心血管病理

1、2024/3/14,1,Major Symptom and Sign of Common Disease in Circulatory System,2024/3/14,2,Mitral Stenosis,MS results from recurrent rheumatic activity.The flow of blood is damped from LA to LV in diastole, and LA pressure

2、is increased , causing LA dilatation and hypertrophy.,2024/3/14,3,The high atrial pressure induces a dilatation and stasis of pulmonary vein and capillary.Pulmonary artery pressure increased gradually due to the increas

3、ed pulmonary circulatory resistance.,2024/3/14,4,The right ventricle is overloaded and then the compensatory hypertrophy and dilatation occur.Right ventricular failure may be present finally.,2024/3/14,5,2024/3/14,6,202

4、4/3/14,7,2024/3/14,8,Symptoms,Exhausted dyspnea(勞力性呼吸困難)Occasional paroxysmal nocturnal dyspnea(夜間陣發(fā)性呼吸困難)CoughHemoptysis(咯血),2024/3/14,9,Signs,Inspection: “Mitral Facies” may be present. The apical pulse may extend t

5、o left side.Palpation: 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.,2024/3/14,10,Auscultation: A loud sn

6、appy first sound and a localized rumbling diastolicmurmur (舒張期隆隆樣雜音) in the mid-late stage may be heard at apex. The opening snap may be present. The pulmonary second sound may be accentuated of splitting.,2024/3/14,11,

7、,2024/3/14,12,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 filling degree and pressure of

8、LA were augmented and then compensatory dilatation of LA occurs.,2024/3/14,13,LV accepts more blood flow during diastole. Over volume load results in LV hypertrophy and dilatation gradually.,2024/3/14,14,2024/3/14,15,202

9、4/3/14,16,2024/3/14,17,Symptoms,The patient 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.,2024/3/14,18,Signs,Inspection

10、: The apical impulse is displaced to left and lower.Palpation: The precordial pulsation is forceful, sustained.Percussion: The cardiac dullness extends to left and downward.,2024/3/14,19,Auscultation: A grade three or

11、more pansystolic blowing murmur(全收縮期吹風(fēng)樣雜音) 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 accentuat

12、ed.,2024/3/14,20,2024/3/14,21,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.,2024/3/14,22,The blood

13、flow is forced under great pressure through a narrowed aortic valve from LV to the aorta. The wall of LV thicken due to increased afterload. The mean pressure of aorta decreases.,2024/3/14,23,2024/3/14,24,2024/3/14,25,20

14、24/3/14,26,Symptom,PalpitationFatigueAngina(心絞痛)Syncope(暈厥),2024/3/14,27,Signs,Inspection: The apical impulse is exaggerated, and sometimes is displaced laterally and inferiorly.Palpation: A systolic thrill may palpa

15、ble at the second interspace lateral to the sternal with a pulsus tardus.Percussion: The cardiac dullness maybe extends to left and downward.,2024/3/14,28,Auscultation: A systolic murmur is heard over the right second i

16、nterspace 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.,2024/3/14,29,2024/3/14,30,Aortic

17、Insufficiency,The cause of AI are rheumatic fever the commonest, arteriosclerosis, infective endocarditis(心內(nèi)膜炎) and syphilis(梅毒).Augmentation of LV volume load results in LVD and relative MI.,2024/3/14,31,The regurgitan

18、t 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.,2024/3/14,32,2024/3/14,33,2024/3/14,34,2024/3/14,35,Symptom

19、,No symptom in early stage.The patient may feel palpitation, vertigo(眩暈) and angina in later stage.,2024/3/14,36,Signs,Inspection: Patients looks pale, the apical impulse is diffuse and displaced laterally or inferiorly

20、.Palpation: The apical impulse is displaced laterally and inferiorly, lifting impulse may be felt.,2024/3/14,37,Percussion: The cardiac dullness is enlarged laterally and inferiorly. The “cardiac waist” is decreased. Th

21、e cardiac silhouette looks like a boot.,2024/3/14,38,Auscultation: A blowing diastolic murmur is audible in the aortic area or third interspace left to sternum and transmitted to apex. A rumbling murmur in eraly-mid dia

22、stole at apex may be heard due to relative MS. It is called “Austin-Flint” murmur.,2024/3/14,39,2024/3/14,40,Peripheral vascular signs due to increased pulse pressure are as follow:Moving of head with each heart beat, i

23、.e. Musset sign.Carotid pulsationCapillary pulsation, water hammer pulse, pistol shot sound and duroziez dicrotic murmur.,2024/3/14,41,Pericardial Effusion,The commonest causes of PE are inflammatory (tuberculosis or

24、purulent disorders) and noninflammatory (rheumatism, nephrosis腎病).If PE increased rapidly or gradually but massive, the elevated pressure limit the diastole, the ventricular filling and output were reduced.,2024/3/14,4

25、2,2024/3/14,43,2024/3/14,44,Symptom,The patient may complain pericardial compression, dyspnea.If the effusion compresses the neighbour organs, cough, hiccup(打嗝), dysphagia(吞咽困難) may be present.There are inflammatory sy

26、mptoms of fever, sweating, fatigue and chest pain.,2024/3/14,45,Signs,Inspection: The cardiac impulse decreases or disappears.Palpation: Apical pulsation reduce or absent, with fast and small pulse, paradoxical pulse ma

27、y be present.Percussion: Cardiac dullness is enlarged and almost coincide with posture.,2024/3/14,46,Auscultation: A faint heart sound and sometimes pericardial friction rub may be heard. Ewart’s sign is found.,2024/3/1

28、4,47,2024/3/14,48,X型題,符合二尖瓣狹窄的體征有A. 梨形心B. 收縮期隆隆樣雜音C. 開瓣音D. S1減弱E. 收縮期噴射音,2024/3/14,49,二尖瓣關(guān)閉不全時出現(xiàn)的體征有A. 心尖搏動向左下移位B. S1常減弱C. 常聽到S3D. 心尖部收縮期雜音E. 心臟雜音向左腋下傳導(dǎo),2024/3/14,50,主動脈瓣狹窄的體征有A. 心尖搏動向左下移位B. 主動脈瓣區(qū)觸及收縮期震顫C. 主