循环系统常见症状体征_重庆医大《检体诊断学》课件（可编辑）

循环系统常见症状体征_重庆医大《检体诊断学》课件 图 二尖瓣面容和梨形心 主动脉 瓣狭窄(aortic stenosis, AS) Brief account: Mainly caused by rheumatic fever. Idiopathic，calcific aortic stenosis is a degenerative desorder common in the elderly . IT may occur in younger patients with a congenitally bicuspid valve. (先天性畸形) Pathophysiology Aortic stenosis LV outflow obstruction ?LV systolic pressure ?LVdiastolic pressure ? cardiac output ?LV mass ?diastolic time LV dysfuction ? myocardial O2 supply cerebral ischemia myocardial ischemia LV failure symptoms In the early stage, the patients remains asymptomatic. The symptoms occur late after years of obstruction. symptoms Angina pectoris it is commonly precipitated by exertion and relieved by rest. Syncope is typically exertional and may be due to arrhythmias , hypotension, or decreased cerebral perfusion resulting from increased blood flow to exercising muscle without compensatory increase in cardiac output. Dyspnea relatively late symptoms exertional dyspnea with orthopnea, paroxysmal nocturnal dyspnea, and pulmonary edema reflect varying degrees of pulmonary venous hypertension. signs Inspection: The apex beat displaces to left and below 左下 . Percussion: The cardiac dullness may be normal or shifts to left and below. palpation The apical impulse is forceful. 心尖搏动有力， 抬举样 A systolic thrill is palpated in the second left intercostal space on right side of the sternum . Auscultation The systolic ejection murmur，harsh and rasping 收缩期粗糙喷射样 may be heard at the aortic area transmitted to the neck. A weak A2 , or paradoxical splitting S2 is present. sometimes S4 is prominent at the apex because atrial contraction is vigorous. ? In AR blood returning to LV can lift up leaflets of mitral valve relative mitral stenosis. ? Blood returning to LV DBP pulse pressure 脉压加大) peripherial vascular signs ( 周围血管征). DBP insufficient blood of coronary artery (冠状动脉 供血不足) Cyanosis and edema in the lower part of body. * * * * * * * * * * * * ? * * * * * * * * * * * * * * * * * * * * * * Signs ? Percussion: The cardiac dullness may be the shape of a boot(靴形心). * Signs ? Auscultation: ? Sighing diastolic decrescendo murmur 舒张期叹气样递减杂 音 may be heard over the 2nd aortic area. * Signs ? Auscultation: ? A rumbling mid-diastolic murmur which is caused by relative mitral stenosis and called Austin-Flint murmur 主动脉瓣关闭不全时回流血液限制二尖瓣开 放所 致) may be heard over the apex area. * Signs ? Peripherial vascular signs: caused by increased pulse pressure ? head bobbing , ? visible pulsation of carotid arteries(颈动脉搏 动明显), ? signs of capillary pulsation ; ? water hammer pulse ; ? pistol shot sounds over femoral arteries and Duroziez’ murmur. * Heart Failure 心力衰竭 Brief account: ? In certain pathological circumstances, if cardiac output is below the level of adaptation to the needs of human body, heart cannot maintain effective circulation. Therefore a series of symptoms and signs develop. * Brief account: ? Classified as acute and chronic heart failure according to its clinical course. ? Classified as left, right and bilateral heart failure according to the clinical manifestations. * Left heart failure 左心衰 Brief account: ? The main pathological change is pulmonary congestion(肺淤血)， pulmonary edema develops in severe cases. * Symptoms ? Dyspnea : ? Exertional dyspnea; ? Paroxysmal nocturnal dyspnea; ? Orthopnea 端坐呼吸 ; ? Cough with pink frothy sputum 粉红色 泡沫痰 in pulmonary edema ; ? Cough with sputum or cough with blood stained sputum 痰中带 血). * Signs ? Inspection: Tachypnea(呼吸 急促), cyanosis and orthopnea 端坐呼吸 ; ? Percussion : Findings of respective organic heart diseases; * Signs ? Auscultation: ? Findings of primary organic heart diseases; ? Fast heart rate and diastolic gallop rhythm 舒张期奔马律， 心肌严重损害的体征); moist crackles 湿罗音 at the lung bases 肺底部 ; in pulmonary edema crackles and wheezing rales over both lungs. 肺水肿时,双肺满布 湿罗音和哮鸣音 * Right ventricular failure 右心衰竭) Brief account: ? The main pathological change is systemic congestion(体循 环淤血). * Symptoms ? Edema 水肿 occurs in the lower part of body abdomen, the lower extremities . ? Bloat 胃胀 , nausea 恶心 , anorexia 食欲不振 , oliguria 少尿. * Signs ? Inspection: Dilatation of the jugular vein 颈静脉充盈或怒张 ; * Signs ? Palpation: Enlargement of liver with tenderness 肝脏增大和压痛 , positive hepatojugular reflux 肝颈静脉回流征阳性 . ? Percussion: Pleural effusion 胸腔积液 and ascites 腹水 ; signs of primary heart diseases. * Signs ? Auscultation: Signs of primary heart diseases. * Pericardial effusion 心包积液 Brief account: ? May be caused by infective pericardial changes such as tuberculosis 肺结核 and non- infective pericardial changes such as tumor. * Symptoms ? Sensation of pressing or pain over the precordial region(心前区压迫感或疼痛); ? Dyspnea, palpitation(心悸 , abdominal distension (腹胀)or edema . * Signs ? Inspection: ? Dyspnea; ? Dilatation of the jugular vein ; ? Diminution in strength of the apex beat or absence of the apex beat weak and undetectable cardic pultation ; * Signs ? Palpation: ? Diminution in strength of the apex beat; ? Rapid and weak pulse(脉搏快而弱)or paradoxical pulse(奇脉)in large effusion. ? enlargement of liver with tenderness, positive hepatojugular reflux 肝颈静脉回流征阳 性 . * Signs ? Percussion: ? Enlargement of cardiac dullness bilaterally; Heart border changes according to body’s position (心界随体 位变化而改变)--it becomes triangular in sitting position and the widening of base of heart in recumbent position (坐位时心尖部增宽， 卧位时心底部增宽). * Signs ? Auscultation: ? Little effusion--- pericardial friction sound(心包摩擦音); ? Large effusion--- fast heart rate, diminution of intensity of heart sounds remote heart sounds，心音弱而遥远 , * Thank you ! * * * * * * * * * * Main symptoms and signs of common diseases of circulatory system 李 骊 华 * Mitral Stenosis MS 二尖瓣狭窄 Brief account: Predominantly caused by rheumatic fever(风湿热). * In MS blood flow from left atrium LA to left ventricle LV impeded compensatory dilation of LA (代偿期) pressure in LA rises (左 房失代偿) dilation and congestion of pulmonary veins and capillaries. increase in resistance of pulmonary circulation pulmonary hypertension right ventricular hypertrophy right heart failure.(右心衰竭期) diastole Pathophysiology * Symptoms 1. Exertional dyspnea 劳力性呼吸 困难 , paroxysmal nocturnal dyspnea , 夜间阵发性呼吸困难 ,orthopnea 端坐 呼吸, or pulmonary edema 肺水肿 . 2. cough 3. hemoptysis 咯血) * Symptoms dyspnea: dyspnea is defined as an abnormally uncomfortable awareness of breathing; it is one of the principal symptoms of cardiac and pulmonary disease. * Signs Inspection: ? Mitral faces 二尖瓣面容) In severe case of mitral stenosis MS , patients show malar flush and lip cyanosis，we call it mitral faces. ? Apex beat displaced to left 右心室增大). * Signs Palpation: ? Diastolic thrill over apical area 心 尖区舒张期震颤). Percussion: ? Cardiac dullness becomes pear shaped 梨形心，肺动脉段、左心耳增大 . * the diastolic murmur of MS is a low pitched, rumbling murmur,best heard at the apex . resume presystole brief * Signs Auscultation: ? Mid and late diastolic crescendo rumbling murmur over apical area 心尖区舒张中晚期、递增、 隆隆样杂音); ? Accentuated S1 over apical area(心尖区 S1亢进) ? Opening snap(开瓣音 ; ? S2 Splitting or accentuated 通常分裂 A2P2, P2亢进) ? Graham Steell murmur. (肺动脉瓣区叹气样舒张早期杂音,肺动脉扩张导致相对性关闭不全 所致的功能性杂音 * Mitral Regurgitation MR 二 尖瓣关闭不全 Brief account: ? Mainly caused by rheumatic fever; ? Other causes include mitral valve prolapse 脱垂 , ischemic heart disease with papillary muscle dysfunction(乳 头肌功能失调), et al. * Pathophysiology In MR part of blood in LV returns to LA LA contains more blood and its pressure increases(左房充盈度和压力均增加) compensatory dilation of LA; In MR LV receives both normal content of blood of LA and the reguigitant blood from LV to LA volume load of LV increases compensatory LV dilation. systole diastole * Pathophysiology 左室持续严重的过度负荷 Left heart failure 左心衰 LV end diastolic pressure and LA pressure increases (左室舒末压和左房压 ) pulmonary congestion 肺淤血) pulmonary hypertension(肺动脉高压) right heart failure.(右心衰) * Symptoms ? Early stage: no subjective symptoms(asymptomatic) ; ? Late stage: heart failure palpitation, cough, Exertional dyspnea 劳力性呼吸困难, lassitude 疲乏无力 secondary to a low cardiac output * Signs ? Inspection: Apex beat displaced to left and downwards 左心室增大). ? Palpation: Apex beat displaced to left and downwards， heaving apex impulse (抬举样心尖搏动). * Signs ? Percussion: The area of cardiac dullness shifts to left and downwards at first and also to right later(左 右心室均增大). * Signs Auscultation: ? Over apical area， harsh blowing pansystolic murmur(心尖区粗糙吹风样 全收缩期杂音 , widely spread, transmitting to left infra scapular angle(肩胛角); ? S1 is weakened and P2 is accentuated and split. 图 主动脉瓣和冠状动脉开口示意图 * Aortic regurgitation AR (主动脉瓣关闭不全) Brief account: ? Mainly caused by rheumatic fever; ? Sometimes caused by non-rheumatic fever such as infective endocarditis 感染性心内膜炎 , congenital valve deformity(先天性畸形), valve prolapse(瓣膜脱垂 ); syphilis 梅毒). * Pathophysiology ? In AR LV receives blood both coming from LA and the returning from aorta blood volume in LV increases compensatory LV dilatation left heart failure. diastole * Symptoms ? No symptoms in the early stage. ? Palpitation, fatigue 疲 劳 , dizziness头晕, angina pectoris 心绞痛, exertional dyspnea. * Signs ? Inspection: The patient’s face may be pale; apex beat displaced downwards and to left 左室增大 . * Signs ? Palpation: Apex beat is rather diffuse and displacs to downwards and left; heaving apex impulse 抬举样心尖搏动 . * * * * * * * * * * * * * * * * * * * * * ? * * * * * * * * * * * * * * * * * * * * *