循环病案分析和循环呼吸复习思考题.docVIP

病案分析 A 60-year-old woman is admitted to the hospital after complaining of extreme fatigue and weakness, shortness of breath (dyspnea), and swelling of her ankles. Her clothes no longer fit around the waist, and she has gained 3 kg in the past month. She finds that breathing is particularly difficult when lying down (orthopnea). Sleeping propped on several pillow no longer brings her relief. She has a history of chest pain and shortness of breath upon exertion. Her physical examination reveals cyanosis (blue skin tone), rapid respirations, rapid pulse, distended neck veins, ascites in the abdomen, edema in the ankles, and cold clammy skin. Her ventricular ejection fraction is 0.30. Her systolic pressure is 100 mm Hg, with a reduced pulse pressure. She is treated with digoxin and a diuretic and placed on a low-sodium diet. 一个60岁的女子被送往医院后，极度疲劳和虚弱，气短，呼吸（呼吸困难）的抱怨，她的脚踝肿胀。她的衣服不再适合在腰上，她已经增加了3公斤，在过去一个月。她发现，平躺（端坐）时呼吸特别困难。睡觉时垫上几个枕头支撑也没有缓解。她有胸部疼痛和劳累后气短的历史。 体检发现她紫绀（蓝肤色），呼吸急促，脉搏快，颈静脉扩张，腹部腹水，脚踝水肿，皮肤湿冷。她的左心室射血分数为0.30。她的收缩压是100毫米汞柱，脉压降低。她以地高辛和利尿剂以及低钠盐饮食治疗。 PS：地高辛 地高辛是用于高血压、瓣膜性心脏病、先天性心脏病等急性和慢性心功能不全的一种药物。 利尿剂主要是通过促进体内电解质(钠离子为主)和水分排出，使血容量减少，血压下降。该药降压作用较温和，作用持久。可能是什么病？为什么？治疗原则是什么？ 压力降低激活了压力感受性反射（压力降低是因为血液从动脉进入静脉循环，因为心室难以射出充足的血液），妇女增加的脉搏数以及湿冷的皮肤都是由于压力感受性反射引起，降低的压力激活压力感受性反射，导致传到心脏和血管的交感神经活动增强（心率加快、皮肤血管收缩）,支配心脏的副交感神经活动减弱（加快心率）。如果测体温,脉搏,呼吸，应该会增加，由于许多血管床的交感缩血管神经，除了皮肤血管。 Explanation of Case. Each of the woman’s signs and symptoms is a classic presentation of heart failure. The history of angina (chest pain) suggests that blockage（堵塞） of the coronary arteries has resulted in insufficient blood flow to the heart. With insufficient coronary blood flow, there is inadequate oxygen delivery to the working myocardial cells, and the ventricles are unable to develop normal pressures for ejection of blood during systole. A negative inotropic state develops in the ventricles, resulting in decreased contractility and decreased stroke volume for a given end-diastolic volume (downward shift of the Frank-S