诊断英文循环系统常见疾病的主要症状与体征杨萃.pptxVIP

ContentValvular 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 increased and splitting5)Graham stell murmur6)RV↑and tricuspid regurgitation , L4-5sm7)Af 二尖瓣[城墙样改变]Mitral Regurgitatio