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Задание 18. Вам предстоит прочитать две статьи и затем заполнить таблицу для дифференциального диагноза стенокардии и острого перикардита. К первой статье прилагается подробный перевод, а вторую статью вам нужно перевести самостоятельно.
СТЕНОКАРДИЯ
Видео с подробными объяснениями к первой статье:
ОСТРЫЙ ПЕРИКАРДИТ
It is useful to classify the types of pericarditis both clinically and etiologically, since this disorder is by far the most common pathological process involving the pericardium. Pain of a pericardial friction rub, electrocardiographic changes, and pericardial effusion with cardiac tamponade and paradoxic pulse are cardinal manifestations of many forms of acute pericarditis and will be considered prior to a discussion of the most common forms of the disorder.
Chest pain is an important but not invariable symptom in various forms of acute pericarditis; it is usually present in the acute infectious types and in many of the forms presumed to be related to hypersensitivity or autoimmunity. Pain is often absent in a slowly developing tuberculous postirradiation, neoplastic, or uremic pericarditis. The pain of pericarditis is often severe. It is characteristically retrosternal or left precordial referred to the back and the trapezius ridge. Often the pain is pleuritic consequent to accompanying pleural inflammation, i.e. sharp and aggravated by inspiration, coughing and changes in body position but sometimes it is a steady, constrictive pain that radiates into either arm or both arms and resembles that of myocardial ischemia; therefore, confusion with myocardial infarction is common. Characteristically, however, the pericardial pain may be relieved by sitting up and leaning forward. The differentiation of acute myocardial infarction from acute pericarditis becomes even more perplexing when with acute pericariditis, the serum transaminase and creatine kinase levels rise, presumably because of concomitant involvement of the epicardium. However, these enzyme elevations, if they occur, are quite modest, given the extensive electrocardiographic ST-segment elevation in pericarditis.
The pericardial friction rub is the most important physical sign: it may have up to three components per cardiac cycle and is high-pitched, scratching, and grating; it can sometimes be elicited only when firm pressure with the diaphragm of the stethoscope is applied to the chest wall at the left lower sternal border. It is heard most frequently during expiration with the patient in the sitting position, but an independent pleural friction rub may be audible during inspiration with the patient leaning forward or in the left lateral decubitus position. The rub is often inconstant and transitory, and a loud to-and-fro leathery sound may disappear within a few hours, possibly to reappear the following day.
Moderate elevation of the MB fraction of creatine phosphokinase may occur and reflect accompanying epimyocarditis.
Видео с подробными объяснениями ко второй статье:
Таблица для дифдиагноза:
Таблицу с ответами смотрите в следующем уроке.
