hope a hoʻemi i ka hoʻopololei venous, e hoʻomaʻamaʻa koke i ka ʻeha ʻana.

No ke aha ʻaʻole pono iaʻu e lawe koke i ka Ibuprofen (Advil/Motrin) ma ka home inā manaʻo wau he pericarditis post-viral?¶

Mai nā hōʻailona wale nō, ʻaʻole hiki ke haʻi ʻia inā ua kaupalena ʻia ka mumū i ka ʻeke waho (pure pericarditis) a i ʻole ua komo pū i ka ʻiʻo puʻuwai ponoʻī (myopericarditis a i ʻole myocarditis). ʻOiai ʻo ka ibuprofen a me ka colchicine ka lāʻau lapaʻau maʻamau no ka pericarditis maʻemaʻe, ʻo ka lawe ʻana i nā NSAID e like me ka ibuprofen i ka wā i hōʻike ʻia ai ka ʻiʻo o ka puʻuwai (myocarditis) i nā haʻawina cardiology e hōʻemi i ka hoʻōla ʻana o ka ʻiʻo o ka naʻau, hoʻonui i ka pōʻino viral, a hoʻonui i ka hāʻule o ka naʻau; e kali mau a hiki i ka ho'āʻo koko o ka lumi pilikia e hōʻoia i ka maʻamau ka pae o ka troponin naʻau.

Pehea e kuhikuhi pono ai ka ʻeha i ka piko o ka poʻohiwi hema (trapezius ridge) i ka pericarditis ma kahi o ka hōʻeha puʻuwai?¶

Hoʻopili ʻia ka ʻeke pericardial a me ka diaphragm waena e ke aʻalolo phrenic, e hoʻopili ʻia i loko o ke kuamoʻo ma nā pae ʻāʻī C3, C4, a me C5, nā ʻāpana ʻāʻī like ʻole e loaʻa nā aʻalolo sensory mai ka ʻili ma luna o ka piko o kou poʻohiwi (ka ʻiʻo trapezius). Ma muli o ka huikau o ka lolo i nā hōʻailona e hōʻea ana i C3-C5, hoʻouna ka pericarditis i ka ʻeha i kuhikuhi ʻia ma ka ʻaoʻao o luna o ka poʻohiwi, akā ʻo ka hōʻeha ʻana i ka puʻuwai e hoʻouna i ka ʻeha ma o nā aʻalolo ʻokiʻoki (T1-T4) ma ka ʻaoʻao o loko o ka lima a i ka ʻāwae paha.

No ke aha e pāpā ai ka poʻe cardiologists i nā haʻuki a me nā hoʻomaʻamaʻa no 3 a 6 mau mahina ma hope o ka myocarditis ʻoiai ke manaʻo nei ʻoe he 100 pakeneka hoʻi i ka maʻamau?¶

ʻOiai inā e pau ka ʻeha a me ka luhi o kou umauma i loko o hoʻokahi pule o ka loaʻa ʻana o ka myocarditis, ʻo nā ʻāpana microscopic o ka pehu a me ka hoʻōla ʻana i ka ʻiʻo ʻili i loko o ka ʻiʻo o ka puʻuwai e paʻa ʻole i ka uila no 3 a 6 mau mahina. Inā holo ʻoe, hāpai i nā mea kaupaona, a pāʻani paha i nā haʻuki hoʻokūkū ma kēia pukaaniani hoʻōla, hiki i ka piʻi ʻana o ka adrenaline a me ka pā o ka naʻau ke hoʻoulu i kahi pōkole make hikiwawe i kapa ʻia ʻo ventricular fibrillation (hopu koke ʻia ka naʻau); e kali ana a hiki i ka hoʻomaʻemaʻe ʻana o ka cardiologist iā ʻoe me ka nānā ʻana o Holter a me ka hoʻāʻo koʻikoʻi e pale i kou ola.

Nānā ʻia nā kumu¶

• European Society of Cardiology (ESC): ESC Guidelines for the Diagnosis and Management of Pericardial Diseases (Adler et al., European Heart Journal; diagnostic criteria for acute pericarditis, NSAID + 3-mahina colchicine regimen, and myopericarditis triage) a me ESC Position Statement on Management of A
• ** American Heart Association (AHA) a me American College of Cardiology (ACC, United States):** Hoʻomaopopo a me ka hoʻokele mua ʻana o Fulminant Myocarditis: He ʻŌlelo ʻepekema mai ka American Heart Association (Kociol et al., Circulation) a me AHA/ACC Eligibility and Disqualification Recommendities for Competitive Athlecarditis (Ka palena hoʻoikaika kino 3 a 6 mau mahina a me ka hoʻāʻo hoʻi i ka pāʻani).
• Lau Hana Ola Lahui (NHS, United Kingdom) a me National Institute for Health and Care Excellence (NICE, United Kingdom): Acute Chest Pain Assessment, Pericarditis, and Myocarditis Clinical Guidance.
• Na Center for Disease Control and Prevention (CDC, United States) and World Health Organization (WHO): Clinical Guidance for Recognition and Management of Post-Viral and Post-Vaccination Myocarditis and Pericarditis.

Nā alakaʻi pili¶

• Ka ʻike ʻana i ka puʻuwai a me ke kōkua mua
• ʻO ka tamponade puʻuwai a me ka hoʻāʻo ʻana i ka trauma umauma
• ʻO ka puʻuwai hoʻokūkū koke (SVT), hoʻololi ʻia ʻo Valsalva manuver, a me nā hae ʻulaʻula arrhythmia
• ʻO ka pulmonary embolism a me ka thrombosis vein hohonu (DVT)
• Ke alakaʻi CPR a me ke keiki makua a me AED