circulatory-system循环系统英文资料.ppt

Logo Anatomy Contents 1 Etiology 2 Diagnosis 3 Treatment 4 Hypertension 5 Anatomy Thecirculatorysystemconsistsoftheheart vesselsandneurohumoraladjustabledevicesofbloodcirculation Theheartafour chamberedpump Itspumpingactioncreatesthepressureneededtopushbloodinthevesselstothelungsaswellastotherestofthebodycells LocationoftheheartTheheartliesobliquelyinthemediastinum betweenthelungs insidethethoraciccavity About2 3oftheheartislocatedtotheleftofthemidline ShapeoftheheartTheheartisahollow fourchamberedmuscularorgan whichisapproximatelythesizeandshapeofaclenchedfistandweighsabout250 350ginadults GeneraldescriptionoftheheartTheheartlookslikeflattenedandroundedpyramidthathasanapex abase twosurfacesandthreeborders margins CardiacapexThecardiacapexisafree cone shapedend whichismadeuponlybytheleftventricle Thecardiacapexislocatedattheleveloftheleft5thintercostalspaceand0 5 1cmmedialtothemidclavicularline Thislocationisanimportantoneforclinicalpurposes forauscultationaswellasforpalpation Logo CardiacbaseThecardiacbaseisprimarilymadeupbytheleftatriumwithalessercontributionoftherightatrium GroovesTherearethreegroovesonthesurfaceofheart thecoronarysulcus theanteriorinterventriculargroove theposteriorinterventriculargroove ChambersoftheheartTheheartisafour chambered doublepump consistingoftherightandleftatriaaboveandtherightandleftventriclesbelow RightatriumFromtherightmarginoftheheart Receivesbloodfromthesuperiorvenacava inferiorvenacavaandcoronarysinus RightventricleBloodfromtherightatriumpassesthoughtthetricuspidvalvetofilltherightventricle Leftatriumlocatedontheposterioraspectoftheheart receivesbloodfromthepulmonaryveinLeftventricleTheleftventriclereceivesthebloodfromtheleftatrium Thesetwochambersareseparatedbythebicuspid mitral valve Structureoftheheart Structureoftheheartwallendocardiumlocatedintheinterialsurfaceheartatriumandventriclewall consistofeveryvalveoftheheart TheplaceiseasilyinvasedbyRheumaticdiseases myocardiumthemajorityoftheheartwall containsmyocardioventricleandmyocardiatrium theformeristhickerthanthelatter especiallyleftmyocardioventricle theydon tcontinueeachother epicardiumAtrialseptalventrialseptalpericardiumfibrouspericardiumandserouspericardium Conductionsystemoftheheart Itconsistsofspecialmyocardialfibers formsaknotorbundle locatesintheheartwall Thesystemhasthecharacterofgeneratingexcitement conductingimpulseandmaintainingnormalrhythmoftheheartbeat sinuatrialnodelocatesintheepicardialdeepsurfacebetweensuperiorvenacavaandrightauricle normalheartpacemaker atrioventricularnodelocatesintheendocardialdeepsurfacebetweencoronarysinusandrightatrioventricularorifice conductsimpulsefromsinuatrialnodeintocardioventriclefrom atrioventricularbundletheonlyimportantwayoflinkingtheheartatriumwithventrile itsbranches HeartVesselsArteriesandVeinsAscendingaortaSource leftventricleoftheheart branches leftandrightcoronaryartery continuesasaorticarch LeftcoronaryarterySource ascendingaorta branches anteriorinterventricularbranchesandcircumflexbranches RightcoronaryarterySource ascendingaorta branches sinoatrialnodalbranches rightmarginalbranches posteriorinterventricularbranches atrioventricularnodalbranches Coronarysinusformedbyunionofgreatcardiacveinandobliqueveinofleftatrium tributaries middlecardiacvein smallcardiacvein Pathwayofbloodcirculation systemiccirculationleftventriclecontractandejectarterialbloodintoaorta passawayitsbranchesintocapillaries exchangewithsubstancesandgasesbyproductionofdifferenttissuesorcells thentransformintoveinbloodandreturntherightatrium pulmonarycirculationrightventriclecontractandejectphelbialbloodintopulmonaryartery passawayitsbranchesintocapillaries exchangewithoxygenfromlungalveoluses thentransformintoarterialbloodandreturntheleftatrium Riskfactorsorcausesforheartdisease Smoking intemperanceHighcholesterol k lest r l hyperlipidemiaDiabetesObesity mal nutritionexercisetoolittle FamilyhistoryHypertension hypotentionCongenitalmalformationPeripheralarterydiseasevirusorbacterialinfectionpoisoningAge sexPhysiologicaldegeneration Chronicsymptoms cardicsymptomschestdistresspalpitationanginapectorispulmonarycirculationcoughexpectorationHemoptysiscyanosisdyspneasystemiccirculationfaintnessabdominaldistensionandpainvomitingoliguriaedamaheadachedizzinesstwitching Physiologicalexamination themostbasicexaminationmethod thedoctorsgetpatients relativedatasbytheireyes ears noses handsandsomesimpletools suchasstethoscope thermometer tentionmeter 1 VitalSignsheartrate pulse respiration bloodpressure2 inspectionObservedinpatientswithskincolor payattentiontowhetherpatientswithhypopneaandothersymptoms Suchasanginamaybecyanoticlips andhypertension mayappearredface Observewhethertherehaveprecardialprominenceorprecardialhassomeabnormalcardiocapexbeat Apexbeatintheleftmidclavicularlineatthefifthintercostalspaceinside0 5cm pulsatilityrangediameterofabout2 0cm 3 palpationTouchattheapexbeat recordwhethertheenhancedandweakenedapexbeat withorwithouttremor pericardialfrictionsensitivity Touchtheradialartery recordpulserate judgementifthearterialpulsationispowerfulornot includingtherhythmisornotinthelow andcomparingbothsidesaresymmetrical Determinewhetherthereispulsusparadoxus alternatingpulseorsignofcapillarypulsation etc 4 PercussionDrawtherelativecardiacdullnessbythepercussionofchest inordertodeterminewhethertheincreaseordecreaseofheart 5 auscultationListentothecardiechemaofthesevalvesbythestethooscopetodetermineiftherhythmisneatornotandtheabnormalcardiechema someimportantsigns 1 Cardiacenlargement2 Abnormalheartsoundsandpulsebeat3 Arrhythmia4 abnormalbreathsounds5 Pulmonaryrales6 hepatomegaly7 Jugularveindistention8 lowerextremityedema Laboratorytests Thedoctorsusephysical chemicalandbiologicallaboratorytechnologytotestpatients blood fluid secretionandtissue soastoobtaindataandassistdiagnosisandtreatment Routineconventionaltestsblood urine faeceroutineexaminationSpecialtests1 microbialculture infectiousheartdisease2 ASO ESR CRP rheumaticheartdisease3 lipidstests coronaryatheroscleroticheartdisease4 CK CK MB cTnT cTnI myocardialinfarctionandanginapectoris Equipmentinspection Electrocardiogramputtheelectrodeontothespecialregionsofbodysurface recordoutcontinuouscurveaboutelectricardiachargeswiththemachine mainlydiagnose ArrhythmiaandMyocardialinfarction24 hourHolter24 hourambulatorybloodpressure Echocardiographymovetheprodeontotheheartsurfaceregions observethecardiographychargesofcomputer mainlydiagnosecardiovalvularopathy angiocardiogram胸片Selectivecoronaryangiography goldstandard Classficationoftheheart EtiologyCongenitalAcquired1 Atherosclerosis2 Rheumatic3 primaryhypertention4 pulmonary5 inflectious6 endocrinopathic7 hematopathic8 Nutritionalandmetabolic9 Cardiacneurosis Pathologicalanatomy 1 Endocardiumdisease endocarditis 2 Myocardosis myocardialischemia Arrhythmia tachycardia 3 pericardialdisease hydropericardium 4 Macrovasculardisease aorticstenosis 5 congenitalmalformation Congenitalheartdisease Pathophysiology 1 heartfailure2 shock3 dysfunctionofcoronarycirculation4 dysfunctionofPapillarymuscle5 Hyperdynamiccirculation6 Cardiactamponade Diagnosis EtiologyPathologicalanatomyPathophysiologyeg Rheumaticvalvularheartdisease1 Rheumaticheartdisease2 bicuspidvalvestenosisorincompetence3 heartfailure4 atrialfibrillation Prevention 1 stopsmoking2 properrest3 moremovement4 loseweight5 decompression6 controlldiets7 healtheducation8 steadyemotion Treatment 1 releasesymptoms 1 dealwiththeemergencyconditionsacutemyocardialinfarction acuteleftheartfailure 2 keepabalanceoflifesign 3 relievepain心痛定 硝酸甘油含化片 4 swelling速尿 螺内酯 氢氯噻嗪 2 removeetiology 1 controlinfectionantibiotic抗生素NSAID非甾体类抗炎药 2 controlhighhypertentionACEI ARB CCB Diureticdrugs 3 controlhighcholesterol立普妥Inhibitionofplateletaggregationdrugs阿司匹林氯吡格雷Anticoagulantdrugs华法林Thrombolyticdrugs尿激酶 4 controlhighbloodsugaroralmedication二甲双胍insulin优泌林 3 intervention 1 Artificialpacemaker4 surgicaloperation 2 Thepercutaneouscoronaryarterybypassgrafting 5 rehabilitation exercise 1 ensuretheindicationsandcontraindications 2 choosesuitableexercisemethods mediumorlowintensityaerobicexercise suchaswalking jogging swimming taichichuanandsoon 3 masterexerciseintensity targetheartrateisoftenusedasanevaluationindex itsdefinition inexercisetest byheartratemonitormachineortouchingthepulsebeating wecanget60 to80 ofmaximumheartrate Butifthepatientcan texercise targetheartrate 170 Age Commonlywhenthepatientstopmotion thedoctorortheorpisttouchesthepulsebestingimmediatelyandlists10seconds radialartery earartery temporalartery then 6representsoneminutepulserate theresultisclosetotheheartrateofmovingexercise 4 masterexercisetime 1to3hoursafterameal readytimefor10minutes trainingtimefor20to30minutes andfinallyrelaxingtimefor10minutes 5 masterexercisefrequency Weeklyexercisefor3to5times clinicalaspectofthecirculatorysysterm atherosclerosisTheaccumulationoffattydepositswithintheliningofanarteryistermedatherosclerosis Thistypeofdeposit calledalaque beginstoformwhenavesselreceivestinyinjuries usuallyatapointofbranching Amajoyriskfactorforthedevelopmentofatherosclerosisisdyslipidemia abnormallyhighlevelsorimbalanceinlipoproteinsthatarecarriedintheblood especiallyhighlevelsofcholesterol containinglow densitylipoproteins LDL Otherriskfactorsforatherosclerosisincludesmoking hypertension poordiet inactivity stress andfamilyhistory Atherosclerosismayinvolveanyarteries butmostofitseffectsareseeninthecornaryvesselsoftheheart theaorta thecrotidarteriesintheneck andvesslesinthebrain thrombosisandembolismAtherosclerosispredisposesapersontothrombosis theformationofthrombuswithinavessle Usuallythemassisabloodclotthatbreaksloosefromthewallofavessle butitmayalsobeair fat bacteriaorothersolidmaterials Oftenaverousthrombuswilltravelthroughtheheartandthenlodgeinanarteryofthelungs resultinginalife threateningembolism Anthrombusfromacarotidarteryoftenblocksacerebralve