循环系统诊断常见症征

SignsandsymptomsofsomecommonheartdiseasesWeiMengShanghaisixthpeople’shospitalShanghaijiaotonguniversityContentsMitralstenosis(MS)Mitralregurgitation(MR)Aorticstenosis(AS)Aorticregurgitation(AR)PericardialeffusionHeartfailure(HF)MitralstenosisConditionscausingleftventricularinflowobstructionCongenitalAcquiredValvularmitralstenosisValvularmitralstenosisCortriatriatumAtrialmyxomaSubvalvularringThrombusPulmonaryveinstenosisNeoplasmInfectivevegetationProstheticvalvedisfunctionMitralstenosisCauseofMSrequiringintervention(n=1050)CauseNumberpercentageRheumaticfever56253.5Rheumaticequivalent13913.2Scarletfever11110.6Infectiveendocarditis353.3Degenerative282.7Congenital131.2Others16215.5PathophysiologyofMitralstenosisLVinflowobstructionLeftatrialpressureLungcongestionO2supplyshortagepulmonaryA&Vhypertension(RHFhemoptysisleftatrialenlargementAtrialfibrillationthrombosis&embolismhoarsenessCommonSymptomsofMitralstenosisAsymptomaticsExertionaldyspnea,paroxysmalnocturnaldyspnea,orthopneaPalpitationduetoarhythmiaMiscellaneousHemoptysis,blood-tingesputum,pinkfrothysputum,chestpain,mitralfacies,Cough,hoarseness,dysphagiaRelationbetweendyspneaandMVAClassMVA(cm2)manifestationminimal2.5noneMild1.4~2.5MinimaldyspneawithmarkedexertionModerate1.0-1.4Dyspnea,orthopnea,paroxysmalnocturnaldyspnea,pulmonaryedemaSevere1.0RestingdyspneaSignsofMitralstenosisInspectionMitralfacies,increasedimpulseatprecardialarea&/orwithlocalelevationofthethoraciccavity,thoseduetorightheartfailurePalpationApicalimpulseisnormalordecreasedRightventricularheaveispresentifwithpulmonaryhypertensionApicaldiastolicthrillmaybepresentSymptomsofMitralstenosisPercussionDullnessareaoftheheartshiftstowardtheleftatwaistoftheheartaswellastowardtherightifmarkedenlargementofrightheartAuscultationLouds1OpeningsnapDiastolicrumble,nearapexLoudP2withorwithoutsplitGrahamsteelmurmurMurmurofTRIrregularrhythmSymptomsofMitralstenosisSymptomsduetochronicHFEdema,Effusion,Hepatomegaly,Jaundice,WetRalesCachexiaMitralregurgitationEtiologyofMR(1)OrganicMRRheumaticheartdiseaseMyxomatouschanges(mitralvalveprolapse)InfectiousendocarditisChordalraptureordysfunctionofpapillarymusclesCollagenvasculardiseaseTrauma:pentratingornonpeneratingMitralregurgitationEtiologyofMR(2)FunctionalMRCoronaryheartdiseaseHypertrophiccardiomyopathyDilatedcardiomyopathyLeftatrialdilatationPathophysiologyofMRPreloadincreasecausedbybloodreturntotheleftventriclefromLAIncreasedleftatrialvolume&pressureDiastolicvolumeaugmentationVentricularcontractionincreasecompensately(Frank-Starlingmechanism)Ventricularremodelingprogressively(heartfailureeventually)SymptomsofMRAsymptomaticDyspneaonexertion,cough,progressingparoxysmalnocturnaldyspnea,orthopneaultimately,evenacutepulmonaryedema(lessthanMS)FatiguePalpitationduetoarhythmiaAtypicalchestpain,inappropriatesympatheticnervesystemactivation,panicattack(ofteninvalveprolaps)SignsofMR(1)InspectionSomehavingincreasedimpulseoftheapexPalpationEnhancedapicalimpulseistotheleftlowerPercussionDullnessareaoftheheartshiftstowardtheleftlowerSymptomsofMR(2)Auscultation(1)NormalormuffledS1,P2ifpulmonarypressurehighS3iscommon,notalwaysindicatingHFHolosytolicmurmurisclassicalattheapex,radiatingtotheaxillaeventheback,thebaseoftheheart.MurmuratlatesystoliccanbeheardatthevalveprolapseoratmildMRSymptomsofMR(3)Auscultation(2)Music-likemurmurcanbeheardatsevereMR,atthevalveprolapseMidsystolicclickwithorwithoutmurmurpresentsatthevalveprolapseOccasionallydiastolicrumblingcanbeheardatsevereMRbecauseofrelativeMSNomurmurcanbeheardatmildevenmoderateMRsometimeAorticstenosisEtiologyCongenitalBicuspidvalve(verycommon)Fusionofthevalveleaflet(rare)DegenerationRheumaticfeverOthersSLE,ochronosis,severefamilialhyper-cholesterolemiaPathophysiologyofASAfterloadofleftventricleincreasedLVhypertrophy,ischemiaCompliance,LAlarge&pressurehighLowcardiacoutputInsufficientbloodsupplytoheart,brain,kidney,etcSymptomsofAS(1)AsymptomaticAnginawithorwithoutcoronaryarterystenosisTypicalchestpainlikeeffortanginaAtypicalchestpainSyncope,usuallyoneffortHeartfailure,diastoliccommon,ComplaintrelatedtoLow(output)BPsignsofAS(1)InspectionPale,carotidpulsationweakenApicalimpulseincreasedOccasionalimpulsecausedbyS4canbeseenPalpationCarotidupstrokelowinvolumeanddelayedForcefulandsustainedapexbeatOccasionaloscillationcausedbyS4ThrillintheaorticareaPercussiondullnessareaoftheheartshiftingleftlowerSymptomsofAS(2)AuscultationReducedandeveninaudibleA2,paradoxicsplittingP2increasedinpulmonaryhypertensionEjectionmurmurradiatingtothecarotidarterieswithorwithoutthrillintheaorticareaS4causedbyatrialkickagainstthestiffventricleS3inadvancedstageDifferentiationofsystolicmurmurFlowTRASMR/VSDMVPHOCMinspiration-or____Stand___Squat___ValsalvaHandgrip__postpvcEtiologyofAR(1)AorticcupsabnormalitiesRheumaticfeverInfectiousendocarditisNon-specificinflammation:SLE,rheumatoidarthritis,Behcet’ssyndromeDegenerative:myxomatouschange,calcificationOthers:tra