1、2018/9/26,1,Major Symptom and Sign of Common Disease in Circulatory System,2018/9/26,2,Mitral Stenosis,MS results from recurrent rheumatic activity. The flow of blood is damped from LA to LV in diastole, and LA pressure is increased , causing LA dilatation and hypertrophy.,2018/9/26,3,The high atria
2、l pressure induces a dilatation and stasis of pulmonary vein and capillary. Pulmonary artery pressure increased gradually due to the increased pulmonary circulatory resistance.,2018/9/26,4,The right ventricle is overloaded and then the compensatory hypertrophy and dilatation occur. Right ventricular
3、 failure may be present finally.,2018/9/26,5,2018/9/26,6,2018/9/26,7,2018/9/26,8,Symptoms,Exhausted dyspnea(劳力性呼吸困难) Occasional paroxysmal nocturnal dyspnea(夜间阵发性呼吸困难) Cough Hemoptysis(咯血),2018/9/26,9,Signs,Inspection: “Mitral Facies” may be present. The apical pulse may extend to left side. Palpati
4、on: diastolic thrill may be felt at apex. Percussion: The cardiac dullness extend to left in early stage and later to right. The cardiac silhouette is like a pear.,2018/9/26,10,Auscultation: A loud snappy first sound and a localized rumbling diastolicmurmur (舒张期隆隆样杂音) in the mid-late stage may be he
5、ard at apex. The opening snap may be present. The pulmonary second sound may be accentuated of splitting.,2018/9/26,11,2018/9/26,12,Mitral Insufficiency,The main cause of MI is rheumatism, and MI may be produced by LV dilatation due to any cause. The blood regurgitation into LA from LV during systol
6、e. The filling degree and pressure of LA were augmented and then compensatory dilatation of LA occurs.,2018/9/26,13,LV accepts more blood flow during diastole. Over volume load results in LV hypertrophy and dilatation gradually.,2018/9/26,14,2018/9/26,15,2018/9/26,16,2018/9/26,17,Symptoms,The patien
7、t may feel no symptom for a long time. The patient has fatigue and palpitation in the early stage. Exertional dyspnea happens in the terminal stage.,2018/9/26,18,Signs,Inspection: The apical impulse is displaced to left and lower. Palpation: The precordial pulsation is forceful, sustained. Percussio
8、n: The cardiac dullness extends to left and downward.,2018/9/26,19,Auscultation: A grade three or more pansystolic blowing murmur(全收缩期吹风样杂音) may be heard and transmitted to the left axilla and scapular region. The first heart sound is decreased and masked by the murmurs. The pulmonary second heart s
9、ound was accentuated.,2018/9/26,20,2018/9/26,21,Aortic Stenosis,The valvular deformity in aortic stenosis may be the result of rheumatic fever but also occur on the basis for a congenital defect or atherosclerosis.,2018/9/26,22,The blood flow is forced under great pressure through a narrowed aortic
10、valve from LV to the aorta. The wall of LV thicken due to increased afterload. The mean pressure of aorta decreases.,2018/9/26,23,2018/9/26,24,2018/9/26,25,2018/9/26,26,Symptom,Palpitation Fatigue Angina(心绞痛) Syncope(晕厥),2018/9/26,27,Signs,Inspection: The apical impulse is exaggerated, and sometimes
11、 is displaced laterally and inferiorly. Palpation: A systolic thrill may palpable at the second interspace lateral to the sternal with a pulsus tardus. Percussion: The cardiac dullness maybe extends to left and downward.,2018/9/26,28,Auscultation: A systolic murmur is heard over the right second int
12、erspace lateral to the stenum and radiated widely. The murmur is loud, harsh, and usually has a crescendo-decrescendo charter. A reversed splitting of the second sound is usually seen.,2018/9/26,29,2018/9/26,30,Aortic Insufficiency,The cause of AI are rheumatic fever the commonest, arteriosclerosis,
13、 infective endocarditis(心内膜炎) and syphilis(梅毒). Augmentation of LV volume load results in LVD and relative MI.,2018/9/26,31,The regurgitant jet hits AMV and causes it moving toward LA during diastole, result in relative MS. The diastolic pressure is decreased causing an increase in pulse pressure.,2
14、018/9/26,32,2018/9/26,33,2018/9/26,34,2018/9/26,35,Symptom,No symptom in early stage. The patient may feel palpitation, vertigo(眩晕) and angina in later stage.,2018/9/26,36,Signs,Inspection: Patients looks pale, the apical impulse is diffuse and displaced laterally or inferiorly. Palpation: The apica
15、l impulse is displaced laterally and inferiorly, lifting impulse may be felt.,2018/9/26,37,Percussion: The cardiac dullness is enlarged laterally and inferiorly. The “cardiac waist” is decreased. The cardiac silhouette looks like a boot.,2018/9/26,38,Auscultation: A blowing diastolic murmur is audib
16、le in the aortic area or third interspace left to sternum and transmitted to apex. A rumbling murmur in eraly-mid diastole at apex may be heard due to relative MS. It is called “Austin-Flint” murmur.,2018/9/26,39,2018/9/26,40,Peripheral vascular signs due to increased pulse pressure are as follow: M
17、oving of head with each heart beat, i.e. Musset sign. Carotid pulsation Capillary pulsation, water hammer pulse, pistol shot sound and duroziez dicrotic murmur.,2018/9/26,41,Pericardial Effusion,The commonest causes of PE are inflammatory (tuberculosis or purulent disorders) and noninflammatory (rhe
18、umatism, nephrosis肾病). If PE increased rapidly or gradually but massive, the elevated pressure limit the diastole, the ventricular filling and output were reduced.,2018/9/26,42,2018/9/26,43,2018/9/26,44,Symptom,The patient may complain pericardial compression, dyspnea. If the effusion compresses the
19、 neighbour organs, cough, hiccup(打嗝), dysphagia(吞咽困难) may be present. There are inflammatory symptoms of fever, sweating, fatigue and chest pain.,2018/9/26,45,Signs,Inspection: The cardiac impulse decreases or disappears. Palpation: Apical pulsation reduce or absent, with fast and small pulse, parad
20、oxical pulse may be present. Percussion: Cardiac dullness is enlarged and almost coincide with posture.,2018/9/26,46,Auscultation: A faint heart sound and sometimes pericardial friction rub may be heard. Ewarts sign is found.,2018/9/26,47,2018/9/26,48,X型题,符合二尖瓣狭窄的体征有 A. 梨形心 B. 收缩期隆隆样杂音 C. 开瓣音 D. S1减
21、弱 E. 收缩期喷射音,2018/9/26,49,二尖瓣关闭不全时出现的体征有 A. 心尖搏动向左下移位 B. S1常减弱 C. 常听到S3 D. 心尖部收缩期杂音 E. 心脏杂音向左腋下传导,2018/9/26,50,主动脉瓣狭窄的体征有 A. 心尖搏动向左下移位 B. 主动脉瓣区触及收缩期震颤 C. 主动脉瓣区舒张期喷射性杂音 D. 第一心音亢进 E. 第二心音亢进,2018/9/26,51,支持主动脉瓣关闭不全的是 A. 心尖搏动向左下移位 B. 脉压差减小 C. 二尖瓣区喷射性杂音 D. 主动脉瓣第二听诊区舒张期叹气样杂音 E. 水冲脉,2018/9/26,52,心包积液者可查出 A. 心尖搏动明显减弱 B. 心脏叩诊呈靴形 C. 心音遥远 D. 脉压增大 E. Ewart征阳性,
