循環(huán)系統(tǒng)障礙Commonsymptomsandsignsofcirculationsystem

1、common symptoms and signs of circulation system common symptoms of heart diseasechest paindyspneapalpitationedemasyncopecyanosiscommon symptoms of heart diseasechest pain ap ami acute pericarditis cardiac neurosiscause:cardiogenic：otherv1, locationcommon symptoms of heart diseasechest painkeypoints

2、of inquiry2, nature and degree3, duration4, incentive5, reliever6, radiation7, accompanied symptomscardiac factors: cardiac dysfunction, pericardial tamponade, etc.common symptoms of heart diseasedyspneacausenon-cardiac factors: disease of respiratory system, disease of blood system, etc.others:1, a

3、cute or chronic2, relationship with position and movement 3, accompanied symptomscommon symptoms of heart diseasedyspneakeypoints of inquiryheartthrob enhancearrhythmiatachycardiabradycardiaarrhythmiacardiac neurosiscommon symptoms of heart diseasepalpitationcommon cause:1, precipitating factor2, ac

4、companied symptoms3, primary diseasecommon symptoms of heart diseasepalpitationkeypoints of inquirycardiogeniccardiac output blockarrhythmiacommon symptoms of heart diseasesyncopeothercause1, attack position2, precipitating factor3, symptoms before the attack4, accompanied symptomscommon symptoms of

5、 heart diseasesyncopekeypoints of inquirycardiogenic factors: cardiac dysfunctionpulmonary embolism, etccommon symptoms of heart diseasecoughcausenon-cardiogenic factors: respiratory system diseasecentral coughcausesystemic edemacardiacnephrogenichepaticother reasonscommon symptoms of heart diseasee

6、demalocal edemalocal inflammationvenous reflux obstruction, etc1,past history2,starting position3,accompanied symptomscommon symptoms of heart diseaseedemakeypoints of inquirycause:central cyanosis:cardiovascularpulmonarycommon symptoms of heart diseasecyanosisperipheral cyanosis: relative increase

7、of peripheral oxygen consumptionarterial ischemiamixed cyanosis: cardiac dysfunctionabnormal hemoglobin derivant1,onset age2,heart and lung disease history3,accompanied symptomskeypoints of inquirycommon symptoms of heart diseasecyanosis ventricular enlargement signsheart rate and rhythm changeheart

8、 sound changeheart murmurother important signsheart sign left ventricular enlargementapex pulse: left ventricular enlargementlower-left shift greater than 2 cm lifting type impulselower-left enlargement apex pulse range: the apex : cardiac dullness border: right ventricular enlargementapex pulse: ri

9、ght ventricular enlargement left-shiftprecordium : lifting type impulsesubxyphoid apex pulse: common in pulmonary emphysema with right ventricular enlargementprotrusion of precordium: onset during childhood cardiac dullness border: left enlargement pear-shaped heartboot-shaped heart mitral (valve) s

10、tenosisaortic insufficiency hydropericardiumupright positinlying position heart rate and rhythm changefast and regular: sinus tachycardia, paroxysmal tachycardiaslow and regular: sinus bradycardia, conduction block of level iii with escape rhythmarrhythmia: sinus arrhythmia, premature beat, conducti

11、on block above ii, atrial fibrillations1s1s2s2left edge of sternum and apex regionbottomnormals1 enhances1 recedes1 divisionapexapexbottom factors that affect s1 integrity of atrioventricular valveactivity of atrioventricular valveventricular systolic rate(dp/dt)mitral stenosistachycardiahigh co fac

12、tors that enhance s1 vmitral valve insufficiencyvatrioventricular block level ivmyocardial damage factors that weaken s1 factors that affect s2 aortic and pulmonary artery pressureintegrity and elasticity of semilunar valvep2 enhancement in:pulmonary hypertensionpulmonary circulation congestion fact

13、ors that enhance s2 a2 enhancement in:hypertensionaortic atherosclerosisvp2 weakened in pulmonary valve lesionsva2 weakened in aortic lesions factors that weaken s2expirationinspirationgeneral splittingfixed splittingreversed splitting121a2p21a2p21a2p21p2a212 extral soundvgallop rhythmv opening snap

14、vabnormal heart sounds after prosthetic valve replacement gallop rhythmvmid-diastolic gallopvpresystolic gallopvquadruple rhythm opening snapvmeaning: mitral stenosisvmechanism abnormal heart sounds after prosthetic valve replacement speedy blood flow stenosis of valve opening or blood vessel relati

15、ve stenosis caused by ventricular enlargement or large blood vessels dilation valvular insufficiency relative valvular insufficiency shunt of large blood vessels or chambers of heart intracardiac floaters heart murmurs mechanismv1.blood flow speedyv2. valvular lesionsv3. large blood vessels or cardi

16、ac enlargementv4. shuntv5. intracardiac floaters listenning content of cardiac murmurvlocationvtimevconduction of murmurvtones of murmurvloudness of murmurvrelationship between murmur and breathing, position, movement or some drugscardiac auscultation region systolic murmurs strength classificationl

17、evel 1: weak noise, a very short time, unheard during the first few seconds level 2: weak noise, more easily heard level 3: noise of medium intensity level 4: a loud noise, often accompanied by tremor systolic murmurs strength classificationlevel 5: very loud, shocking , unheard after taking stethos

18、cope away from chest wall , all accompanied by tremor level 6: extremely loud, heard even with stethoscope a certaindistance away from chest wall , with strong tremor cardiac murmurmitral insufficiencyventricular septal defect vsdaortic stenosispulmonary valve stenosisaortic insufficiencymitral (val

19、ve) stenosispatent ductus arteriosus pdaconduction of murmur tones of murmur relationship between murmur and breathing, position, movementdifferentiation between physiological and pathological murmurphysiological pathologicallocationpulmonary valveapexperiodsystolicsystolic or diastolicintensitylowe

20、r then level iihigher than level iiinaturesoftroughconductionnoalways pericardial rubother important sighstremorperipheral vascular signsthe clinical significance of various cardiac tremorperiodlocationdiseasesystolesternum right edge, 2nd intercostal assternum left edge, 2nd intercostal pssternum r

21、ight edge, 3rd 4th intercostal vsddiastoleapexmscontinuitysternum left edge, 2nd intercostal pda peripheral vascular signvwater hammer pulsevcapillary pulsationvshooting sound abnormal pulsewater hammer pulse:pulse rises rapidly, and suddenly falls, indicating pulse pressure increase，common in aorti

22、c incompetence.pulse deficit：pulse rate slower than ventricular rate, indicating atrial fibrillation.abnormal pulseparadoxical pulse:pulse weaken obviously or disappear during inspiration.suggesting pericardial effusion or constrictive pericarditis (cp).pulsus alternans：rhythm is normal , strong and

23、 weak pulse appear alternately , serious myocardial damage performance.mitral stenosis auscultation: s1 enhancement in apex, and late diastole rumbling murmur, most clear in left decubitus, p2 hyperfunction or division, valve openning tonepercussion: pear-shaped heartpalpation: diastolic fine tremor

24、 in apex area inspection: mitral valve face, apex impulse left- shiftmitral insufficiencyauscultation: apex rough blowing pansystolic murmurs, range is wide, conduct to left axillary or left shoulder angle, conduction, s1 abate, p2 hyperfunctionpercussion: left enlargement of cardiac dullness border

25、palpation: lifting type impulse of the apexinspection: apex impulse lower-left shift aortic stenosis asauscultation: a2 weaken or disappear, rough systolic murmur can be heard in aortic valve area, conducting to neckinspection: apex impulse lower-left shiftpalpation: lifting type impulse of the apex

26、,systolic tremor in aortic valve areapercussion: lower-left enlargement of cardiac dullness border aortic insufficiencyauscultation: apex s1 abate, a2 weaken or disappear, sighing diastolic murmur can be heard in the second aortic auscultation area , conducting to the apex regioninspection: apex imp

27、ulse lower-left shift, range dispersedpalpation: apex impulse lower-left shift, lifting type impulse of the apexpercussion: lower-left enlargement of cardiac dullness border, boot-shaped heartperipheral vascular signs: capillary pulsation sign, water shock pulse, artery shooting tone ventricular sep

28、tal defect vsdinspection: apex impulse normal or slight left shiftpalpation: systolic tremor can be heard in sternal left edge 3rd and 4th intercostal space percussion: cardiac dullness border normal or slight enlargement, slight cardiac waist bulgingauscultation: rough systolic murmur in sternal le

29、ft edge 3rd and 4th intercostal space, p2 hyperfunction,middle diastolic murmur can be heard during large shunt patent ductus arteriosusinspection: apex impulse normal or slight left shiftpalpation: systolic tremor can be heard in sternal left edge 2nd intercostal space , it can be continuouspercussion: cardiac dullness border normal or slight left enlargement, slight car