1、2018/7/16,1,Major Symptom and Sign of Common Disease in Circulatory System,2018/7/16,2,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.,2018/7/16,3,The high atrial
2、 pressure induces a dilatation and stasis of pulmonary vein and capillary.Pulmonary artery pressure increased gradually due to the increased pulmonary circulatory resistance.,2018/7/16,4,The right ventricle is overloaded and then the compensatory hypertrophy and dilatation occur.Right ventricular fa
3、ilure may be present finally.,2018/7/16,5,2018/7/16,6,2018/7/16,7,2018/7/16,8,Symptoms,Exhausted dyspnea(劳力性呼吸困难)Occasional paroxysmal nocturnal dyspnea(夜间阵发性呼吸困难)CoughHemoptysis(咯血),2018/7/16,9,Signs,Inspection: “Mitral Facies” may be present. The apical pulse may extend to left side.Palpation: dia
4、stolic 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.,2018/7/16,10,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 heard at a
5、pex. The opening snap may be present. The pulmonary second sound may be accentuated of splitting.,2018/7/16,11,2018/7/16,12,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 systole. The fi
6、lling degree and pressure of LA were augmented and then compensatory dilatation of LA occurs.,2018/7/16,13,LV accepts more blood flow during diastole. Over volume load results in LV hypertrophy and dilatation gradually.,2018/7/16,14,2018/7/16,15,2018/7/16,16,2018/7/16,17,Symptoms,The patient may fee
7、l no symptom for a long time.The patient has fatigue and palpitation in the early stage.Exertional dyspnea happens in the terminal stage.,2018/7/16,18,Signs,Inspection: The apical impulse is displaced to left and lower.Palpation: The precordial pulsation is forceful, sustained.Percussion: The cardia
8、c dullness extends to left and downward.,2018/7/16,19,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 sound was acce
9、ntuated.,2018/7/16,20,2018/7/16,21,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.,2018/7/16,22,The blood flow is forced under great pressure through a narrowed aortic valve from LV
10、 to the aorta. The wall of LV thicken due to increased afterload. The mean pressure of aorta decreases.,2018/7/16,23,2018/7/16,24,2018/7/16,25,2018/7/16,26,Symptom,PalpitationFatigueAngina(心绞痛)Syncope(晕厥),2018/7/16,27,Signs,Inspection: The apical impulse is exaggerated, and sometimes is displaced la
11、terally 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.,2018/7/16,28,Auscultation: A systolic murmur is heard over the right second interspace lateral to
12、 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.,2018/7/16,29,2018/7/16,30,Aortic Insufficiency,The cause of AI are rheumatic fever the commonest, arteriosclerosis, infective endocar
13、ditis(心内膜炎) and syphilis(梅毒).Augmentation of LV volume load results in LVD and relative MI.,2018/7/16,31,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.,2018/7/16,32,2018/7/1
14、6,33,2018/7/16,34,2018/7/16,35,Symptom,No symptom in early stage.The patient may feel palpitation, vertigo(眩晕) and angina in later stage.,2018/7/16,36,Signs,Inspection: Patients looks pale, the apical impulse is diffuse and displaced laterally or inferiorly.Palpation: The apical impulse is displaced
15、 laterally and inferiorly, lifting impulse may be felt.,2018/7/16,37,Percussion: The cardiac dullness is enlarged laterally and inferiorly. The “cardiac waist” is decreased. The cardiac silhouette looks like a boot.,2018/7/16,38,Auscultation: A blowing diastolic murmur is audible in the aortic area
16、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.,2018/7/16,39,2018/7/16,40,Peripheral vascular signs due to increased pulse pressure are as follow:Moving of head with each
17、 heart beat, i.e. Musset sign.Carotid pulsationCapillary pulsation, water hammer pulse, pistol shot sound and duroziez dicrotic murmur.,2018/7/16,41,Pericardial Effusion,The commonest causes of PE are inflammatory (tuberculosis or purulent disorders) and noninflammatory (rheumatism, nephrosis肾病).If
18、PE increased rapidly or gradually but massive, the elevated pressure limit the diastole, the ventricular filling and output were reduced.,2018/7/16,42,2018/7/16,43,2018/7/16,44,Symptom,The patient may complain pericardial compression, dyspnea.If the effusion compresses the neighbour organs, cough, h
19、iccup(打嗝), dysphagia(吞咽困难) may be present.There are inflammatory symptoms of fever, sweating, fatigue and chest pain.,2018/7/16,45,Signs,Inspection: The cardiac impulse decreases or disappears.Palpation: Apical pulsation reduce or absent, with fast and small pulse, paradoxical pulse may be present.P
20、ercussion: Cardiac dullness is enlarged and almost coincide with posture.,2018/7/16,46,Auscultation: A faint heart sound and sometimes pericardial friction rub may be heard. Ewarts sign is found.,2018/7/16,47,2018/7/16,48,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减弱E. 收缩期喷射音,2018/7/16,49,二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S3D. 心尖部收缩期杂音E. 心脏杂音向左腋下传导,2018/7/16,50,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,2018/7/16,51,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,2018/7/16,52,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,
