循環(huán)系統(tǒng)常見癥狀體征英

1MainSymptomsandSignsofCommonCardiovascularDiseases1循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Outline2010ClinicalDiagnosticsValvularHeartDisease

MitralStenosis (MS)

MitralRegurgitation/Insufficiency(MR/MI)

AorticStenosis (AS)

AorticRegurgitation/Insufficiency(AR/AI)HeartFailurePericardialEffusion2循環(huán)系統(tǒng)常見癥狀體征英5/8/2024ValvesofHeartvalveannulus/valveringvalveleaflet/cuspmitr3循環(huán)系統(tǒng)常見癥狀體征英5/8/202444循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Mfi1llUfl0fCló]f)YalvesofHeart???Q@(heartindiastole:vie?edir0mbasewahariaemo?ec5循環(huán)系統(tǒng)常見癥狀體征英5/8/20246MitralStenosis(MS)Predominantlycausedbyrheumaticfever.6循環(huán)系統(tǒng)常見癥狀體征英5/8/20247mitralvalveareaMSnormalMVAmildmoderatesevere4~6cm21.5~2.0cm21.0~1.5cm2<1.0cm27循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Normal----thecross-sectionalarea4～6cm2AbnormalMildMS -------orifice<2cm2bloodLA——→LVpropelledbyasmallandabnormalpressuregradient20mmHgModerateMS:--------orifice<1.5cm2PVP↑,PCWP↑,——→interstitialedemameansLVpressureof25mmHgSevereMS------orifice<1cm2PAP↑—→RVoverload—→RVfailure8循環(huán)系統(tǒng)常見癥狀體征英5/8/2024PathophysiologyCross-sectionalareaofthemitralvalveorifice↓Rateofbloodflowacrossthemitralorifice↑Leftatrialpressure↑DilationofLAPulmonaryvenousandcapillarypressures↑PulmonarycongestionandedemaPulmonaryhypertensionRight heart failureDyspnea2010ClinicalDiagnostics9循環(huán)系統(tǒng)常見癥狀體征英5/8/202410

LApressure↑

Pulmonarycirculationpressure↑

RightheartfailurePathophysiologydilationhypertrophyfailure10循環(huán)系統(tǒng)常見癥狀體征英5/8/202411Symptomsdyspnea: isdefinedasanabnormallyuncomfortableawarenessofbreathing.Thatisshortnessofbreath,difficultyinbreathing/laboredbreathing.Itisasubjectivesymptom.Itisoneof theprincipalsymptomsofcardiacandpulmonarydisease.11循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Symptomsdyspneaexertional

dyspnea,dyspneaon

rest,paroxysmalnocturnal

dyspnea,orthopneapulmonaryedemacoughhemoptysis12循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Iforthopneacausesawakeningduringthenight

andisrelievedbysitting,itiscalledparoxysmalnocturnal

dyspnea.Shortnessofbreathevenintheuprightpositionandcough

with

pink

frothysputum (粉紅色泡沫痰) inpulmonary edema.13循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Themostcommoncomplaintisshortnessofbreath, chieflyexertionaldyspneaatfirstandthenprogressingtorestdyspnea,paroxysmalnocturnal dyspnea, andorthopnea.14循環(huán)系統(tǒng)常見癥狀體征英5/8/2024PhysicalSigns1. Inspection2. Palpation3. Percussion4. Auscultation視觸叩聽2010ClinicalDiagnosticsMS15循環(huán)系統(tǒng)常見癥狀體征英5/8/202416Inspection:Mitral

facePatientsshow

malarflush (pinkish-purplepatchesonthecheeks)andlipcyanosis.Apexbeatdisplacestoleftbecause of

rightventricular

hypertrophy.二尖瓣面容16循環(huán)系統(tǒng)常見癥狀體征英5/8/202417PalpationDiastolicthrilloverapicalarea.tinyvibration,smallshaking17循環(huán)系統(tǒng)常見癥狀體征英5/8/202418PercussionCardiacdullnessbecomespear-shaped.18循環(huán)系統(tǒng)常見癥狀體征英5/8/202419梨形心，xrayfilm左房增大（左前斜位）19循環(huán)系統(tǒng)常見癥狀體征英5/8/202420AuscultationMidandlatediastolic

crescendorumblingmurmurinapical

area20循環(huán)系統(tǒng)常見癥狀體征英5/8/202421AuscultationAccentuated S1over

apical areaOpening

snapS2Splittingor

accentuatedGrahamSteell

murmurAhigh-pitcheddecrescendodiastolic

murmursecondarytopulmonaryregurgitation,canbeheard

inpulmonaryvalve

area.肺動(dòng)脈瓣區(qū) 吹風(fēng)樣 舒張?jiān)缙?雜音“二狹”導(dǎo)致

肺動(dòng)脈壓增高、肺動(dòng)脈擴(kuò)張 引起肺動(dòng)脈瓣相對性關(guān)閉不全 所致的 功能性雜音 .21循環(huán)系統(tǒng)常見癥狀體征英5/8/202422MitralRegurgitation(MR)22循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Mitralregurgitation(MR)isdefinedasanabnormalreversalofbloodflowfromtheleftventricle(LV)totheleftatrium(LA).Itiscausedbydisruptioninanypartofthemitralvalveapparatus.valveannulus/valve

ringvalveleaflet/

cusp23循環(huán)系統(tǒng)常見癥狀體征英5/8/202424Etiology★Mainlyrheumaticfever,★mitralvalveprolapse,infectiveendocarditis,calcification,ischemicheartdiseasewithpapillarymuscledysfunction,etal.24循環(huán)系統(tǒng)常見癥狀體征英5/8/2024SystolePathophysiologycompensatoryLAdilationpartofbloodinLVreturnstoLAmorebloodandpressure↑inLAInMRDiastoleLVreceivesnormalcontentregurgitantofbloodbothvolumeloadofLV↑c(diǎn)ompensatoryLVdilation2010ClinicalDiagnosticsMR25循環(huán)系統(tǒng)常見癥狀體征英5/8/2024WhenvolumeloadofLVcontinuouslyincreasingLVenddiastolicpressureandLApressureincreaseLeftheartfailurePulmonarycongestionandedema(肺淤血和肺水腫)PulmonaryhypertensionRightheartfailure26循環(huán)系統(tǒng)常見癥狀體征英5/8/202427

compensatorydilationofLA

compensatoryLVdilation

leftheartfailure

RightheartfailurePathophysiology27循環(huán)系統(tǒng)常見癥狀體征英5/8/2024EarlyStage------

asymptomatic------heartfailureLate

StagePalpitationCoughExertional

dyspneaFatigue/verygreat

tiredness(secondaryto↓cardiacoutput

)Symptoms2010ClinicalDiagnosticsMR28循環(huán)系統(tǒng)常見癥狀體征英5/8/2024PhysicalSignsInspectionApexbeatdisplacedtoleftanddownwardsPalpationApexbeatdisplacedtoleftanddownwards,heavingapexbeat, hyperdynamiccardiacimpulsePercussionTheareaofcardiacdullnessshiftstoleftanddownwardsatfirst,thentorightlater2010ClinicalDiagnosticsMR29循環(huán)系統(tǒng)常見癥狀體征英5/8/202430Auscultation:★Inapicalarea,harshblowingpansystolicmurmur,widelyspread,transmittingtoleftaxillaorsubscapularregion.★S1isweakenedandP2isaccentuatedandsplit.30循環(huán)系統(tǒng)常見癥狀體征英5/8/2024主動(dòng)脈瓣狹窄（aorticstenosis,AS）EtiologyMainlycausedby rheumatic

fever.Others

caused

by

senile

calcification

orcongenitallybicuspidvalve

.31循環(huán)系統(tǒng)常見癥狀體征英5/8/2024圖 主動(dòng)脈瓣和冠狀動(dòng)脈開口示意圖32循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Aorticstenosis(AS)33循環(huán)系統(tǒng)常見癥狀體征英5/8/20242010ClinicalDiagnosticsASNormalcross-sectionalarea

3.0cm2＜1.0cm2，

cross-sectional pressure﹥5

mmHgshowsclinical

signs.ASistheobstructionofbloodflowacrosstheaorticvalve.34循環(huán)系統(tǒng)常見癥狀體征英5/8/20242010ClinicalDiagnosticsAorticStenosis (AS)AS35循環(huán)系統(tǒng)常見癥狀體征英5/8/2024PathophysiologyAorticstenosisLV outflowobstruction↑LVsystolicpressure↓cardiacoutputLVhypertrophyLVdysfuctioncerebralischemiamyocardialischemiaLVfailure36循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Early

stage------ asymptomatic.Late

stage ------ symptomsoccur

lateafteryearsof

obstruction.Symptoms2010ClinicalDiagnosticsAS37循環(huán)系統(tǒng)常見癥狀體征英5/8/2024(common)(relativelylate)Symptoms2010ClinicalDiagnosticsAngina

pectoris90%Syncope

(typical)60%Dyspnea30%AS38循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Angina

pectoris (myocardial

ischemia)itiscommonlyprecipitated/inducedby

exertionandrelievedby

rest.Dyspnea (relativelylatesymptom

)exertionaldyspneawithorthopnea,

paroxysmalnocturnaldyspnea,andpulmonaryedemareflect

varyingdegreesofpulmonaryvenous

hypertension.39循環(huán)系統(tǒng)常見癥狀體征英5/8/202440Syncope (cerebralischemia)which maybedefinedasalossofconsciousness, results most commonly fromreducedperfusion of the brain.Syncopeis typicallyexertionalandmaybeduetoarrhythmias,hypotension,ordecreasedcerebralperfusionresultingfromincreasedbloodflowtoexercisingmusclewithoutcompensatoryincreaseincardiacoutput.40循環(huán)系統(tǒng)常見癥狀體征英5/8/2024signsInspection:Theapexbeatdisplacestoleftandbelow.Percussion:Thecardiacdullnessmaybenormalorshiftstoleftandbelow.41循環(huán)系統(tǒng)常見癥狀體征英5/8/2024palpationTheapicalimpulseis

forceful.Asystolic

thrillmaybepalpatedinthesecondintercostalspace

onrightsideofthesternum

.42循環(huán)系統(tǒng)常見癥狀體征英5/8/2024AuscultationThesystolicejectionmurmur，harsh

andrasping,canbe

heard intheaortic

areatransmittedtothe

neck.Aweak

A2,

or

paradoxical

splitting

S2

ispresent.43循環(huán)系統(tǒng)常見癥狀體征英5/8/20242010ClinicalDiagnosticsAorticregurgitation(AR)AR44循環(huán)系統(tǒng)常見癥狀體征英5/8/202445Etiology★ Mainlycausedby rheumaticfever;★ Sometimescausedbynon-rheumaticfeversuchasinfectiveendocarditis,congenitalvalvedeformity, valveprolapse,syphilis,Manfan’ssyndrome.45循環(huán)系統(tǒng)常見癥狀體征英5/8/2024PathophysiologyFromBraunwald'sHeartDisease8thARbloodreturningfromaortatoLVDBP↓morebloodliftupleafletsofmitralvalvebloodvolumeinLV↑c(diǎn)ompensatoryLVdilatationpulsepressure↑relativeMSAustin-FlintmurmurLVHeartFailureperipheralvascularsignsInsufficientofcoronaryartery2010ClinicalDiagnosticsAR46循環(huán)系統(tǒng)常見癥狀體征英5/8/2024SymptomsEarlystage--------

asymptomatic.Latestage

--------PalpitationFatigueDizzinessAngina

pectorisExertional

dyspnea2010ClinicalDiagnosticsAR47循環(huán)系統(tǒng)常見癥狀體征英5/8/2024SignsInspectionFacemaybepale;Apexbeatdisplacedtoleftandbelow.PalpationApexbeatisratherdiffuseanddisplacestodownwards and left; /heavingapeximpulsePercussioncardiacdullness------shapeofaboot2010ClinicalDiagnosticsAR48循環(huán)系統(tǒng)常見癥狀體征英5/8/2024AuscultationSighingdiastolicdecrescendo

murmur,canbeheardinthe2ndaortic

area.Austin-FlintmurmurArumblingmid-diastolicmurmurcaused

byrelativeMS,canbeheardovertheapex

area.(主動(dòng)脈瓣關(guān)閉不全時(shí)回流血液限制二尖瓣開放所致）2010ClinicalDiagnosticsAR49循環(huán)系統(tǒng)常見癥狀體征英5/8/2024---------causedby↑pulsepressure

Headbobbing

Visiblepulsationofcarotidarteries

Signsofcapillarypulsation

Waterhammerpulse

PistolshotsoundsoverfemoralarteriesandDuroziez’murmurPeripherialVascularSigns2010ClinicalDiagnosticsAR50循環(huán)系統(tǒng)常見癥狀體征英5/8/202451循環(huán)系統(tǒng)常見癥狀體征英5/8/202452HeartFailureBriefaccount：★Incertainpathologicalcircumstances,ifcardiacoutputisbelowthelevelofadaptationtotheneedsofhumanbody,heartcannotmaintaineffectivecirculation.Thereforeaseriesofsymptomsandsignsdevelop.52循環(huán)系統(tǒng)常見癥狀體征英5/8/202453★ Classifiedasacuteandchronicheartfailureaccordingtoitsclinicalcourse.★ Classifiedasleft,rightand bilateralheartfailureaccordingtotheclinicalmanifestations.53循環(huán)系統(tǒng)常見癥狀體征英5/8/202454Leftheartfailure★ Themainpathologicalchangeispulmonarycongestion，pulmonary edemadevelopsinseverecases.54循環(huán)系統(tǒng)常見癥狀體征英5/8/202455Symptoms★Dyspnea:Exertional

dyspnea;Paroxysmalnocturnal

dyspnea;Orthopnea;Coughwithpinkfrothysputum(粉紅色

泡沫痰)inpulmonaryedema

;★

Cough

withsputum

or

cough

with

bloodstained

sputum.55循環(huán)系統(tǒng)常見癥狀體征英5/8/202456Signs★ Inspection:Tachypnea（呼吸急促）,cyanosisandorthopnea;★ Percussion:Signsofprimaryheartdiseases;56循環(huán)系統(tǒng)常見癥狀體征英5/8/2024★ Auscultation:Findingsofprimaryorganic

heart

diseases;Fastheartrateanddiastolic

galloprhythm

；

moistrales

(濕羅音)

at

the

lung

bases

;

in

pulmonary

edema

bubble

and

wheezing

rales

(哮鳴音)

over

both

lungs.5757循環(huán)系統(tǒng)常見癥狀體征英5/8/202458RightventricularfailureBriefaccount：★Themainpathologicalchangeissystemiccongestion（體循環(huán)淤血）.58循環(huán)系統(tǒng)常見癥狀體征英5/8/202459Symptoms★Edema(水腫)occursinthelowerpartofbody(abdomen,thelowerextremities).★Bloat(胃脹),nausea（惡心),anorexia(食欲不振),oliguria少尿.59循環(huán)系統(tǒng)常見癥狀體征英5/8/202460Signs★Inspection:Dilatationofthejugularvein.60循環(huán)系統(tǒng)常見癥狀體征英5/8/2024Cyanosisandedemainthelower

partof body.61循環(huán)系統(tǒng)常見癥狀體征英5/8/202462★Palpation:Enlargementofliverwithtenderness,positivehepatojugularreflux(肝頸靜脈回流征陽性).★ Percussion:Pleuraleffusion(胸腔積液)andascites(腹水);signsofprimaryheartdiseases.62循環(huán)系統(tǒng)常見癥狀體征英5/8/202463★Auscultation:Signsofprimaryheart diseases.63循環(huán)系統(tǒng)常見癥狀體征英5/8/202464PericardialeffusionBriefaccount：★Maybecausedbyinfectivepericardialchangessuchastuberculosis(肺結(jié)核)andnon-infectivepericardialchangessuchast