课件参考文稿

PhysicalexamofthecardiacJensHäggström,DVM,PhD,DECVIM-CAProfessorInternalMedicineFacultyofVeterinaryMedicine,Uppsala,

Source:Agria Int.disease内科Int.disease内科蓄BonediseaseVertebraldiscLiverdiseaseHipHeartdisease

No

Agria .1995-Skeletal

Genital(incl.

38%

Unspecified(thewholebody)9%Cardiovascular

12%

16%Digestive

Urinary6049deaths.Males3180,Females2867.MedianAge5.2HeartDiseasein犬的心脏获得性AcquiredHeartDiseasein犬的获得性mitralvalve二尖瓣粘液

CardiacMortality心脏 Egenvall,Bonnett,Haggstrom.JVetInternMed2006;20;894-ListencarefullytotheListencarefullytotheclient!Askadequatequestions仔 畜主表述，询问合适的问General S ReasonfordogbeingpresentedOnsetanddurationofproblemsProgressionofproblemsExposuretoinfectiousdiseaseVaccinationhistoryHistoryofResponsetoDefinitionofdogattitudeExerciseAnyfamiliarhistoryofheartdiseaseHealthofotherhouseholdpetsResultsfromprevioustestsFeedingbehaviousTypeoffoodReproductivestatusLamenessorparesisCoughingorsneezingConcurrentdiseasesTreatmentofconcurrent

CharacterofeventWhentheeventoccursStimulievokingevent….犬就诊的原问题的起始和持续时问题的连续 其他疾病现在在用的药药物效运动耐受任 性的心脏病排尿/并发疾病的治

发生症状的刺激因素Hallmarksofcardiacdisease心脏疾病的特Dyspnea呼吸SyncopeDyspnea呼吸SyncopehabitsWeaknessandexerciseAscites腹水Cyanosis苍白病WeightlossParesis(catsin轻瘫（尤其是猫AreallunspecificforheartdiseaseTypeofAcutebronchitis,acuteleftheartfailure(dogs)ChronicTrachealinstability,rightorleftheartfailure,heartworms,compressionofmainstembronchus,neoplasia,asthma(catonly),Acuteonset,softthat esPulmonaryMild,intermittentcough,harsh,lowpitchedinChronicheartLoudharsh,dry,suddenonsetfollowedbygagindogsHonking,highpitchedinTracheal aroxsmalloud Lare excitementCoughafterdrinkingindogs tracheitis/bronchitis,laryngealparalysis,dshaCoughaftereatingindogs varscularringabnormalities,esophagealdiverticular,esophagealforeignbody,esophagealtumorsCoughwithoutinciting Cardiac,pulmonaryorextrapulmonary咳嗽类

急性左心衰竭（犬

Productivecough BronchoscopyoftracheaandJohnsson,etal.JVetInternMedDsnic Adsneiccat呼 TetralogyofFallot法络 Weightloss消Femoral Absent Erratic

ArrhythmiaHyperkineticPulse

Heartfailure,Aorticregurgitation,Fear,Fever,PDA,Severeanemia,PulsusPulsus

Pulsus CardiacFemoralpulse

脉原二尖瓣返流 脉原二尖瓣返流DistendedjugularAuscultationAUSCULTATION听AuscultationafterexerciseClassificationofmurmurGrade1:Aquietmurmurheardonlyaftercarefulauscultationoveralocalizedarea.Grade2:Aquietmurmurthatisheardimmedia yasthestethoscopeisplacedoverthePointof alIntensity(PMI)Grade3:A yloudGrade4:Aloudmurmurthatcanbeauscultatedoverseveralareasbutnopalpableprecordialthrill.Grade5:Aloudmurmurassociatedwithapre-cordialGrade6:Averyloudmurmurwithapalpablethrillalsoheardwiththestethoscoperaisedjustoffthechestwall. 3级：中等强度的心杂5级：伴有心前区震颤的响亮杂6级伴有可触诊震颤的非常响亮的杂音将听LoudAnemia,Exercise,Fear,Fever,Hyperthyroidism,Mitralregurgitation,Positiveinotropicdrugs,Pregnancy,SystemicLoudAnemia,Exercise,Fear,Fever,Hyperthyroidism,Mitralregurgitation,Positiveinotropicdrugs,Pregnancy,SystemicSoftBradycardia,Decreasedcardiacoutput,Diaphragmatichernia,systolicheartfailure,ThoracicSplit Atrialorventricularbeats,cardiacpacing,Rightbundlebranchblock,mitralortricuspid LoudSoftSplitAbsent

Atrialseptaldefect,Mildvalvularpulmonicstenosis,PDA,hypertension,Systemichypertension,Valvularaorticstenosis,VSDSystolicheartfailure(DCM),Hypothyroidism,Severeaorticregurgitation,Shock,SignificantAtrialseptaldefect,Heartworms,Mitralstenosis,Severepulmonaryhypertension,Pulmonicstenosis,Rightorleftbundlebranchblock,RighttoleftshuntingPDA,Ventricularectopies,Significantaorticregurgitation.变 病

的PDA，室性早搏,明显主动脉返流

pensatedMRorSstolicheartfailureDCM Lareatrialseptaldefect,SeverePDA,LargeVSD,Severeanemiaincats,Severehyperthyroidismcats,SevereaorticregurgitationAnemia,Hypertrophiccardiomyopathy,Chordalruture,hypertension,3rddegreeAVblock,ThyrotoxicolisMitralvalveAnemia,Atrialseptaldefect,Dilatationofgreatvessels,Exercise,Heartworm,embolism,Pulmonatystenosis,Valvularpulmonic变 病奔马调失代偿性MR或TR，收缩性心力衰竭大隔缺损，严重PDA，较大的VSD，猫 aMostmurmursincats intensityoverthe心杂音层 出口道狭窄（主动脉或肺动脉出口道狭窄（主动脉或肺动脉4.短路 Anemia,Athleticheart,Fever,

Aorticstenosis,Pulmonicstenosis,VSD,ASD(relativepulmonicstenosis),Mitralregurgitation,Hypertrophiccardiomyopathy(incl.SAM),Mitralortricuspiddysplasia,PDA,Systolicheartfailure(secondaryMR),Aorticopulmonaryseptaldefect,Mitralortricuspidstenosis,fistula,VSDSevereaorticregurgitation,Severeaorticregurgitation,Mitralortricuspid 心杂 病 SomeHeartDiseasein犬的心脏获得性Mitral GallopSummaryInMR,murmurintensityisinproportiontodiseaseTheexceptionismusical对于MR，心杂音的轻度TheexceptionismusicalSingleprematurebeatsarecommoninhealthysmallbredThemajorityofdogswithcardiomyopathyhaveabnormalheartsoundsoramurmur(usuallymild)oranarrhythmiaRunsoftachycardiaisusuallyabnormalin

AsymptomaticcatwithFunctionalmurmur(anemia,highCO,aorticdilatation)Pleural

MediastinalmassesIntrapulmonaryDyspneiccatwithDyspneiccatwith表 可能的心肌 鉴别诊有心杂音但无症状性心脏病功能性杂音（贫血无心杂音但呼吸的胸腔积液，气胸

有心杂音且呼 的性心脏有心杂音且呼 的性心脏病高血压+慢性心衰贫血+慢性心Systolicmurmurprimaryprimaryrespiratorydiseaseincatsrespiratorysinus HeartmurmursincatsarebestheardovertheCatsmayhavemurmurswithoutanydetectableformofheartdiseaseThemajorityofcatswithcardiomyopathyhaveabnormalheartsoundsoramurmuroranarrhythmiaDynamicmurmursare 性疾