循环系统常见症状体征(英)课件

1、1Main Symptoms and Signsof CommonCardiovascular DiseasesOutline2010 Clinical DiagnosticsValvular Heart DiseaseMitral Stenosis(MS)Mitral Regurgitation / Insufficiency (MR / MI)Aortic Stenosis(AS)Aortic Regurgitation / Insufficiency (AR / AI ) Heart FailurePericardial EffusionValves of Heartvalve annu

2、lus / valve ringvalve leaflet / cuspmitr4Mfi1llUfl0f Clf)Yalves of Heart Q(heart in diastole: vieed ir0m base wah aria emoec6Mitral Stenosis (MS)Predominantly caused by rheumatic fever.7mitral valve areaMSnormal MVAmildmoderatesevere46cm21.52.0cm21.01.5cm21.0cm2Normal- the cross-sectional area 46 cm

3、2AbnormalMild MS- orifice 2 cm2bloodLA LV propelled by a small and abnormal pressure gradient 20 mmHgModerate MS: - orifice 1.5 cm2PVP, PCWP, interstitial edema means LV pressure of 25 mm HgSevere MS - orifice 1 cm2PAP RV overload RV failurePathophysiologyCross-sectional area of the mitral valve ori

4、fice Rate of blood flow across the mitral orifice Left atrial pressure Dilation of LAPulmonary venous and capillary pressures Pulmonary congestion and edemaPulmonary hypertensionRightheartfailureDyspnea2010 Clinical Diagnostics10LA pressurePulmonary circulation pressureRight heart failurePathophysio

5、logydilationhypertrophyfailure11Symptomsdyspnea:is defined as an abnormally uncomfortable awareness of breathing.That is shortness of breath, difficulty in breathing / labored breathing.It is a subjective symptom.It is one ofthe principal symptomsof cardiac and pulmonary disease.Symptomsdyspneaexert

6、ional dyspnea,dyspnea on rest,paroxysmal nocturnal dyspnea,orthopneapulmonaryedemacoughhemoptysisIf orthopnea causes awakening during the night andis relieved by sitting, it is called paroxysmal nocturnal dyspnea.Shortness of breath even in the upright position andcough with pink frothy sputum(粉红色泡沫

7、痰)in pulmonaryedema.The most common complaint is shortness ofbreath,chiefly exertional dyspnea at first and then progressing to rest dyspnea,paroxysmal nocturnaldyspnea,andorthopnea.Physical Signs1.Inspection2.Palpation3.Percussion4.Auscultation视触叩听2010 Clinical DiagnosticsMS16Inspection:Mitral face

8、Patients show malarflush( pinkish-purplepatches on the cheeks ) and lip cyanosis.Apex beat displaces to left becauseof right ventricular hypertrophy.二尖瓣面容17PalpationDiastolic thrill over apical area .tiny vibration, small shaking18PercussionCardiac dullness becomes pear-shaped.19梨形心，x ray film左房增大（左

9、前斜位）20AuscultationMid and late diastolic crescendorumbling murmur in apical area21AuscultationAccentuatedS1 over apicalareaOpening snapS2 Splitting or accentuatedGraham Steell murmurA high-pitched decrescendo diastolic murmur secondary to pulmonary regurgitation, can be heard in pulmonary valve area

10、.肺动脉瓣区吹风样舒张早期杂音 “二狭”导致 肺动脉压增高、肺动脉扩张引起肺动脉瓣 相对性关闭不全所致的功能性杂音.22Mitral Regurgitation (MR)Mitral regurgitation (MR) is defined as an abnormal reversal of blood flow from the left ventricle (LV) to the left atrium (LA).It is caused by disruption in any part of the mitral valve apparatus.valve annulus / va

11、lve ringvalve leaflet / cusp24Etiology Mainly rheumatic fever, mitral valve prolapse ,infective endocarditis , calcification ,ischemic heart disease withpapillary muscle dysfunction, et al.SystolePathophysiologycompensatory LA dilationpart of blood in LV returns to LAmore blood and pressure in LAIn

12、MRDiastoleLV receivesnormal contentregurgitantof bloodbothvolume load of LV compensatory LV dilation2010 Clinical DiagnosticsMRWhen volume load of LV continuously increasingLV end diastolic pressure and LA pressure increaseLeft heart failurePulmonary congestion and edema(肺淤血和肺水肿)Pulmonary hypertensi

13、onRight heart failure27compensatory dilation of LAcompensatory LV dilationleft heart failureRight heart failurePathophysiologyEarly Stage - asymptomatic- heart failureLate StagePalpitationCoughExertional dyspneaFatigue / very great tiredness(secondary to cardiac output )Symptoms2010 Clinical Diagnos

14、ticsMRPhysical SignsInspectionApex beat displaced to left and downwardsPalpationApex beat displaced to left and downwards, heaving apex beat,hyperdynamic cardiac impulsePercussionThe area of cardiac dullness shifts to left anddownwards at first, then to right later2010 Clinical DiagnosticsMR30Auscul

15、tation: In apical area, harsh blowingpansystolic murmur, widely spread,transmitting to left axilla or subscapular region. S1 is weakened and P2 is accentuated and split.主动脉瓣狭窄（aortic stenosis, AS）EtiologyMainly caused byrheumatic fever.Others caused by senile calcification or congenitally bicuspid v

16、alve .图主动脉瓣和冠状动脉开口示意图Aortic stenosis(AS)2010 Clinical DiagnosticsASNormal cross-sectional area 3.0cm2 1.0cm2， cross-sectionalpressure5 mmHgshows clinical signs.ASis the obstruction of blood flow across the aortic valve.2010 Clinical DiagnosticsAortic Stenosis(AS)ASPathophysiologyAortic stenosisLVout

17、flow obstructionLV systolic pressure cardiac outputLV hypertrophyLV dysfuctioncerebral ischemiamyocardial ischemiaLV failureEarly stage-asymptomatic.Late stage-symptoms occur lateafter years of obstruction.Symptoms2010 Clinical DiagnosticsAS(common)(relatively late)Symptoms2010 Clinical DiagnosticsA

18、ngina pectoris90%Syncope(typical)60%Dyspnea30%ASAngina pectoris(myocardial ischemia)it is commonly precipitated / induced by exertion and relieved by rest.Dyspnea( relatively late symptom )exertional dyspnea with orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema reflect varying degrees of

19、 pulmonary venous hypertension.40Syncope(cerebral ischemia)whichmay be defined as a loss of consciousness ,resultsmostcommonlyfrom reduced perfusionofthebrain .Syncope istypically exertional and may be due toarrhythmias , hypotension, or decreased cerebral perfusion resulting from increased blood fl

20、ow to exercising musclewithout compensatory increase in cardiac output.signsInspection:The apex beat displaces to left and below.Percussion:The cardiac dullness may be normalor shifts to left and below.palpationThe apical impulse is forceful.A systolic thrillmay be palpated in the second intercostal

21、 space on right side of the sternum .AuscultationThe systolic ejection murmur，harsh and rasping, can be heardin the aortic area transmitted to the neck.A weak A2 , or paradoxical splitting S2is present.2010 Clinical DiagnosticsAortic regurgitation (AR)AR45EtiologyMainly caused byrheumatic fever;Some

22、times caused by non-rheumaticfever such as infective endocarditis, congenital valve deformity,valve prolapse, syphilis , Manfans syndrome.PathophysiologyFrom Braunwalds Heart Disease 8thARblood returning from aorta to LVDBP more blood lift upleaflets of mitral valveblood volume in LV compensatoryLV

23、dilatationpulse pressure relative MSAustin-Flint murmurLV Heart Failureperipheralvascular signsInsufficient ofcoronary artery2010 Clinical DiagnosticsARSymptomsEarly stage - asymptomatic.Late stage -PalpitationFatigueDizzinessAngina pectorisExertional dyspnea2010 Clinical DiagnosticsARSignsInspectio

24、nFace may be pale;Apex beat displaced to left and below.PalpationApex beat is rather diffuse and displaces to downwardsandleft;/ heaving apex impulsePercussioncardiac dullness -shape of a boot2010 Clinical DiagnosticsARAuscultationSighing diastolic decrescendo murmur,can be heard in the 2nd aortic a

25、rea.Austin-Flint murmurA rumbling mid-diastolic murmur caused byrelative MS, can be heard over the apex area.(主动脉瓣关闭不全时回流血液限制二尖瓣开放所致）2010 Clinical DiagnosticsAR- caused by pulse pressureHead bobbingVisible pulsation of carotid arteriesSigns of capillary pulsationWater hammer pulsePistol shot sounds

26、over femoral arteries and Duroziez murmurPeripherial Vascular Signs2010 Clinical DiagnosticsAR52Heart FailureBrief account： In certain pathological circumstances, if cardiac output is below the level ofadaptation to the needs of humanbody, heart cannot maintain effectivecirculation. Therefore a seri

27、es ofsymptoms and signs develop.53Classified as acute and chronic heart failure according to its clinical course. Classified as left, right andbilateral heart failure according to the clinical manifestations.54Left heart failureThe main pathological change is pulmonary congestion， pulmonaryedema dev

28、elops in severe cases.55Symptoms Dyspnea :Exertional dyspnea;Paroxysmal nocturnal dyspnea;Orthopnea;Cough with pink frothy sputum (粉红色 泡沫痰) in pulmonary edema ; Cough with sputum or cough with blood stained sputum.56SignsInspection:Tachypnea（呼吸急促）, cyanosis and orthopnea;Percussion :Signs of primary

29、 heart diseases;Auscultation:Findings of primary organic heart diseases;Fast heart rate and diastolic gallop rhythm ； moist rales (湿罗音) at the lung bases ; in pulmonary edema bubble and wheezing rales (哮鸣音) over both lungs.5758Right ventricular failureBrief account： The main pathological change is s

30、ystemic congestion（体循环淤血）.59Symptoms Edema (水肿) occurs in the lower part ofbody (abdomen, the lower extremities). Bloat (胃胀), nausea（恶心), anorexia(食欲不振), oliguria 少尿.60Signs Inspection:Dilatation of the jugular vein.Cyanosis and edema in the lower partofbody.62 Palpation:Enlargement of liver with te

31、nderness , positive hepatojugular reflux (肝颈静脉回流征阳性).Percussion:Pleural effusion (胸腔积液) and ascites(腹水); signs of primary heart diseases.63 Auscultation:Signs of primary heartdiseases.64Pericardial effusionBrief account： May be caused by infective pericardial changes such as tuberculosis (肺结核) and non- infective pericardial ch