Acute Myocarditis, Pericarditis, ndi Positional Chest Pain Triage¶

Kupweteka kwakuthwa, kubaya pakati chakumanzere chakumanzere komwe kumakula kwambiri mukagona chagada kapena kupuma mozama komanso kumva bwino mukakhala tsonga ndikuyang'ana kutsogolo **, makamaka patatha masiku kapena milungu ingapo mutadwala matenda obwera chifukwa cha kupuma, chimfine, m'mimba (gastroenteritis), kapena mRNA/katemera wa virus, ndiye chizindikiro cha **** red pericarditis mtima) kapena myopericarditis (kutupa kophatikizana kwa thumba la mtima ndi minofu ya mtima yokha). Ngakhale kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda nthawi zambiri timayankha mofulumira ku mankhwala oletsa kutupa, ** acute acute myocarditis ** (kutupa kwa khoma la minofu ya mtima, ** myocardium **) ndi chimodzi mwa zifukwa zomwe zimayambitsa ** kumangidwa kwadzidzidzi kwa mtima kwa achinyamata, ana, ndi othamanga **, omwe amatha kuyambitsa imfa ya ventricular ventricular * ventricular fibrillation *, kutsekeka kwa mtima thunthu, kapena kugwedezeka kofulumira kwa cardiogenic (**fulminant myocarditis **). Kuonjezera apo, madzimadzi omwe amawunjikana molumira mkati m thumba la pericardial lopsa amatha kutseketsa zipinda zamtima (tamponade ya mtima). Kuwunika kwadzidzidzi (12-lead ECG, high-sensitivity cardiac troponin blood test, ndi echocardiography), yoyenera **kukhala-patsogolo malo **, kupewa aspirin / NSAIDs ngati myocarditis akukayikira dokotala asanayesedwe, ndi ** kuletsa 100 peresenti yoletsa masewera olimbitsa thupi ** kupulumutsa miyoyo.

Chitani izi tsopano¶

1. Ikani zolimbitsa thupi nthawi yomweyo ndipo mukhazikitseni munthuyo mowongoka, ndikutsamira patsogolo pang'ono (\(30\text{ mpaka }45\text{degree}\) patsogolo pa pilo patebulo kapena maondo).
2. Chifukwa chiyani kutsamira kutsogolo kumachepetsa ululu wa pericardial: Munthu akagona chagada chagada (chogona), mphamvu yokoka imakokera mtima kumbuyo ndi kutambasula chotupa chotupa cha parietal pericardium motsutsana ndi diaphragm ndi pleura, kumayambitsa kupweteka kobaya ndi kugunda kwa mtima kulikonse ndi kupuma. Kukhala mowongoka ndi kutsamira kutsogolo (malo atatu/pilo-kukumbatirani) kumakokera mtima patsogolo pang'ono kuchoka ku posterior lung pleura ndi posterior mediastinum, kuchepetsa kukangana kwa makina nthawi yomweyo.
3. Chifukwa chiyani kuchita masewera olimbitsa thupi kumapulumutsa moyo: Ngati minofu ya mtima pawokha yatupa (myocarditis), adrenaline (catecholamines) yotulutsidwa pokwera masitepe, kunyamula zakudya, kapena kuchita masewera olimbitsa thupi kumayambitsa magesi akupha (ventricular fibrillation) mu minyewa yamtima yotupa.
4. Chitani 60-Sekondi ya "Myocarditis & Cardiac Tamponade Red Flag Screen" ndikuyimba 911/112/999 nthawi yomweyo:
5. Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, kapena onani zonse manambala angozi.
6. Mbendera Zofiira za Myocarditis (Kutupa kwa Minofu Yamtima): Kupweteka pachifuwa kapena kuthina komwe kumaphatikizidwa ndi **kupuma mosadziwika bwino mukapuma kapena poyenda m'chipinda , kulephera kugona mosapumira (orthopnea), kugunda kwa mtima wopumula molingana ndi kutentha thupi (sinus tachycardia{>01001{2} bpm}$), kugunda kwamphavu/kudpha kugunda , chizungulire/kukomoka, kapena **kutopa kwambiri ngati chimfine, kusanza, ndkupweteka m'mimba (makamaka mwa ana).
7. Mbendera Zofiira za Cardiac Tamponade (Chidziŵitso Chophwanya Mtima): Kupuma kofulumira kwambiri, kutupa kwa mitsempha ya m'khosi (jugular venous distension) mutakhala mowongoka, kumutu mukupumira mozama (pulsus paradoxus), ndi kugunda kofooka, kofulumira.
8. OSATI mwachimbulimbuli kumwa mankhwala a Ibuprofen, Naproxen, kapena Aspirin Asanayezetse magazi a troponin m'chipinda chadzidzidzi ngati muli ndi Pericarditis kapena Myocarditis.
9. Kusiyanitsa Kwambiri Kwachipatala: Ngakhale kuti ma NSAID apamwamba (monga ibuprofen kapena aspirin) kuphatikizapo colchicine ndi chithandizo chachipatala choyamba cha ** pericarditis yosadziwika bwino ** (pamene kuyesa kwa mtima wa troponin ndi 100% yachibadwa), NSAIDs amatsutsana kapena amaletsedwa muvuto lalikulu la viral ndi minofu ya mtima wakwezeka). Maphunziro a Cardiology (European Society of Cardiology [ESC] ndi American Heart Association [AHA]) amasonyeza kuti kutenga NSAIDs panthawi yogwira ntchito ya myocarditis ya viral kusokoneza machiritso a myocardial, kumawonjezera mavairasi mu minofu ya mtima, ndikuwonjezera kulephera kwa mtima. Dikirani mpaka madotolo azadzidzidzi ayese kuyezetsa mtima kwa troponin (kapena perekani \(325\mawu amodzi{mg}\)matafunidwa aspirin pokha ngati mukudwala kwambiri matenda a mtima amaganiziridwa kwambiri ndi otumiza mwadzidzidzi mwa munthu wachikulire).
10. Fufuzani Zomwe Zaposachedwa za Viral, Autoimmune, kapena Zoyambitsa Mankhwala (Masabata 1 mpaka 4 Asanachitike) ndikulembera dokotala wa ER:
11. Kodi wodwalayo anali ndi chimfine, zilonda zapakhosi, COVID-19, fuluwenza, matenda a manja ndi phazi (Coxsackievirus B), kapena chimfine cha m'mimba (m'mimba/kusanza) m'masabata 1 mpaka 4 apitawa?
12. Kodi wodwala posachedwapa adalandira ** Katemera ** (makamaka mkati mwa 1 kwa masiku 7 apitawo kwa achinyamata kapena amuna achikulire) kapena kuyamba **cancer immunotherapy (immune checkpoint inhibitor monga pembrolizumab kapena nivolumab) ** kapena mankhwala amisala (**clozapine **)?
13. Kodi wodwalayo ali ndi vuto la impso (**uremia **), lupus, nyamakazi ya nyamakazi, kapena opaleshoni yaposachedwa ya mtima / matenda a mtima (**Dressler syndrome **)?
14. Sungani Automated External Defibrillator (AED) pafupi ngati ilipo ndikukonzekera CPR ngati wodwalayo akomoka kapena kugunda kwa mtima. Chifukwa chakuti myocarditis yoopsa ingayambitse kugunda kwa mtima mwadzidzidzi popanda chenjezo, musalole wodwala amene akuganiziridwa kuti ndi myocarditis adziyendetsa yekha ku chipatala kapena kuyenda mosathandizidwa kupita ku galimoto.

Kupweteka pachifuwa, pericarditis, ndi mtengo wa chisankho cha myocarditis¶

Gwiritsani ntchito tchati chachipatalachi kuti muwone kupweteka pachifuwa komwe kuli komanso zizindikiro zamtima pambuyo pa ma virus nthawi yomweyo.

flowchart TD
    Start["Kupweteka Kwambiri pachifuwa, Kupanikizika, Kapena Kupuma pang'onopang'ono<br/>(makamaka ndi Kusintha Kwamalo Kapena Pambuyo pa Matenda a Viral)"] --> RedFlags{"Yang'anani Mbendera Zofiira Zomwe Zili Pachiwopsezo:<br/>- Kukomoka (syncope) kapena chizungulire kwambiri<br/>- Kupuma pang'ono popuma kapena orthopnea <br/>- Kuthamanga / kugunda kwapang'onopang'ono kapena kugunda <br/>- Kuphulika kwa mitsempha ya pakhosi, thukuta lozizira, kapena kupweteka kwapweteka"}

    RedFlags -->|"INDE (Mbendera Iliyonse Yofiira Ikupezeka)"| Call911["911 / 112 / 999 ZOCHITIKA ZONSE:<br/>1. Suspect Fulminant Myocarditis, Tamponade, STEMI, kapena PE<br/>2. Khalani pansi choongoka chotsamira patsogolo pang'ono; ZERO kuyenda<br/>3. OSATI kupatsa Ibuprofen/NSAIDs (zowopsa mu myocarditis)<br/>4. Sungani AED / CPR okonzeka mpaka azachipatala afika"]

    RedFlags -->|"PALIBE Kusakhazikika kwa Hemodynamic Komabe"| PainPattern{"Unikani Khalidwe lenileni la Ululu <br/>ndi Makhalidwe Abwino"}

    PainPattern -->|"ZOCHITIKA, PLEURITIC & POSITIONAL:<br/>- Kugona moyipirapo chakumbuyo (chapamwamba) & kudzoza kwambiri<br/>- Kumatsitsimutsidwa pokhala ndi kutsamira kutsogolo<br/>- Nthawi zambiri kumawonekera kumanzere kwa trapezius ridge (pamwamba pamapewa)"| PeriMyo["KUGANIZIRA PERICARDITIS KAPENA MYOPERICARDITIS:<br/>1. Patsiku Limodzi-modzi Kuwunika kwa Zadzidzidzi Kufunika <br/>2. Imafunika 12-Lead ECG (kufalitsa ST elevation + PR depression),<br/> High-Sensitivity Cardiac Troponin, CRP/ESR, & Echocardiogram"]

    PeriMyo --> TropSplit{"Kodi Chipatala cha Troponin<br/>& Echocardiogram Chimawonetsa Chiyani?"}

    TropSplit -->|"Troponin NORMAL + Normal Kupopera:<br/>PURE ACUTE PERICARDITIS"| PurePeri["CHIPATALA / CARDIOLOGY PERICARDITIS PROTOCOL:<br/>1. Mlingo wambiri wa NSAID/Aspirin taper + Colchicine (miyezi 3)<br/>2. Ngati kutulutsa kwakukulu / tamponade -> Pericardiocentesis<br/>3. Zoletsa zolimbitsa thupi mpaka CRP & ECG zitakhazikika"]

    TropSplit -->|"Troponin ELEVATED or Wall Motion / Rhythm Abnormal:<br/>ACUTE MYOCARDITIS / MYOPERICARDITIS"| MyoProtocol["NTCHITO YOGWIRITSA NTCHITO YA CHIPATALA CHA MYOCARDITIS:<br/>1. Kuwunika kwa telemetry kwa odwala arrhythmias/heart block <br/>2. PEWANI NSAIDs ngati makamaka kutupa kwa myocardial <br/>3. Cardiac MRI + Yokhwima 3 kwa Mwezi wa 6 Kuletsa kwa Masewera Onse / Zolimbitsa Thupi"]

    PainPattern -->|"KUPANIZIDWA KWAMBIRI / KUSINTHA:<br/>- Osasintha potsamira patsogolo<br/>- Imatuluka nsagwada, khosi, kapena mkati mwa mkono wakumanzere"| ACS["SUSPECT ACUTE CORONARY SYNDROME (HEART ATACK)<br/>OR PREDOMINANT MYOCARDITIS:<br/>Imbani 911 / 112 / 999 Pompo"]

Anatomy & Pathophysiology: Pericardium vs. Myocardium¶

Kuti mumvetse chifukwa chake pericarditis ndi myocarditis zimayambitsa zoopsa zosiyanasiyana ndipo zimafuna malamulo otsutsana ndi mankhwala, yang'anani zigawo zitatu za khoma la mtima wa munthu:

1. ** Pericardium (The Outer-Layered Sac, Yokhudzidwa ndi Pericarditis):**
2. Mtima umakhala mkati mwa thumba lakunja lolimba la fibrous (fibrous pericardium) lokhala ndi membrane yosalala, yonyowa yamkati iwiri (** the visceral and parietal serous pericardium **).
3. Nthawi zambiri, mpata wa pericardial pakati pa nembanemba ziwirizi umakhala \(15\text{ to }50\text{milliliters}\) (\(1\text{ to }3\text{ tablespoons}\)) yamadzimadzi oterera kotero kuti mtima umagunda mopanda kugunda.
4. Mu Acute Pericarditis, kutupa kwa ma virus, autoimmune, kapena pambuyo povulala kumapangitsa zigawo ziwiri za pericardial kukhala zolimba, zotupa, komanso zomata ngati zidutswa ziwiri za sandpaper zolimba zomwe zimapaka pamodzi ndi kugunda kwa mtima kulikonse (**pericardial friction rub **).
5. ** Chifukwa chiyani ululu umatuluka makamaka pamwamba pa phewa lakumanzere ( Trapezius Ridge ): ** Pakati pa pericardium ndi diaphragm ndizosavomerezeka ndi ** Phrenic Nerve **, yomwe imachokera ku mizu ya mitsempha ya msana ** C3, C4, ndi C5 ** pakhosi. Chifukwa ** Mitsempha ya Supraclavicular ** yomwe imapereka kumverera kwa khungu pamwamba pa ** pamwamba pa phewa (trapezius minofu) ** imakhalanso kuchokera ku ** C3 ndi C4 **, ubongo umatanthauzira kupweteka kwa pericardial monga kupweteka kwakuthwa motsatira ** trapezius ridge **. *(Ngale yachipatala: Kupweteka kwa mtima kumachokera ku mkono wamkati wakumanzere / biceps [T1-T4] kapena nsagwada, pamene * uulu wotuluka pamwamba pa trapezius paphewa ndi wapadera kwambiri kwa pericarditis *.)
6. Myocardium (The Thick Muscular Pumping Wall, Yokhudzidwa ndi Myocarditis):
7. Pansi pa thumba laling'ono la pericardial sac pali khoma lamphamvu lamanzere ndi lamanja la ventricles (** myocardium ), yomwe imakhalanso ndi makina opangira magetsi a mtima ( His-Purkinje conduction fibers **).
8. Chosangalatsa ndichakuti, minofu yamtima palokha ilibe zolandilira zowawa za "kuthwa / malo", pomwe ** Myocarditis ** imachitika (kuchokera ku kachilombo koyambitsa matenda a Coxsackievirus B, Adenovirus, Parvovirus B19, Influenza, SARS-CoV-2, kapena kuwonongeka kwa autoimmune, kuchititsa chitetezo cha mthupi) ndi patchy cell necrosis **.
9. Izi zimapanga **zosawoneka bwino, zolemetsa, zolimba ngati chifuwa chamtima ** (kapena osapweteka pachifuwa nkomwe.), **kutulutsa mapuloteni amtima a troponin m'magazi , kufooketsa kupopa kwa mtima (acute systolic heart failure / cardiogenic shock), ndikupanga zipsera zamagetsi zokwiyitsa zomwe zimayambitsa kutulutsa kwadzidzidzi, tarichycardia yathunthu, AV. moyo.
10. Myopericarditis ndi Perimyocarditis (Pamene Zigawo Zonse Zili Zotupa):
11. Chifukwa mkati mwa visceral pericardium imakhala pamwamba pa minofu yakunja ya mtima, kutupa nthawi zambiri kumadutsa malire:
12. Myopericarditis: Makamaka pericarditis (kupweteka kwakuthwa kwapamalo) ndi kutupa pang'ono kwa spillover mu minofu yapamtima (kuyambitsa **kuyesa kwa mtima wabwino wa troponin **, kuphulika kwabwino kwa mtima kupopa ntchito pa echocardiogram).
13. Perimyocarditis: Myocarditis yoopsa kwambiri (kukwezeka kwa troponin kuphatikizanso kufooka kwa mtima kupopa / kusuntha kwa khoma pa echocardiogram) kutsagana ndi kupweteka kwa pericardial.

Kuyerekeza kwathunthu: Pericarditis vs. Myocarditis vs. Heart Attack (STEMI) vs. Pulmonary Embolism¶

Chifukwa zinthu zinayi zonsezi zimabweretsa odwala ku dipatimenti yodzidzimutsa omwe ali ndi ululu pachifuwa chachikulu, gwiritsani ntchito tebulo ili lofananizira kuti mumvetsetse momwe madokotala amawalekanitsira:

Special Lifesaving Focus: How to Spot Fulminant Myocarditis in Children, Young Adults, and Athletes¶

Why Myocarditis is frequently misdiagnosed as "Stomach Flu," "Asthma," or "Anxiety"¶

In children, teenagers, and young adults under age 40, acute myocarditis is one of the most dangerous diagnostic traps in medicine because young patients rarely walk in saying, "I have classic cardiac pain." Instead, watch for these 4 Deceptive Presentations of Myocarditis:

1. The "Gastrointestinal / Stomach Flu" Mask (Especially in Children & Teens):
2. Over 50 percent of pediatric acute myocarditis cases present initially with abdominal pain, nausea, recurrent vomiting, poor appetite, and profound fatigue/lethargy rather than chest pain.
3. Why does heart inflammation cause stomach pain and vomiting? When the inflamed left and right ventricles weaken rapidly, blood backs up directly into the liver (acute hepatic congestion, stretching the liver capsule) while low forward blood flow starves the gut (mesenteric ischemia).
4. How to tell myocarditis apart from a simple stomach bug: Check the child's resting heart rate and breathing. In a normal stomach bug, a child's heart rate comes down once they receive fluids and fever reducer. In myocarditis, the child has persistent resting tachycardia (\(>120\text{ to }160\text{ beats per minute}\) even when afebrile and resting), fast shallow breathing (tachypnea) without wheezing, cool/pale hands and feet, and extreme exhaustion where they can barely sit up or walk to the bathroom.
5. The "New Asthma / Bronchitis" Mask:
6. A young adult recovering from a viral cold suddenly develops a dry hacking cough, wheezing, and severe shortness of breath when lying down flat at night (orthopnea and paroxysmal nocturnal dyspnea). Urgent care clinics sometimes prescribe an albuterol inhaler for "post-viral bronchitis," when the lungs are actually filling with fluid (acute cardiogenic pulmonary edema) from myocarditis. (Note: Beta-agonist inhalers like albuterol speed up the heart and can trigger dangerous arrhythmias in myocarditis.)
7. The "Arrhythmia / Syncope" Presentation:
8. Sudden unexplained kukomoka (syncope), near-fainting during mild activity, or sudden pounding/skipping heartbeats. In rare severe variants like Giant Cell Myocarditis or Cardiac Sarcoidosis, the first symptom is sudden complete atrioventricular (AV) heart block (pulse dropping below \(35\text{ bpm}\)) or sustained ventricular tachycardia.
9. Post-Vaccination or Immune-Checkpoint Inhibitor Myopericarditis:
10. Post-mRNA COVID-19 or Smallpox Vaccination Myopericarditis: Occurs predominantly in adolescent and young adult males (aged 12 to 29) within 1 to 7 days (peak Days 2 to 4) after the second dose. It typically presents with acute chest pain, shortness of breath, or palpitations, elevated troponin, and diffuse ECG changes. While the vast majority (>95%) of post-vaccine cases are mild and resolve rapidly with hospital monitoring, every case requires immediate emergency room ECG, troponin, and echocardiogram evaluation plus a temporary sports ban.
11. Cancer Immunotherapy (Immune Checkpoint Inhibitor [ICI]) Myocarditis: Patients receiving PD-1, PD-L1, or CTLA-4 antibodies (such as pembrolizumab, nivolumab, atezolizumab, or ipilimumab) for cancer who develop chest pain, shortness of breath, drooping eyelids (ptosis / diplopia), or muscle weakness within the first 1 to 3 months of treatment face ICI-associated myocarditis, which has a 30 to 50 percent mortality rate unless treated immediately in the hospital with high-dose intravenous methylprednisolone (\(1,000\text{ mg}\) IV/day).

Complication Alert: Progression from Pericarditis to Cardiac Tamponade¶

Whenever the pericardial sac is inflamed, it can leak excess fluid (pericardial effusion) into the closed space around the heart. - If fluid accumulates slowly over months, the fibrous sac stretches gradually to hold up to \(1\text{ liter}\) (\(33\text{ fluid ounces}\)) without crushing the heart. - However, in acute viral, bacterial (purulent), autoimmune, post-surgical, or malignant pericarditis, if just \(150\text{ to }250\text{ milliliters}\) (\(5\text{ to }8\text{ fluid ounces}\)) of fluid pours into the stiff, unstretched pericardial sac over hours or days, intrapericardial pressure exceeds the filling pressure of the right atrium and right ventricle. - The heart chambers collapse inward during relaxation (diastole) so the heart can no longer fill with blood: Acute Cardiac Tamponade.

Watch every pericarditis patient for the 4 Warning Signs of Cardiac Tamponade: - [ ] Paradoxical disappearance of the sharp chest pain paired with rapidly WORSENING shortness of breath: Why? As fluid fills the sac, it pushes the two rough sandpaper layers of the pericardium apart so they stop rubbing (stopping the sharp pain), while the fluid simultaneously crushes the heart. - [ ] Distended neck veins (Jugular Venous Distension [JVD]): The veins on the side of the neck bulge out visibly even when the person is sitting straight up at \(45\text{ to }90\text{ degrees}\). - [ ] Dizziness or pulse weakening every time the person takes a deep breath in (Pulsus Paradoxus): When inhaling deeply, blood pressure drops by more than \(10\text{ mmHg}\) because the swollen right ventricle bulges across the septum and crushes the left ventricle inside the tight fluid-filled sac. - [ ] Restlessness, confusion, pale/clammy skin, and falling blood pressure (Beck's Triad).

Understanding the 4 ECG Stages of Acute Pericarditis vs. STEMI¶

When paramedics or emergency room clinicians hook a patient with chest pain up to a 12-lead electrocardiogram (ECG), distinguishing Stage 1 Acute Pericarditis from an acute ST-Elevation Myocardial Infarction (STEMI / Heart Attack) is critical because giving intravenous clot-busting drugs (thrombolytics) or high-dose blood thinners to a patient with acute pericarditis can cause fatal hemorrhagic cardiac tamponade (bleeding into the pericardial sac):

Mitundu Yapadera ya Pericarditis: Uremic, Purulent, ndi Dressler Syndrome¶

1. Post-Cardiac Injury Syndrome (Dressler Syndrome): Imachitika 1 kwa masabata a 6 pambuyo pa vuto la mtima (myocardial infarction), opaleshoni yotsegula mtima, kuika pacemaker lead, kapena ablation ya mtima, pamene chitetezo chamthupi chimayambitsa kuchedwa kwa autoimmune motsutsana ndi mapuloteni a pericardial otulutsidwa panthawi ya kuvulala koyambirira. Amakhala ndi ululu wam'chifuwa wa pleuritic, malungo, ndi pleural/pericardial effusions.
2. Uremic Pericarditis (Impso Kulephera Mwadzidzidzi): Odwala omwe ali ndi matenda aakulu a impso kapena ma dialysis omwe anaphonya magawo, poizoni wochuluka wa nayitrogeni amayaka pericardium, zomwe zimapangitsa kuti "mkate-ndi-batala" utuluke. *(Zindikirani: Uremic pericarditis nthawi zambiri imakhala yopanda mawonekedwe apamwamba a ST pa ECG ndipo ndi chizindikiro cha *kutulutsa magazi mwachangu ** popanda heparin kuteteza tamponade yotaya magazi.)
3. Purulent (Bacterial) Pericarditis: Kutentha thupi kwambiri (\(>39^\circ\text{C}\) [\(102.2^\circ\text{F}\)]), kuuma, ndi maonekedwe apoizoni mwa wodwala chibayo, empyema, opareshoni pachifuwa, kapena sepsis amafuna kutulutsa maantibayotiki obwera mwadzidzidzi.

Chithandizo Chachipatala & Chifukwa Chake "Kuletsa Masewera kwa Miyezi 3 mpaka 6" Kupulumutsa Miyoyo¶

1. Momwe Zipatala Zimachitira ndi Acute Uncomplicated Pericarditis (ESC Guidelines)¶

Madokotala azadzidzidzi akatsimikizira ** pure acute pericarditis ** (troponin wamba, palibe myocarditis, palibe tamponade, komanso palibe chifukwa cha bakiteriya / TB): - Mapiritsi Awiri Oletsa Kutupa: Mlingo wapamwamba Ibuprofen (\(600\text{mpaka }800\text{mg}\)maola 8 aliwonse) kapena Aspirin (\(750\text{mpaka }1,000\text{mg}\)maola 8 aliwonse) yophatikizidwa ndi pump-protecting inhibido protagonist (\(0.5\text{mg}\) kamodzi kapena kawiri tsiku lililonse kwa miyezi itatu yathunthu)**. (Chifukwa chiyani Colchicine ndi yofunikira: Mayesero odziwika bwino achipatala [mayesero a COPE ndi ICAP] atsimikizira kuti kuwonjezera miyezi itatu ya colchicine kumachepetsa chiopsezo cha pericarditis yopweteka kwambiri pakati, kuchoka pa 37% kutsika kufika pa 16%.) - Chifukwa chiyani Oral Corticosteroids (Prednisone) Amapewedwa Mzere Woyamba mu Viral Pericarditis: Kupereka oral prednisone kwa pericarditis wamba kumapangitsa kupweteka kuzimiririka mu maola 24, **koma kumayambitsa kubwereza kobwerezabwereza kamodzi kokha ** chifukwa ma steroid amalimbikitsa kulimbikira kwa ma virus. Corticosteroids amasungidwa kokha kwa autoimmune pericarditis, kulephera kwaimpso, mimba, kapena milandu yokana.

2. Chifukwa Chake Othamanga ndi Akuluakulu Okangalika AYENERA KUMVERA Zoletsa Kwambiri Zolimbitsa Thupi¶

Kaya ndinu wothamanga wampikisano, wachinyamata pamasewera a kusukulu, wolembedwa usilikali, kapena wongothamanga momasuka, malangizo apadziko lonse lapansi a zamtima (American Heart Association / American College of Cardiology [AHA/ACC] ndi European Society of Cardiology [ESC]) khazikitsani lamulo loletsa kuchita masewera olimbitsa thupi: kapena mperiitis khadi - Pambuyo pa Pure Acute Pericarditis: Kuletsedwa kwathunthu kumasewera ampikisano komanso kuchita masewera olimbitsa thupi molimbika (sungani kugunda kwa mtima kuchepera \(100\mawu{bpm}\) / kuyenda kopepuka kokha) mpaka **zizindikiro zonse zitathetsedwa NDI zolembera zotupa m'magazi (CRP/ESR), 12-lead ECG, ndi echocardiogram yabwerera ku miyezi 3000 mpaka 3000m*maperesenti yabwerera ku miyezi 3000) - After Acute Myocarditis (kapena Myopericarditis with Elevated Troponin): Malizani 100 peresenti yoletsa masewera onse ampikisano, kuthamanga, kunyamula katundu, ndi kuchita masewera olimbitsa thupi pang'onopang'ono kwa 3 mpaka 6 YAMYEZI YONSE. - Chifukwa chiyani kuchita masewera olimbitsa thupi panthawi yochira kumatha kupha: Ngakhale kupweteka pachifuwa kutha pakatha masiku atatu, tizigawo tating'ono tating'ono tating'onoting'ono ta edema ndi kuchira timabala timakhala mkati mwa minofu yamtima kwa masiku 90 mpaka 180. Kuchita masewera olimbitsa thupi adrenaline kungayambitse imfa ya ventricular fibrillation (kumangidwa mwadzidzidzi kwa mtima) pa bwalo la mpira kapena treadmill. Asanabwerere ku masewera olimbitsa thupi pa 3 kwa miyezi 6, katswiri wa zamtima ayenera kutsimikizira troponin yabwino, echocardiogram / MRI ya mtima wamtima, ** 24-to-48-hour Holter monitor yomwe ikuwonetsa zero oopsa arrhythmias **, ndi yachibadwa **kuyesa kwakukulu kolimbitsa thupi **.

Zolemba zenizeni za 911/112/999 ndi kuyeserera kuchipatala¶

Gwiritsani ntchito zolemba zomveka bwino zachipatala kuti otumiza mwadzidzidzi ndi anamwino achipatala nthawi yomweyo achite mayeso a 12-lead ECG ndi high-sensitivity troponin test:

• Pa Kupweteka Kwa Chifuwa (Pokayikira Pericarditis / Myopericarditis):

  "Ndili pachiwopsezo chadzidzidzi ndi wodwala wazaka [Zaka] yemwe amamva kupweteka pachifuwa chapakati chakumanzere komwe kumakulirakulira kwambiri akagona pansi kapena kupuma mozama komanso kumakhala bwino akakhala ndi kutsamira kutsogolo [kuphatikiza ululu wotuluka kumanzere kwa phewa la trapezius]. Wodwalayo anali ndi [matenda a virus / Katemera] [Nambala] yomwe simunapatsidwepo NSAID kapena sitinadziwebe masiku apitawo. 12-lead ECG, high-sensitivity cardiac troponin, ndi echocardiogram ya pambali pa bedi kuti athetse vuto la myocarditis ndi pericardial effusion."

• Kwa Oganiziridwa Kuti Acute Myocarditis (Post-Viral Shortness of Breath, Tachycardia, kapena Syncope):

  *"Ndikufuna ambulansi yadzidzidzi ku [Adilesi Yeniyeni]. Wodwalayo ndi [Wazaka] wazaka zakubadwa akuchira ku matenda a virus omwe tsopano ali ndi [kuthina pachifuwa / kupuma movutikira kwambiri akagona / kupuma mosadziwika bwino kugunda kwa mtima kwa ___ bpm / palpitations / kukomoka]. Timakayikira Acute Viral Myocarditis ndipo timafunikira dipatimenti yoyang'anira mwamsanga ndi chithandizo chadzidzidzi. "

Mafunso omwe amafunsidwa pafupipafupi¶

Chifukwa chiyani pericarditis yowopsa imapweteka kwambiri mukagona chagada, ndipo chifukwa chiyani kutsamira patsogolo kumapangitsa kuti mukhale bwino?¶

Mukagona chagada, mphamvu yokoka imakokera mtima kumbuyo ku msana ndikutambasula thumba lakunja lotupa la pericardial molimbana ndi diaphragm ndi mapapo (pleura), pomwe magazi ochulukirapo obwera kuchokera kumiyendo amakulitsa zipinda zamtima motsutsana ndi thumba laiwisi ndi kugunda kulikonse. Kukhala mowongoka ndi kutsamira patsogolo pa ngodya ya digirii 30 mpaka 45 kumapangitsa mtima kupita kutsogolo kuchoka ku posterior lung pleura ndikuchepetsa kutambasula kwa venous, nthawi yomweyo kumachepetsa ululu wakuthwa wakuthwa.

Chifukwa chiyani sindiyenera kumwa Ibuprofen (Advil/Motrin) nthawi yomweyo kunyumba ngati ndikuganiza kuti ndili ndi post-viral pericarditis?¶

Kuchokera kuzizindikiro zokha, ndizosatheka kudziwa ngati kutupa kumangokhala ku thumba lakunja (pure pericarditis) kapena kudalowanso minofu yamtima (myopericarditis kapena myocarditis). Ngakhale kuti ibuprofen ndi colchicine ndizomwe zimagwiritsidwa ntchito m'chipatala cha pericarditis yoyera, kutenga NSAIDs monga ibuprofen pamene minofu ya mtima ikuyaka kwambiri (myocarditis) yasonyezedwa mu maphunziro a cardiology kuti awononge machiritso a minofu ya mtima, kuonjezera kuwonongeka kwa mavairasi, ndi kuwonjezereka kwa mtima kulephera; nthawi zonse dikirani mpaka kuyezetsa magazi kuchipinda chadzidzidzi kutsimikizira kuti mtima wanu wa troponin ndi wabwinobwino.

Kodi ululu womwe umatuluka pamwamba pa phewa lakumanzere (trapezius ridge) umawonekera bwanji makamaka ku pericarditis m'malo mwa matenda a mtima?¶

Mphuno ya pericardial ndi diaphragm yapakati imayendetsedwa ndi mitsempha ya phrenic, yomwe imalowa mumtsempha wa msana pamagulu a khosi C3, C4, ndi C5, magawo enieni a msana omwe amalandira mitsempha yochokera pakhungu pamwamba pamphepete mwa phewa lanu (trapezius minofu). Chifukwa ubongo umasokoneza zizindikiro zomwe zikufika ku C3-C5, pericarditis imatumiza ululu wopweteka pamwamba pa phewa, pamene vuto la mtima limatumiza ululu kudzera m'mitsempha ya thoracic (T1-T4) pansi mkati mwa mkono kapena nsagwada.

Nchifukwa chiyani akatswiri amtima amaletsa masewera onse ndi masewera olimbitsa thupi kwa miyezi 3 mpaka 6 pambuyo pa myocarditis ngakhale mukumva kuti 100 peresenti kubwerera mwakale?¶

Ngakhale kupweteka pachifuwa ndi kutopa kwanu kutha pakangotha ​​sabata imodzi mutadwala myocarditis, tizigawo tating'ono ta kutupa ndi kuchiritsa zipsera mkati mwa minofu yamtima zimakhala zosakhazikika pamagetsi kwa miyezi itatu mpaka 6. Ngati mumathamanga, kukweza zolemera, kapena kusewera masewera opikisana pawindo la machiritso ili, kuthamanga kwa adrenaline ndi kutambasula kwa khoma la mtima kungayambitse kupha kwadzidzidzi kwafupipafupi kotchedwa ventricular fibrillation (kumangidwa mwadzidzidzi kwa mtima); kudikirira mpaka dokotala wamtima adzakuyeretsani ndi chowunikira cha Holter ndikuyesa kupsinjika kumateteza moyo wanu.

Magwero afufuzidwa¶

• European Society of Cardiology (ESC): ESC Guidelines for the Diagnosis and Management of Pericardial Diseases (Adler et al., European Heart Journal; njira zodziwira matenda a acute pericarditis, NSAID + 3-month colchicine regimen, ndi myopericarditis triage) ndi *ESC Position Statement on Management of Acute Myocard.
• American Heart Association (AHA) ndi American College of Cardiology (ACC, United States): Kuzindikira ndi Kuwongolera Koyamba kwa Fulminant Myocarditis: A Scientific Statement From the American Heart Association (Kociol et al., Circulation) ndi AHA/ACC Eligibility and Disqualification and Disqualification Recommendations for Cartiovascular Athletic Pericarditis (kuletsa kuchita masewera olimbitsa thupi kwa miyezi 3 mpaka 6 ndi kuyesa kubwereranso kosewera).
• National Health Service (NHS, United Kingdom) ndi National Institute for Health and Care Excellence (NICE, United Kingdom): Acute Chest Pain Assessment, Pericarditis, ndi Myocarditis Clinical Guidance.
• Centers for Disease Control and Prevention (CDC, United States) ndi World Health Organization (WHO): Clinical Guidance for Recognical and Management of Post-Viral and Post-Vaccination Myocarditis and Pericarditis.

Maupangiri ogwirizana¶

• Kuzindikira matenda a mtima ndi chithandizo choyamba
• Cardiac tamponade ndi kulowerera pachifuwa triage
• Mwadzidzidzi racing heart (SVT), kusinthidwa kwa Valsalva, ndi mbendera zofiira za arrhythmia
• Pulmonary embolism ndi deep vein thrombosis (DVT)
• CPR wamkulu ndi mwana ndi kalozera wa AED