Cecil心内科1概要1.doc

APPROACH TO THE PATIENT WITH POSSIBLE CARDIOVASCULAR DISEASELee Goldman 接待可能有心血管病的病人 Patients with cardiovascular disease may present with a wide range of symptoms and/or signs, each of which may be caused by noncardiovascular conditions. Conversely, patients with substantial cardiovascular disease may be asymptomatic. Because cardiovascular disease is the leading cause of death in the United States and other developed countries, it is crucial that patients be evaluated carefully to detect early cardiovascular disease, that symptoms or signs of cardiovascular disease be evaluated in detail, and that appropriate therapy be instituted. Improvements in diagnosis, therapy, and prevention have contributed to an impressive decline in age-adjusted cardiovascular death rates in the United States since the late 1960s. Because of the increase in the number of persons older than 40 years, however, the absolute number of deaths from cardiovascular disease in the United States has not declined. 心血管病患者可以种种症状和体征出现，每一种症状和体征，又可能是由非心血管病引起的。另一方面确有心血管病患者又可毫无症状。由于在美国和其他发达国家，心血管病都是首屈一指的死亡原因，因此必须认真对待这批患者，及早发现心血管病，对心血管的症状和体征，都要深入检查，并给予适当治疗。20世纪60年代以来，由于诊断、治疗和预防方面的一系列进步，美国经年龄校正的心血管病死亡率已大为下降。但由于40岁以上人口的增多，美国死于心血管病的绝对人数仍未减少。 In evaluating a patient with known or suspected heart disease, the physician must determine quickly whether a potentially life-threatening condition exists. In these situations, the evaluation must focus on the specific issue at hand and be accompanied by the rapid performance of appropriately directed additional tests. Examples of potentially life-threatening conditions include acute myocardial infarction (Chapter 68), unstable angina (Chapter 68), suspected aortic dissection (Chapter 75), pulmonary edema (Chapter 56), and pulmonary embolism (Chapter 94). 检查已知或已有心脏病患者时，医生必须迅速决定是否有可能危及生命的情况的存在。面对这样的情况，检查必须集中有当前的特定问题，同时迅速从事方向明确的有关检验。可能危及生命的情况如急性心肌梗死(Chapter 68)、非稳定型心绞痛 (Chapter 68)、疑为主动脉夹层形成(Chapter 75)、肺水肿(Chapter 56)和肺栓塞 (Chapter 94)。 History for Detection of Card