1 the main symptoms and signs of common diseases of circulatory system 1 st affiliated hospital...
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The main symptoms and signs
of common diseases of
circulatory system
1st Affiliated Hospital Liaoning Medical College
He Xin
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1、 Causes:
---RHD:rheumatic heart disease
---CHD:congenital heart disease
---Other reasons: senile retrograde
一、 Mitrial stenosis
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2、 Symptoms
---cough
---hemoptysis
---dyspnea: dyspnea on exertion→
paroxysmal nocturnal dyspnea →
pneumonedema
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3、 Signs:---Inspection
mitrial face
Apex impulse may be displaced to the left
---Palpation
diastolic thrill palpable over the apical area
---Percussion
normal heart borders→pear shape heart
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---Auscultation --the first sound (S1)↑ --diastolic murmur :apical area; localized; mild and la
tediastolic ; crescendo ; rumbling; more clearly when the patient is lying on his left side
--opening snap may be auscultatory --accentuation of second pulmonary sound (P2↑), s
plitting --Graham Steel’s murmur (PV diastolic) --Maybe atrial fibrillation(late stage)
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二、 Mitral Insufficiency1、 Causes ---RHD / non-RHD ---acute/chronic
2、 Symptoms ---fatigue ---palpitations ---dyspnea on exertion ---Left heart failure
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3、 Signs :
---Inspection apex beat is displaced downwards and to the left
---Palpitation --apical impulse forceful --Heaving apex impulse --Severe systolic thrill
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---Percussion the area of dullness to left and downwards---Auscultation --S1 ↓(attenuation) --murmurs: harsh; pansystolic murmur;
blowing; 3/6 grade ↑ wide spread-transmitted to
left axilla left infrascapularangle
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三、 Aortic Stenosis1、 Causes
--- RHD ---Congenital ---Senile retrograde
2、 Symptoms palpitation ,dizziness, angina pectoris, syncope, HF-dyspnea
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3、 Signs :---Inspection
--apical impulse increase
--Displaced to left and downwards
---Palpation
--apex beat is elevated and forceful
--systolic thrill can be palpated over aortic
auscultatory valve area
--Pulse tardus
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---Percussion the area of dullness is normal or to left and downward---Auscultation --murmur aortic auscultatory valve area systolic murmur harsh ,ejection sound ,3/6 grade↑ (thrill), transmitted to neck --A2 ↓,reversed splitting --S4
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四、 Aortic Insufficiency
1、 Causes
---RHD
---Non-RHD: congenital prolapse syphilis aortitis arteriosclerosis endocarditis
acute/chronic
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2、 Symptoms palpitation, dizziness, LHF
3、 Signs---Inspection
apical impulse to left and downwards
---Palpation
apex impulse to left and downwards
Heaving apex impulse
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---Percussion
--the area of cardiac dullness is
enlarged downwards and to the left
--the concave part of the heart is not
enlarged (boot shape)
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---Auscultation
--specific murmur
diastolic
sighing
aortic area
heard clearly sitting erect and forward
--Austin Flint murmur
relative MS
(rumbling mid-diastolic murmur)
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---Peripheral vascular signs*head bobbing (Musset’s sign):nodding
motion of the head with each systole*signs of capillary pulsation*water hammer pulse*pistol shot sounds : esp. Femoral arteries*Duroziez’s murmur*Visible pulsation of carotid arteries
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五、 Pericardial effusion
1、 Causes infective and non-infective pericarditis
2、 Symptoms pain over the pericardial region Dyspn
ea, cough, fever, lassitudeShock
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3、 Signs : ---Inspection
diminution in strength of the apex beat
or absence of the apex beat
jugular venous enlargement
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---Palpation
--diminution in strength of the apex
--beat or the apex beat palpated uneasily
paradoxical pulse may be present
---Percussion
enlargement of the cardiac dullness
bilaterally, changed with posture
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---Auscultation
--pericardial friction sound
--HR↑,diminution of intensity of cardiac
sound (S1/S2↓)
--pericardial knock may be heard
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4、 Large effusion ---Jugular varicosity ---Liver enlargement ---Paradoxical pulse ---Pulse pressure ↓ ---Kussmaul sign ---Ewart sign
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---Kussmaul sign
deep inspiration –jugular vein distension
---Ewart sign: left infrascapular region
vocal fremitus↑
dullness -- percussion
bronchovesicular breath sound--auscultation
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六、 Heart Failure
1、 Causes myopathy ; ventricular load ↑
promote factors
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2、 Symptoms ---LHF: fatigue, cough, frothy sputum
dyspnea(on exertion → orthopnea →
paroxysmal nocturnal ~)
---RHF: abdominal distension, oliguria,
nausea, vomiting
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3、 Signs :LHF:---Inspection : tachypnea , cyanosis, semireclining/sitting position
Acute pneumoedema: frothy sputum, hyperhidrosis---Palpation : pulse alternans---Percussion :---Auscultation :diastolic gallop rhythm
P2↑ Fine rales, rhonchi
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RHF---Inspection :Jugular distension
Pericardial cyanosis Edema(pitting, pendulous)
---Palpation : liver enlargement, tenderness Hepatojugular reflux(+)
---Percussion : pleural effusion (right side) ascites---Auscultation : RV diastolic gallop rhythm
TV systolic blowing murmurs
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THANK
YOU !
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