Acute Pericarditis vs. STEMI Heart Attack: Te mamae o te uma Pleuritic na te Anga whakamua me te Taponade Cardiac (Beck Triad)¶

Ko te pericarditis whakapeka he mumura tere o te pericardium, te pukoro fibroserous paparanga-rua e karapoti ana i te ngakau, ka puta koi, ka werohia ** te mamae o te uma pleuritic** i muri i te ivi uma ka tino kino atu i te wa e takoto ana te tuara, te manawa hohonu, te maremare, te horomia ranei, ka tino pai ake i te noho tika me te okioki ki mua. Na te mea ka puta te pericarditis whakapeka i te whanui ST-segment elevation i runga i te 12-lead electrocardiogram (ECG) ka taea te tuku wai ki roto i te putea pericardial tae noa ki te pakaru i nga ruma o te ngakau (Cardiac Tamponade), ka noho ki te pokapū o te whitinga mate-mate-mate ranei me te ST-Elevation Heart attack Myocardial () Mena ka puta te mamae ohorere o te uma, te poto o te manawa, te mamae o te pokohiwi, te ringa ranei, te mahunga ranei, waea atu ki to rohe. tau ohorere tonu. I a koe e tatari ana ki nga paramedics, arotakehia nga aratohu e pa ana ki te mohio ki te mate ngakau me te awhina tuatahi, te whakaheke pericardial me te tamponade rongoa, a pericarditis, myocarditis, me te mamae o te uma i muri i te huaketo nga haki whero.

Ahakoa ko te mamae o te uma e whakaatu ana i nga ahuatanga o te pericarditis tawhito (ka mamae te mamae ma te noho ki runga me te okioki ki mua i runga i te urunga, te mamae ranei e pa ana ki te trapezius hiwi kei runga o te pakihiwi), me ** kaua rawa koe e ngana ki te tirotiro i te pericarditis i te kainga, ki te tango ranei i te ibuprofen horopeta nui i mua i te hohipera 12-arahi ECG, he cardiac totoro ki waho o te moenga, he cardiac troponside. te aukati i nga uaua o te ngakau, te myocarditis, te wehenga aortic, me te tamponade ngakau.

Mahia tenei inaianei¶

1. Waea wawe ki to nama whawhati tata mo nga mamae o te uma hou. Waea 911 i te United States me Canada, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom, 000 i Ahitereiria, tirohia ranei ta matou raarangi korero tau ohorere. Kaua rawa e peia koe, he turoro ranei e mamae ana te uma ki te hohipera, na te mea ka taea e nga kaiparapara te tuhi i te ECG 12-arahi i roto i te ruma noho i roto i nga meneti hei tirotiro mo te mate ngakau STEMI me nga hiko hiko.
2. ** Tukua te manawanui ki te noho tika me te anga whakamua ki runga i te urunga, te teepu ranei (te tuunga Tripod) mena kei te takoto papatahi te mamae. Ko te noho tika me te anga whakamua ka whakatarewa i te ngakau ki mua i roto i te uma me te whakaiti i te waku i waenga i nga paparanga pericardial.
3. Tukuhia nga NSAID nui (ibuprofen, naproxen, indomethacin) me te corticosteroids kia whakatauhia e te hohipera he whakaeke ngakau. Ahakoa ko nga NSAID me te colchicine te rongoa tuatahi mo te pericarditis whakapeka, ka hoatu te ibuprofen, prednisone ranei ki te turoro e pa ana ki te myocardial infarction (te mamae o te ngakau) te rahi, me te tino whakanui ake i te tupono ka mate ka pakaru noa te pakitara o te ventricular.
4. Kia ata titiro ki nga tohu whakatupato e 4 o Cardiac Tamponade (Beck's Triad + Pulsus Paradoxus). Ki te kaha ake te manawa o te tangata turoro e mohiotia ana, e whakapaetia ana ranei he pericarditis me te marama o te pukahukahu, ka tupu ** nga uaua kaki (jugular venous distension)** i a ia e noho tika ana, e whakaatu ana i te tere tere o te ngakau me te 100 o te hekenga o te ngakau (> 100 te heke o te manawa) te pehanga, he pupuhi ringaringa ranei e ngoikore ana i te wa e ngotea ana (pulsus paradoxus > 10 mmHg), kia mataara tonu nga kaiparapara kei te whanake te ** tamponade cardiac**.
5. ** KAUA e hoatu he nitroglycerin i raro i te reo me te diuretics (pire wai) mena he iti te pehanga toto, kei te pupuhi ranei nga uaua kaki.** Kare a Nitroglycerin e whakaora i te mamae o te pericarditic, a mena kei te kohia te wai ki roto i te pukoro pericardial (tamponade), na te nitroglycerin me te furosemide ka tihorea te pehanga whakakī o te uaua ki te pupuri i te porowhita o te toto.
6. Kia noho te manawanui ki te okiokinga tinana me te kore noa ma te waha (kahore he kai, he inu ranei). Tae atu ki te 15 ki te 30 paiheneti o nga keehi pericarditis viral whakapeka he mumura o te ngakau (myopericarditis), i reira ka taea e te whakakorikori tinana, i nga hakinakina ranei te whakaoho i te arrhythmias ventricular whakamate. Kia tau te manawanui, kia mahana, me te NPO mena ka hiahiatia te angiography coronary whawhati tata, pericardiocentesis ranei.

Rakau whakatau: te arotake i te mamae o te uma me te mamae o te uma me te haki whero tamponade¶

flowchart TD
    Start["Te mamae o te uma: Aromātaihia te ahua o te mamae, te urupare o te tuunga, me te pumau o te hemodynamic"] --> TamponadeCheck{"Tirohia nga Tohu Tamponade Cardiac (Beck Triad & Pulsus Paradoxus): Te pupuhi o nga uaua kaki (JVD), Systolic BP < 100 mmHg, Narrow Pulse Pressure ranei, Heart Rate > 100 bpm, Severe Dyspnea?"}

    TamponadeCheck -->|"ĀE: TAMPONADE OBSTRUCTIVE"| Tamponade["TAMPONADE KAUPAPA KAUPAPA KAUPAPA KAUPAPA: Waea 911/112/999, Noho Whakatika Whakamua, KORE he Nitroglycerin, Diuretics ranei, Pericardiocentesis Arahi Aro-Arahi"]

    TamponadeCheck -->|"KORE: Tirohia te ahua o te mamae me te paanga o te tuu"| PainType{"He pehea te ahua o te mamae o te uma ki te manawa me te tu?"}

    PainType -->|"Te kuru, te pehanga taumaha/te kuru; KAUA i whakarereketia ma te manawa, ma te okioki ki mua; ka puta ki te kauae/ringa maui; hauhau"| STEMI["Te whakapae mo te Acute Coronary Syndrome / STEMI Heart Attack: Waea 911/112/999, 12-Lead ECG i roto i te 10 meneti, Ngaua 162-325 mg Aspirin (mehemea karekau he tohu wehewehenga), Tonu Cath Lab"]

    PainType -->|"Koi, werohia te mamae pleuritic; TE INOI te takoto papatahi, te hoha hohonu ranei; HEI te noho tika me te anga whakamua; ka rere ki te hiwi trapezius"| Pericarditis["Pikitia Haumanu Matarohia o te Pericarditis Acute: Kei te hiahia tonu ki te Hohipera ED 12-Lead ECG, Troponin Tino-Tirohanga, me te Echocardiogram i te Moenga ki te whakakore i te STEMI & Myopericarditis"]

    Pericarditis --> HospitalWorkup["Ko te Pericarditis Acute i Whakamanahia e te Hospital (ESC Paearu >= 2 o te 4): Colchicine Tuatahi-Raina + Aspirin/NSAIDs, Te Whakawhanaunga Tino Mahi, Te Whakauru Mena he Kirika> 38C, Te Whakangao, te Troponin Whakanuia ranei"]

Pathophysiology: he aha te mamae o te pericarditis i te wa e takoto papatahi ana ka toro atu ki te hiwi trapezius¶

E rua nga paparanga o te pericardium: 1. Ko te visceral pericardium (epicardium), he paparanga kotahi o nga pūtau mesothelial i piri tika ki waho o te uaua ngakau e patupatu ana (he kore nga muka mamae). 2. Ko te parietal pericardium, he pukoro uaua o waho 2-millimeter te pukoro kiko e whakakikoruatia ana e te mesothelium serous kei te raro me te mata o mua e whakakorikoria ana e nga muka mamae somatic e mau ana i roto i te Phrenic Nerve (nga pakiaka nerve C3, C4, me C5).

Ina he mate huaketo (Coxsackie B, echovirus, adenovirus, rewharewha, SARS-CoV-2), te mate kitakita, te mura autoimmune (lupus, rheumatoid arthritis), te uremia (raruraru o te whatukuhu), te tauhohenga aukati ranei i muri i te whakaeke ngakau (Dressler syndrome) ka mumura te paparanga pericardial, ka whakahinuhinu te mata o te kirikiri me te kiri maeneene. ("paraoa-me-pata" fibrinous pericarditis). E whakamarama ana tenei anatomy i nga whanonga e toru o te taha moenga o te mamae o te uma pericarditic:

WHY POSITION & BREATHING CHANGE PERICARDITIS PAIN (C3-C4-C5 PHRENIC NERVE PATHWAY)

  [ LYING FLAT ON BACK (SUPINE) ]           [ SITTING UP & LEANING FORWARD ]
  Gravity pulls the heart backward          Gravity suspends the heart forward
  and stretches the inflamed parietal       away from the posterior pleura and
  pericardium tightly against the           diaphragm, reducing mechanical rub
  diaphragm and lungs during breathing.     on the phrenic nerve fibers.
         |                                         |
         v                                         v
  SEVERE STABBING PAIN                      DRAMATIC PAIN RELIEF
  (Worse on every deep breath,              (The classic "Tripod" or prayer
   cough, hiccup, or swallow)                posture of acute pericarditis)

• He aha te mamae e puta ai te mamae ki te Trapezius Ridge (me te aha e tata ana te pathognomonic): No te mea ko te phrenic nerve i ahu mai i nga wahanga o te kirikiri cervical C3, C4, me C5, he rite tonu nga waahanga o te tuara e tuku ana i te rongo kiri ma nga nerves supraclavicular ki te trapezius hiwi (ko te titahatanga o te uaua o te kaki kei waenganui i te turanga o te roro) te mamae o te nerve phrenic mai i te pericardium he mamae koi i te tihi o te hiwi trapezius maui (bilateral ranei). Kaore i te rite ki te whakaeke ngakau (e toro ana ki te ringa maui o roto, tuke, ringaringa, kauae ranei ma te T1 ki te T4 nerves sympathetic), he mea tino motuhake te whakamaarama ki te hiwi trapezius mo te riri pericardial, diaphragmatic ranei.

Whakataurite Haumanu me te ECG: Pericarditis Acute vs. STEMI Heart Attack vs. Repolarization Moata¶

I roto i te tari waka tūroro me te tari whawhati tata, ka whakakotahihia e nga kairoro te hitori o nga tohu, te tirotiro stethoscope, me nga ** 12-arahi nga ture ngaru ECG ** hei wehewehe i te pericarditis whakapeka mai i te aukati coronary occlusion (STEMI):

Ripanga whakataurite matawhānui: Pericarditis vs. STEMI vs. Benign Early Repolarization¶

E 4 nga wahanga ECG raupapa o te pericarditis whakapeka¶

Kaore i rite ki te whakaeke ngakau ka huri i roto i nga meneti ki nga haora me te ngaro o te teitei ngaru-R me nga ngaru hohonu Q, ka tere haere te pericarditis whakapeka matarohia i roto i 4 nga waahanga ECG motuhake mo te 2 ki te 6 wiki:

STAGE I (Hours to Days - First 2 Weeks)
  * Diffuse concave ("upward-curving") ST elevation in I, II, aVL, aVF, V2-V6
  * Reciprocal ST depression + PR-segment ELEVATION in Lead aVR
  * Diffuse PR-segment DEPRESSION in inferior/lateral leads + Spodick sign
          |
          v
STAGE II (Days 7 to 14)
  * ST segments and PR segments gradually return to the normal flat (isoelectric)
    baseline; T waves flatten out (T-wave amplitude decreases).
          |
          v
STAGE III (Weeks 2 to 3)
  * Diffuse T-wave inversion across multiple leads (occurring ONLY AFTER the
    ST segments have returned to baseline, without Q-wave formation).
          |
          v
STAGE IV (Weeks 3 to 6+)
  * Gradual resolution of T-wave inversions back to the patient's normal baseline ECG.

Official European Society of Cardiology (ESC) paearu tātaritanga mo te pericarditis whakapeka¶

I raro i te European Society of Cardiology (ESC) Guidelines for the Diagnosis and Management of Pericardial Diseases, he taunga haumanu ōkawa o te pericarditis whakapeka me ** kia 2 iti rawa o nga paearu e 4 e whai ake nei**:

1. Te mamae o te uma o te uma (kei roto i te 85% ki te 90% o nga keehi): Ko te mamae o te uma whakamuri me te pleuritic kua pai ake ma te noho ki runga me te okioki ki mua.
2. Pericardial Friction Rub (kei roto i te 33% ki te 85% o nga keehi, ahakoa he wa poto, ka haere mai me te haere mai i ia haora ki ia haora, no reira ka whakarongo tonu nga taote).
3. Hou Horapa ST-Waihanga Whakanuia, PR-Waihanga Paheketanga ranei kei runga 12-arahi ECG (kei te 60% o nga keehi).
4. Pericardial Effusion (he kohinga wai hou, he kino haere ranei i roto i te pukoro pericardial e kitea ana i runga i te taha o te moenga transthoracic echocardiography, kei te 60% o nga keehi).
5. Tauwhito Tautoko me nga Whakaaturanga Ataata: Nga tohu inflammatory teitei (C-Reactive Protein [CRP], Erythrocyte Sedimentation Ree [ESR], me te tatau toto toto ma) he tohu ranei o te mumura pericardial i runga i te Cardiac Magnetic Resonance (CMR) ranei CT.

Ka pewhea mehemea ka piki te Troponin? (Myopericarditis vs. Pericardiomyopathy)¶

Na te mea e noho tika ana te pericardium visceral o roto ki runga ake o te paparanga o waho o te uaua ngakau (subepicardial myocardium), ka rere te mumura ki roto i nga uaua o te ngakau. - I roto i te 15 ki te 30 paiheneti o nga turoro me te pericarditis whakapeka angamaheni, ka piki ake te ** cardiac troponin I, T** ranei i roto i te toto. - Myopericarditis: Ko te nuinga o te pericarditis me te mahi papua ventricular maui maui (he hautanga whakangao noa i te echocardiogram) engari he troponin teitei. - Pericardiomyopathy (Myocarditis-nui): Ko te troponin teitei e haere tahi ana me he rerekee nga nekehanga o te pakitara o te pakitara maui maui ranei o te ao (he iti te hautanga o te pananga) me te ngoikore o te ngakau/arrhythmias. - Ko nga turoro me te mamae o te uma me te nui o te troponin ka tukuna ki te hohipera ** mo te aro turuki i te waea waea, te echocardiography, me te angiography coronary me te MRI ngakau kia kore e ngaro te arai o te ngakau (mate ngakau).

Te ahunga whakamua ki te Cardiac Tamponade: te mohio ki te Triad a Beck me te Pulsus Paradoxus¶

Ko te tino riri mo te ora tonu i roto i nga turoro me te pericarditis whakapeka ko te kohi tere o te mumura, te purulent, te mate kino, te wai hemorrhagic ranei i roto i te peke pericardial o waho, ka ahu whakamua ki te Taponade Cardiac.

Ka tere te kohi wai (i roto i nga haora ki etahi ra), kaore e taea e nga muka collagen uaua o te parietal pericardium te toro. Ina neke ake te nui o te wai i te 150 ki te 250 milliliters, ka piki te pehanga intrapericardial ki runga ake i te pehanga whakakī o te atrium matau me te ventricle matau (ko te tikanga 3 ki te 8 mmHg), ** ka kuru i nga ruma o te taha matau ka tutakina i te wa diastole** kia kore ai e uru te toto ki roto ki te ngakau.

Me pehea te mohio ki te whakawhiti mai i te Pericarditis ngawari ki te Tamponade¶

Kia ata titiro ki nga 5 haki whero haumanu o Cardiac Tamponade (tae atu ki te Beck's Triad):

1. Ko te ngaronga paradoxical o te mirimiri waku me te kino haere o te manawa: I te timatanga o te pericarditis fibrinous maroke, ka koi te mamae o te uma, ka kaha te kaha o te mirimiri waku. Mena ka puhoi te mamae koi ki roto i te kikitanga o te uma i te wa e kore e mutu te manawa o te manawanui (dyspnea me te tachypnea > 20 manawa/meneti)** me te oro maramara o te pukahukahu, ko te whakawhanui o te wai kei te turaki i nga paparanga pericardial ka wehea te ngakau.
2. Waitohu Tokotoru a Beck #1 - Te Whakanuia o Te Huka (JVD): Ahakoa e noho tika ana te manawanui ki te 45 ki te 90 nga nekehanga, ka pupuhi nga uaua nui o nga taha o te kaki na te mea kua araia te toto venous e hoki mai ana i te mahunga kia kore e uru ki roto ki te atrium matau.
3. Waitohu Tokotoru a Beck #2 - Systemic Hypotension & Narrowed Pulse Pressure: I te wa e paheke ana te rōrahi o te whiu, ka heke te tau o runga toto (systolic) i te kaha o te whakahekenga adrenaline e pana ana te nama raro (diastolic) ki runga, ka piri nga tau e rua kia tata tahi (hei tauira, 98/82 mmHg) i mua noa i te 16 mmHg te pehanga toto, te pehanga toto i raro i te 16 mmHg noa**, he pehanga toto kei raro noa i te 16 mmHg. 90 mmHg.
4. Waitohu Tokotoru a Beck #3 - Nga Oro Manawa Pamamao, Muffled: Ko te paraikete matotoru o te wai e karapoti ana i te ngakau ka whakamau i nga oro ngakau i runga i te tirotiro stethoscope.
5. Pulsus Paradoxus (> 10 mmHg te maturuturunga iho o te manawa i te BP systolic) me te Resting Sinus Tachycardia (> 100 bpm):
6. Nā te mea ka taea e te ngakau kōpeke te pupuhi i te rōrahi whiu iti mo ia pao, ka piki te reiti o te manawa whakatā ki 100 ki te 140 pao ia meneti kia ora tonu ai te manawanui.
7. I nga manawa katoa i roto i te manawa (whakahau), ka kumea e te pehanga o te uma kino etahi atu toto ki roto i te ventricle matau; i roto i te pukoro pericardial karekau, ka kuhu e te ventricle matau whakawhänui te septum interventricular ki te taha maui ki roto i te ventricle maui, ka heke te pehanga toto systolic i te ** neke atu i te 10 mmHg (he 20 ki te 30+ mmHg)** ka ngoikore, ka ngaro atu ranei te pupuhi o te ringaringa i te wa e ngohia ana (**pulsus paradoxus).
8. I runga i te ECG 12-arahi, ka puta mai he rerenga nui me te tamponade ** iti QRS ngaohiko** me te hikoi hiko (ka piki te QRS i te roa-poto-roa-poto-poto i te wa e huri haere ana te ngakau ki roto i te putea wai).

Te maimoatanga o te hōhipera ohorere o Tamponade: Iratuki-Guided Pericardiocentesis¶

I te wa e whakau ana te echocardiography i te taha o te moenga o te tamponade ngakau (e whakaatu ana i te whakahekenga porowhita o te pericardial me te te tiango o te atrial systolic matau, te tiango diastolic ventricular matau, me te vena cava inferior plethoric kore e tiango), ka tukuna tonutia e te manawanui te ultrasound-guided: pericardiocentesis - I te wa e noho tika ana te manawanui, karohia te whakaurunga pehanga pai me nga vasodilators, me te whakauru i nga crystalloids IV mena kei te hypovolemic, ka kuhu te kaimatai ngakau, rata ohorere ranei i te ngira i raro i te arataki ultrasound o te waa ki roto i te putea pericardial me te tuu i te ** poaka catheter whakahekeheke **. - Ma te tango noa i te 50 ki te 100 miririta o te wai tuatahi ka heke tonu te pehanga intrapericardial ki raro i te taha poutū poutū o te ānau pehanga-rōrahi Spodick, ka whakahoki i te whakakī o te ventricular matau me te pehanga toto i roto i nga hēkona.

Te whakamatautau i te hōhipera: ko wai e hiahia ana ki te whakauru mai ki te maimoatanga tuuroro ki waho (Rārangi Arowhai Tohu Matapae Nui)¶

Ehara i te mea me noho nga turoro katoa e mate ana i te pericarditis viral uaua ki te hohipera, ** mena kua whakakorehia te STEMI me te tamponade, a kaore tetahi o nga ESC Major or Minor Poor Prognostic Predictors i reira. Mena kei te ** ahakoa KOTAHI** o nga ahuatanga morearea nui e whai ake nei, me whakahau te urunga ** ki te hōhipera** na te mea he nui te mate o te tamponade ngakau, te purulent/whakararuraru kino, te raru nui ranei:

• Ko nga Kaipupuri Morearea Nui (Ko te 1 e whakahau ana kia uru wawe ki te hohipera):
• ** Te Kirika Teitei:** Te Pawera > 38.0 nga nekehanga Celsius (100.4 nga nekehanga Fahrenheit) (e tino pa ana ki te purulent bacterial pericarditis, mate kino kino ranei).
• Te timatanga o raro: Nga tohu e ngoki haere ana i roto i nga ra maha, wiki ranei karekau he timatanga whakapeka (matarohia mo te mate kohi, mate kino, autoimmune ranei he nui te mate o te tamponade).
• Waiwhanga Pericardial Nui: Mokowā echo-free > 20 millimeters i runga i te echocardiography, i etahi tohu hemodynamic ranei o Taponade Cardiac.
• Kare i te Whakautu i roto i nga Ra 7 i te tiimata o te aspirini horopeta-katoa, te rongoa NSAID ranei.
• Ko nga Kaimatapae Moorearea Iti (Me whakahau ano te whakauru ki te hohipera):
• Myopericarditis: Te pikinga o cardiac troponin I, T ranei i roto i te toto.
• Te Whakatairanga Aro-a-waha: Ko nga turoro e tango ana i te warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel ranei (he nui te mate o te toto ki roto i te pute pericardial ka pa te hemopericardium me te tamponade).
• Te aukati i te mate: HIV, te rongoa mate pukupuku kaha, te hunga tango i te okana, me nga raau taero mate mate mau tonu.
• Te mamae o naianei: Te wharanga o te uma kua tukitukia ranei, he pokanga ngakau o tata nei ranei, ka whakakorehia te catheter.

Te maimoatanga tino o te pericarditis whakapeka kore uaua: Colchicine + NSAIDs me te Rahui Mahi.¶

Ina whakatauhia e te arotakenga o te hōhipera he uaua whakapeka idiopathic/viral pericarditis (karekau he STEMI, he troponin noa, kahore he tamponade, kahore he tohu morearea nui), ka whai te maimoatanga i te kawa hauora 3-pou hei whakatau i te mumura me te aukati i te ** Pericarditis Recurrent** (e pa ana ki te 15% ki te 30% o nga turoro e rongoa ana me nga NSAID anake):

1. Pilla 1 - Hauora Whakatau-a-Taarua (Colchicine + High-Dose Aspirin or NSAID):
2. Colchicine (Ko te Taapiri Huri-Keemu): Te taapiri i te horopeta iti te taumaha kua whakaritea Colchicine (0.5 mg once daily mo nga turoro < 70 kg, ranei 0.5 mg twice daily mo nga turoro >= 70 kg) mo te katoa 3 marama ki runga ake o te NSAID ka tapahia te morearea o te pericarditis auau ki te haurua (whakamatautau COPE me ICAP).
3. High-Dose Aspirin or Ibuprofen (me te Tiaki Pupu): Ka honoa ki te Ibuprofen (600 mg i ia 8 haora) ranei Aspirin (750 ki te 1,000 mg ia 8 haora) mo te 1 ki te 2 wiki, ka ** ka whakaheke haere i roto i te 3 ki te 4 wiki** i muri noa i te taunga o nga tohu me te C-Reactive kua hoki mai ano ki te C-Reactive. (Tuhipoka: Ko nga turoro katoa e mau ana i te aspirini horopeta nui/NSAIDs ka tohua he Proton Pump Inhibitor [PPI] penei i te omeprazole, pantoprazole ranei hei tiaki i te puku mai i nga whewhe).
4. He rereke mo te Pericarditis I muri i te Whakamate-Ngakau: Mena ka puta te pericarditis i muri tonu i te mate o te ngakau, ka whakamahia te Aspirin + Colchicine; Ko nga NSAID kore-aspirin (ibuprofen, indomethacin) ka tino karohia na te mea ka pakaru te whakaora o te pakitara o te ngakau infarcted.
5. Pilla 2 - He aha i karohia ai te Corticosteroids (Prednisone) hei Raina Raina Tuatahi:
6. Ahakoa ka whakamutua e te prednisone te mamae o te uma pericarditis i roto i nga haora, ka whakamatauhia e nga whakamatautau haumanu ko ** ka whakatairangahia e te corticosteroids te tukuruatanga viral me te neke atu i te rua o te tere o te mate ma'i, te hokinga mai o te pericarditis hou** i nga wa katoa ka whakahekehia te steroid. Corticosteroids (i nga pota iti, 0.2 to 0.5 mg/kg/day prednisone) kua rahuitia mo nga turoro me te aukati pono ki nga NSAID (penei i te ngoikore o te whatukuhu, te haputanga i muri i te 20 wiki, te mura o te lupus autoimmune kaha).
7. Pilla 3 - Mandatory Extension & Sports Restrictions:
8. Ko nga turoro katoa e mate ana i te mate pericarditis me me tino karo i nga taakaro whakataetae me nga mahi whakakori tinana kaha kia mutu ra ano nga tohu me te CRP, ECG, me te echocardiogram kua rite noa (he iti rawa o 4 wiki ki te 3 marama mo te hunga kore-kaitakaro/kaitakaro me te pericarditis parakore, me 3 ki te 6 marama mena kua piki te troponin e tohu ana myopericarditis).

Nga nama ohorere a rohe me nga tikanga umanga¶

Ko te mamae mamae o te uma ka hiahia wawe ki te aromatawai hauora ohorere me te ECG 12-arahi i roto i te 10 meneti i te taenga mai:

• Te Hononga o Amerika me Kanata: Waea 911. Ka whakahaerehia i raro i te American Heart Association (AHA) / American College of Cardiology (ACC) Acute Chest Pain Guidelines, e whakahau ana kia 12-arahi te tango ECG i roto i te 10 meneti, te whakamatautau troponin ngakau-nui, me te ultrasound cardiac point-of-care ki te whakakore i te STEMI, te wehenga aortic, te pulmonary cardiac.
• United Kingdom: Waea 999 mo te waka tūroro ohorere, haere tonu ranei ki A&E. Whakahaerehia i raro i te NICE Te mamae o te Uma o nga Aratohu Whakaoho Hou (CG95) me ESC Pericardial Disease Guidelines.
• Uniana Pakeha: Waea 112. Ka whakahaerehia tika e te European Society of Cardiology (ESC) Guidelines for the Diagnosis and Management of Pericardial Diseases.
• Ahitereiria me Aotearoa: Waea 000 i Ahitereiria, 111 ranei i Aotearoa. Whakahaerehia i raro i National Heart Foundation of Australia / CSANZ Acute Coronary Syndrome and Pericarditis Guidelines.
• India me Ahia-Kiwa: Waea 112 (ranei 108 i Inia), 995 i Singapore, 119 i Hapani me Korea ki te Tonga, 999 ranei i Malaysia me Hong Kong.

Pātai auau¶

Me pehea e mohio ai ahau he pericarditis whakapeka toku mamae ngakau, he mate ngakau ranei (STEMI)?¶

Ahakoa me waea tonu koe ki nga ratonga whawhati tata mo te ECG 12-arahi me te whakamatautau toto troponin kia mohio ai, ko te pericarditis whakapeka te nuinga o te mamae o te uma pleuritic e werohia ana, ka tino kino atu ina takoto koe i to tuara, ka hoha, ka maremare ranei, ka pai ake te ahua ina noho tika koe ka anga whakamua, ka toro atu ki te hiwi o runga (trapezius o to hiwi). Ko te mate o te ngakau STEMI te nuinga o te wa ka paheke, ka kuru, ka pehia te pehanga puta noa i te uma karekau e huri i te wa e noho ana koe, ka anga whakamua, ka manawa ranei, me te werawera makariri, te nausea, me te mamae ka puta ki roto i te kauae, i roto ranei i te ringa maui.

He pehea te korero a te taote ruuma whawhati tata ki a Pericarditis i tua atu i te STEMI i runga i te ECG?¶

I runga i te ECG 12-arahi, ma te whakaeke ngakau STEMI ka piki ake te ahua o te waahanga ST-ahua (convex) ki nga arataki motuhake o tetahi arai coronary kua aukatia (pēnei i te pakitara raro, te pakitara o mua ranei) me te paheketanga o te wahanga ST tauutuutu hohonu i nga arataki. Ko te pericarditis whakapeka ka piki whakarunga ("ahua-kanohi" concave) Ko te teiteitanga o te ST-waahanga ka horahia puta noa i te tata ki nga mata katoa (nga rohe o mua me raro i te wa kotahi) karekau he paheketanga ST tauutuutu (haunga i te Lead aVR), me te paheketanga o te wahanga PR matarohia me te raina tohu TP heke.

He aha te mea kino ki te tango i te ibuprofen i te kainga i mua i te whakatau a te taote ki te mate ngakau?¶

Mena ko te mamae o te uma i puta mai i te mate o te ngakau (myocardial infarction) kaua ko te pericarditis ngawari, ko te tango i nga raau taero anti-inflammatory kore-steroidal (NSAIDs) penei i te ibuprofen, naproxen, indomethacin ranei ka whakararu i te whakatikatika toto ma me te hanga nawe collagen i roto i te uaua ngakau mate. Ma tenei ka ngoikore te pakitara ventricular infarcted me te tino whakanui ake i te tupono o te pakaru o te myocardial pakitara kore-kore, te recurrent infarction, me te mate.

He aha te tokotoru a Beck, me pehea e mohio ai ahau kei te huri te pericarditis ki te Cardiac Tamponade?¶

Ka puta te tamponade cardiac i te wa ka whakakiia e te wai mumura, te toto ranei te pute pericardial inelastic ki te katia nga ruma o te ngakau. E toru nga tohu matarohia o Beck's triad: te whakaheke toto (te whakaheke toto), te pupuhi o nga uaua kaki i te wa e noho tika ana (te toronga o te jugular venous), me te ngongo o te ngakau o tawhiti. Kaua rawa koe e tatari mo nga tohu e toru: waea atu ki nga ratonga whawhati tata mena ka kaha ake te manawa o te tangata e mate ana i te pericarditis, he tere o te ngakau okiokinga neke atu i te 100 pao i ia meneti, he mangere, he waahi iti i waenga i o ratou nama o runga me raro o te toto, he paheketanga ranei e ngoikore ana i te wa e ngotea ana (pulsus paradoxus).

He aha nga taote i tohu ai i te Colchicine (he rongoa kauti) mo te mate pericarditis?¶

Ko te Colchicine ka aro ki roto i nga ruma toto ma (neutrophils) ka aukati i te huihuinga microtubule me te mumura NLRP3 e peia ai te mumura pericardial. Ko nga whakamatautau haumanu rongonui (penei i nga whakamatautau COPE me te ICAP) i whakaatu ko te tango i te colchicine iti-iti mo te 3 marama ki te taha o te aspirini, te ibuprofen ranei, ka whakaitihia te mate o te pericarditis auau i te haurua (mai i te 30 paiheneti ki raro iho i te 15 paiheneti) me te tere ake te whakatau i nga tohu.

He aha ahau ka mutu ai te whakakorikori tinana, te takaro hakinakina ranei i muri i taku kitenga he pericarditis?¶

Ko te whakapau kaha o te tinana ka piki ake te tere o te ngakau me te tohanga toto, ka piki ake te ahotea kutikuti miihini me te waku i waenga i nga paparanga pericardial mumura, tae atu ki te 15 ki te 30 paiheneti o nga turoro pericarditis he mumura o raro o te uaua ngakau o raro (myopericarditis). Ko te korikori i te wa e mumura ana te uaua o te ngakau, te uaua ranei, ka pa mai te arrhythmias ventricular ora me te hopukina ohorere. Ka whakahaua e nga aratohu te aukati katoa mai i nga mahi totika tae noa ki nga tohu katoa, nga tohu mumura toto (CRP), nga huringa ECG, me nga kitenga echocardiogram kua hoki katoa ki te tikanga (i te iti rawa ki te 1 ki te 3 marama, ki te 3 ki te 6 marama ranei mena kua piki te troponin).

Nga puna me nga aratohu whai mana¶

• European Society of Cardiology (ESC, Europe): ESC Guidelines for the Diagnosis and Management of Pericardial Diseases (Adler Y et al., European Heart Journal, Paearu tātaritanga, tohu tohu whakauru morearea nui, colchicine dosing, me te aukati mahi).
• American Heart Association (AHA) & American College of Cardiology (ACC, United States): *2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Aratohu mo te Aromātai me te Whakamatau i te mamae o te uma * me te * AHA/ACC Tauākī Pūtaiao mo Myocarditis me Pericarditis *.
• Imazio M et al. (New England Journal of Medicine & Circulation): He Whakamātautau Randomized of Colchicine for Acute Pericarditis (ICAP & COPE Trials).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Te mamae o te uma o te timatanga o tata nei: Aromatawai me te Tohu (CG95).
• Kaunihera Whakaora UK & International Federation of Red Cross and Red Crescent Societies (IFRC): Whakatairanga ohorere o te mamae o te uma me te obstructive shock (cardiac tamponade).

Nga kaiarahi e pa ana¶

• Te aro ki te whakaeke ngakau me te awhina tuatahi
• Te pupuhi o te pericardial, te pulsus paradoxus, me te tamponade hauora
• Pericarditis, myocarditis, me nga haki whero o te mamae o te uma i muri i te huaketo
• Ko te tamponade o te ngakau me te whakamatautau i te mamae o te uma
• Te wehenga aortic me te ruptured aneurysm aortic abdominal