心血管病理2ppt课件

* 1Major Symptom and Sign of Common Disease in Circulatory System* 2Mitral 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.* 3 The high atrial pressure induces a dilatation and stasis of pulmonary vein and capillary. Pulmonary artery pressure increased gradually due to the increased pulmonary circulatory resistance.* 4 The right ventricle is overloaded and then the compensatory hypertrophy and dilatation occur. Right ventricular failure may be present finally.* 5* 6* 7* 8Symptoms 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 )* 9Signs Inspection: “Mitral Facies” may be present. The apical pulse may extend to 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.* 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 apex. The opening snap may be present. The pulmonary second sound may be accentuated of splitting. * 11* 12Mitral 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 LA were augmented and then compensatory dilatation of LA occurs.* 13 LV accepts more blood flow during diastole. Over volume load results in LV hypertrophy and dilatation gradually.* 14* 15* 16* 17Symptoms 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.* 18Signs Inspection: 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.* 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 accentuated.* 20* 21Aortic 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. * 22 The blood 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.* 23* 24* 25* 26Symptom Palpitation Fatigue Angina(心绞痛 ) Syncope(晕厥 )* 27Signs Inspection: The apical impulse is exaggerated, and sometimes 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.* 28 Auscultation: A systolic murmur is heard over the right second interspace 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. * 29* 30Aortic Insufficiency The caus