诊断英文循环系统常见疾病的主要症状与体征杨萃.pptxVIP

The main symptome and sign of common disease of circulation systemShenyang Medical College Shenzhou HospitalYang CuiContentValvular disease 心脏瓣膜病Pericardial effusion 心包积液Heart failure 心力衰竭Valvular Heart DiseaseMitral stenosisMitral regurgitation Aortic stenosisAortic regurgitation Mitral stenosis-pathogeny Rheumatic feverDeformityCalcificationreheumatoidMitral openning area:☆ Normal:4-6cm2 ☆ mild stenosis:≤ 2cm2☆ moderate stenosis:≤ 1.5cm2☆ severe stenosis:≤ 1.0cm2 Pathology and Pathophysiology ↓ LA output suffocate→LV filling↓→LVEDP↓→CO↓ ↓(end-diastolic pressure) LA↑ ↓ LA pressure↑→LA-LV pressure↑ ↓ pulmonary ，PCWP↑→pneumal circulation vena pressure hematostatic ↓ pulmonary hypertension ↓ RVH(right ventricular hypertrophy) ↓ Right HF→RV diastolic pressure↑→RA pressure↑→systemic circulation ↓hematostatic RV expansionMitral stenosis -MSPathology and Pathophysiology：Left atrium expansion，left ventricle output↓Pulmonary congestionpulmonary hypertensionRight ventricle dysfunction二.symptom1.??? in mild cases: no symptom2.??? ≤1.5 cm21)??? dyspnea: exertional dyspnea paroxysmal nocturnal dyspnea orthopnea acute pulmonary edema2)??? cough 3)??? hemoptysis: a lot of pink frothy sputum4） dysphagia 症 状 劳力性呼吸困难、夜间阵发性呼吸困 难甚至肺水肿 咳嗽，咯血，吞咽困难，声音嘶哑。体 征 视诊：二尖瓣面容；右心室增大—心尖搏动左移1.??? inspection①??? mitral face②??? cyanosis③??? RV↑→apex beat to left 触诊：心尖可触及舒张期震颤，左侧卧位明显；右心室肥大时，胸骨左下缘或剑突下可触及右心室抬举样搏动。2. palpation① diastolic thrill② RV↑→apical impulse at left③ Elevated apical impulse on left sternal edge 叩诊：左房、肺动脉及右心室增大与增宽，心腰消失，心浊音界可呈梨形3.percussion: pear shaped heart体 征 听诊：⑴心尖区S1亢进，⑵有局限性舒张中、晚期隆隆样杂音，于舒张晚期递增，左侧卧位更为清晰。⑶心尖内侧可闻开瓣音，提示为单纯二尖瓣狭窄或二尖瓣狭窄为主，瓣叶弹性及活动尚好。⑷肺动脉瓣区P2亢进、分裂，可有相对性收缩期吹风样杂音；⑸严重肺动脉高压者，在肺动脉瓣区可闻及舒张期早期叹气样杂音，吸气末增强，称Graham Steell杂音。⑹晚期病人可出现心房颤动，心音强弱不等，心律绝对不规则，有脉搏短绌。⑺右室增大伴三尖瓣关闭不全时，胸骨左缘第4，5肋间可有收缩期吹风样杂音，吸气末增强。4.auscultation: (a apical low rumble localized crescendo)1)a localized crescendo rumbling mild and late diastolic murmur near the apex2)S1 increased 3)opening snap4)P2 in