循环系统诊断常见症征ppt课件

1、Signs and symptoms of some common heart diseasesWei MengShanghai sixth peoples hospitalShanghai jiaotong universityContentsMitral stenosis(MS)Mitral regurgitation(MR)Aortic stenosis(AS)Aortic regurgitation(AR)Pericardial effusionHeart failure(HF)Mitral stenosisConditions causing left ventricular inf

2、low obstructionCongenitalAcquiredValvular mitral stenosisValvular mitral stenosisCor triatriatumAtrial myxomaSubvalvular ringThrombusPulmonary vein stenosisNeoplasmInfective vegetationProsthetic valve disfunctionMitral stenosisCause of MS requiring intervention(n=1050)CauseNumberpercentageRheumatic

3、fever56253.5Rheumatic equivalent13913.2Scarlet fever11110.6Infective endocarditis353.3Degenerative 282.7Congenital131.2Others16215.5Pathophysiology of Mitral stenosisLV inflow obstruction Left atrial pressure Lung congestionO2 supply shortage pulmonary A & V hypertension(RHF hemoptysisleft atrial en

4、largementAtrial fibrillationthrombosis & embolismhoarsenessCommon Symptoms of Mitral stenosisAsymptomaticsExertional dyspnea, paroxysmal nocturnal dyspnea, orthopneaPalpitation due to arhythmiaMiscellaneousHemoptysis, blood-tinge sputum, pink frothy sputum, chest pain, mitral facies, Cough, hoarsene

5、ss, dysphagiaRelation between dyspnea and MVA ClassMVA(cm2)manifestationminimal2.5noneMild1.42.5Minimal dyspnea with marked exertionModerate1.0-1.4Dyspnea,orthopnea, paroxysmal nocturnal dyspnea,pulmonary edemaSevere 10mmHg. Ewart sign left lower lobe lung become nullnessengorgement of jugular vein,

6、 positive sign of hepatojugular refluxPericardial taponadeCirculation collapse or shock caused by rapid or large volume fluid accumulationHR , BP decreased, pulsus paradoxus, jugular vein pressure Extremities are cold and wetDyspnea, restlessness, diminished response , unconsciousnessPulse pressure

7、diminishedHeart failureA complex clinical syndrome in which the heart is incapable of maintaining a cardiac output adequate to accommodate metabolic requirements and the venous return.Etiology of Heart FailureWhat causes heart failure?The loss of a critical quantity of functioning myocardial cells a

8、fter injury to the heart due to:Ischemic Heart Disease Hypertension Idiopathic CardiomyopathyInfections (e.g., viral myocarditis, Chagas disease)Toxins (e.g., alcohol or cytotoxic drugs) Valvular Disease Prolonged ArrhythmiasVolume OverloadPressure OverloadLoss of MyocardiumImpaired ContractilityLV

9、DysfunctionEF 40% Cardiac OutputHypoperfusion End Systolic Volume End Diastolic Volume Pulmonary Congestion Left Ventricular Dysfunction30%70%Diastolic DysfunctionSystolic Dysfunction(EF 40 %)Left Ventricular DysfunctionSystolic: Impaired contractility/ejectionApproximately two-thirds of heart failu

10、re patients have systolic dysfunction1Diastolic: Impaired filling/relaxation1 Lilly, L. Pathophysiology of Heart Disease. Second Edition p 200Hemodynamic Basis forHeart Failure SymptomsLVEDP Left Atrial Pressure Pulmonary Capillary Pressure Pulmonary CongestionLeft Ventricular DysfunctionSystolic an

11、d DiastolicSymptomsDyspnea on ExertionParoxysmal Nocturnal DyspneaTachycardiaCoughHemoptysisPhysical SignsBasilar RalesPulmonary EdemaS3 GallopPleural EffusionCheyne-Stokes RespirationRight Ventricular FailureSystolic and DiastolicSymptomsAbdominal PainAnorexiaNauseaBloatingSwellingPhysical SignsPer

12、ipheral EdemaJugular Venous DistentionAbdominal-Jugular RefluxHepatomegalyNew York Heart Association Functional ClassificationClass I:No symptoms with ordinary activityClass II:Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation

13、, dyspnea, or anginaClass III:Marked limitation of physical activity. Comfortable at rest, but less than ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal painClass IV:Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency may be

14、 present even at restHF Classification: Evolution and Disease ProgressionFour Stages of HF (ACC/AHA Guidelines):Stage A: Patient at high risk for developing HF with no structural disorder of the heartStage B: Patient with structural disorder without symptoms of HFStage C: Patient with past or current symptoms of HF associated with underlying stru