《儿科学》Cardiovascular Disease.pptVIP

病理生理 1.分流量大小与导管的粗细及主、肺动脉的压差有关。 2.左→右分流（连续）；肺循环、LA、LV、AAO血流量↑，左心负荷加重； LA扩大、LV肥厚扩大；动力性肺动脉高压→梗阻性肺动脉高压，右室肥厚，甚至右心衰竭，当肺动脉压力超过主动脉压力时，右→左分流，临床出现差异性青紫。 RA systemic circulation peripheral artery (blood supply?) diastolic pressure? shunt RV PA AO LV LA (blood flow?) (hypertrophy, dilation) (dilation) dilation of PA pulmonary congestion (may result in pulmonary hypertension) Hemodynamic change of PDA 3. Clinical Manifestation： Depends on the ductus size. Small ductus may cause no symptoms, only has murmur by PE; large ductus cause large shunt volume, may shows short breath, cough, hypodynamia, sweatiness, palpitation, hoarseness if recurrent nerve be compressed by dilated PA. Signs： inspection：bulged chest, diffused apical impulse. palpation：systolic diastolic thrill at L2 percussion：enlarged cardiac dullness auscultation： 3~4/6 rough SM 2—3/ 6 DM continuous machinery at L2，P2? large shunt volume?relative mitral stenosis?mid-diastolic rumbling murmur at apex Special situation: during infancy, pulmonary hypertension or heart failure only SM can be heard. peripheral vascular sign： capillary pulsation, water-hammer pulse, pistol-shot. obvious pulmonary hypertension: differential-cyanosis 4. X-ray examination 2.Pathophysiology 1.左→右分流，肺循环量↑ 2.血流动力学改变与缺损大小及肺血管床状况有关。 小VSD（＜0.5cm）:分流量小，血流动力学变化不大； 中VSD（0.5～1.5cm）：明显左→右，Qp＞2~3倍Qs； 大VSD（ ＞ 1.5cm）：分流量很大， Qp＞3~5倍Qs 3.病情进展，肺循环量持续↑，动力性PH →梗阻性PH，右→左分流，艾森曼格综合征。 Pathophysiology A before pulmonary hypertension RA LA hypertrophy shunt PA RV LV hypertrophy （dilation) （blood volume )（ejection volume ） pulmonary RV