[教育]循环系统障碍Commonsymptomsandsignsofcirculationsystem
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A2 enhancement in: Hypertension Aortic atherosclerosis
• factors that weaken S2
❖P2 weakened in pulmonary valve lesions ❖A2 weakened in aortic lesions
•expiratio n
•Common symptoms of heart disease——cough
•Cause
Cardiogenic factors: cardiac dysfunction pulmonary embolism, etc
Non-cardiogenic factors: respiratory system disease central cough
• Right ventricular enlargement
• Right ventricular enlargement Apex pulse: • left-shift
•Precordium : lifting type impulse
•Subxyphoid apex pulse:
common in pulmonary emphysema with right ventricular enlargement
[教育]循环系统障碍 Commonsymptomsan dsignsofciຫໍສະໝຸດ culationsystem
Common symptoms of heart disease
Chest Pain Dyspnea Palpitation Syncope Edema Cyanosis
Common symptoms of heart disease——chest pain •Cause:
•1 •2
•1 •A2P2
•1 •P2A2
•inspiration
•general Splitting •1 •A2P2
•fixed splitting
•1 •A2P2
•reversed splitting
•1
•2
Extral sound
❖gallop rhythm ❖ opening snap ❖abnormal heart sounds after prosthetic valve
•Common symptoms of heart disease——edema
Cause Systemic edema cardiac nephrogenic hepatic Other reasons
Local edema Local inflammation Venous reflux obstruction, etc
•Common symptoms of heart disease—— Palpitation
•Common cause:
heartthrob enhance arrhythmia tachycardia bradycardia arrhythmia cardiac neurosis
•Common symptoms of heart disease—— Palpitation
•Protrusion of precordium:
onset during childhood
•Cardiac dullness border: left enlargement
•pear-shaped heart mitral (valve) stenosis
•boot-shaped heart aortic insufficiency
•Common symptoms of heart disease——cyanosis
•Keypoints of inquiry
❖1,Onset age ❖2,Heart and lung disease history ❖3,Accompanied symptoms
•Heart sign
Ventricular enlargement signs Heart rate and rhythm change Heart sound change Heart murmur Other important signs
position, movement or some drugs
•Cardiac auscultation region
•Common symptoms of heart disease——edema
•Keypoints of inquiry ❖1,Past history ❖2,Starting position ❖3,Accompanied symptoms
•Common symptoms of heart disease——cyanosis
•upright positin
•lying position
• hydropericardium
Heart rate and rhythm change
Fast and regular: sinus tachycardia, paroxysmal tachycardia
Slow and regular: sinus bradycardia, conduction block of level III with escape rhythm
•Other
•Common symptoms of heart disease——syncope
•keypoints of inquiry
❖1, Attack position ❖2, Precipitating factor ❖3, Symptoms before the attack ❖4, Accompanied symptoms
listenning content of cardiac murmur
❖ location ❖ time ❖conduction of murmur ❖tones of murmur ❖loudness of murmur ❖relationship between murmur and breathing,
•Others:
•Common symptoms of heart disease——dyspnea
•keypoints of inquiry
❖1, acute or chronic ❖2, relationship with position and movement ❖3, accompanied symptoms
• factors that enhance S1
Mitral stenosis Tachycardia High CO
• factors that weaken S1
❖Mitral valve insufficiency ❖Atrioventricular block level I ❖Myocardial damage
•keypoints of inquiry
❖1, precipitating factor ❖2, accompanied symptoms ❖3, primary disease
•Common symptoms of heart disease——syncope
•Cause Cardiogenic Cardiac output block Arrhythmia
relative valvular insufficiency
shunt of large blood vessels or chambers of heart
intracardiac floaters
Heart murmurs mechanism
❖1.Blood flow speedy ❖2. Valvular lesions ❖3. Large blood vessels or cardiac enlargement ❖4. Shunt ❖5. Intracardiac floaters
•bottom
•apex •left edge of sternum and apex region
factors that affect S1
Integrity of atrioventricular valve Activity of atrioventricular valve Ventricular systolic rate(dp/dt)
replacement
gallop rhythm
❖mid-diastolic gallop ❖presystolic gallop ❖quadruple rhythm
opening snap
❖Meaning: mitral stenosis ❖ Mechanism
abnormal heart sounds after prosthetic valve replacement
Arrhythmia: sinus arrhythmia, premature beat, conduction block above II, atrial fibrillation
•S •S2
1
•normal
•bottom
•apex
•S1 enhance •S1 recede •S1 division
•• Left ventricular enlargement
• Left ventricular enlargement
Apex pulse: •lower-left shift •Apex pulse greater than 2 cm range:
•The apex : lifting type impulse •Cardiac dullness border: •lower-left enlargement
•cardiogenic： AP AMI Acute pericarditis Cardiac neurosis
•other
Common symptoms of heart disease——chest pain
•keypoints of inquiry ❖1, location ❖2, nature and degree ❖3, duration ❖4, incentive ❖5, reliever ❖6, radiation ❖7, accompanied symptoms
•Common symptoms of heart disease——dyspnea
•Cause
Cardiac factors: cardiac dysfunction, pericardial tamponade, etc. Non-cardiac factors: disease of respiratory system, disease of blood system, etc.
Cause: Central cyanosis: cardiovascular pulmonary
Mixed cyanosis: Cardiac dysfunction Abnormal hemoglobin derivant
Peripheral cyanosis: Relative increase of peripheral oxygen consumption Arterial ischemia
speedy blood flow
stenosis of valve opening or blood vessel
relative stenosis caused by ventricular enlargement or large blood vessels dilation
valvular insufficiency
factors that affect S2
Aortic and pulmonary artery pressure Integrity and elasticity of semilunar valve
• factors that enhance S2
P2 enhancement in: Pulmonary hypertension Pulmonary circulation congestion
• factors that weaken S2
❖P2 weakened in pulmonary valve lesions ❖A2 weakened in aortic lesions
•expiratio n
•Common symptoms of heart disease——cough
•Cause
Cardiogenic factors: cardiac dysfunction pulmonary embolism, etc
Non-cardiogenic factors: respiratory system disease central cough
• Right ventricular enlargement
• Right ventricular enlargement Apex pulse: • left-shift
•Precordium : lifting type impulse
•Subxyphoid apex pulse:
common in pulmonary emphysema with right ventricular enlargement
[教育]循环系统障碍 Commonsymptomsan dsignsofciຫໍສະໝຸດ culationsystem
Common symptoms of heart disease
Chest Pain Dyspnea Palpitation Syncope Edema Cyanosis
Common symptoms of heart disease——chest pain •Cause:
•1 •2
•1 •A2P2
•1 •P2A2
•inspiration
•general Splitting •1 •A2P2
•fixed splitting
•1 •A2P2
•reversed splitting
•1
•2
Extral sound
❖gallop rhythm ❖ opening snap ❖abnormal heart sounds after prosthetic valve
•Common symptoms of heart disease——edema
Cause Systemic edema cardiac nephrogenic hepatic Other reasons
Local edema Local inflammation Venous reflux obstruction, etc
•Common symptoms of heart disease—— Palpitation
•Common cause:
heartthrob enhance arrhythmia tachycardia bradycardia arrhythmia cardiac neurosis
•Common symptoms of heart disease—— Palpitation
•Protrusion of precordium:
onset during childhood
•Cardiac dullness border: left enlargement
•pear-shaped heart mitral (valve) stenosis
•boot-shaped heart aortic insufficiency
•Common symptoms of heart disease——cyanosis
•Keypoints of inquiry
❖1,Onset age ❖2,Heart and lung disease history ❖3,Accompanied symptoms
•Heart sign
Ventricular enlargement signs Heart rate and rhythm change Heart sound change Heart murmur Other important signs
position, movement or some drugs
•Cardiac auscultation region
•Common symptoms of heart disease——edema
•Keypoints of inquiry ❖1,Past history ❖2,Starting position ❖3,Accompanied symptoms
•Common symptoms of heart disease——cyanosis
•upright positin
•lying position
• hydropericardium
Heart rate and rhythm change
Fast and regular: sinus tachycardia, paroxysmal tachycardia
Slow and regular: sinus bradycardia, conduction block of level III with escape rhythm
•Other
•Common symptoms of heart disease——syncope
•keypoints of inquiry
❖1, Attack position ❖2, Precipitating factor ❖3, Symptoms before the attack ❖4, Accompanied symptoms
listenning content of cardiac murmur
❖ location ❖ time ❖conduction of murmur ❖tones of murmur ❖loudness of murmur ❖relationship between murmur and breathing,
•Others:
•Common symptoms of heart disease——dyspnea
•keypoints of inquiry
❖1, acute or chronic ❖2, relationship with position and movement ❖3, accompanied symptoms
• factors that enhance S1
Mitral stenosis Tachycardia High CO
• factors that weaken S1
❖Mitral valve insufficiency ❖Atrioventricular block level I ❖Myocardial damage
•keypoints of inquiry
❖1, precipitating factor ❖2, accompanied symptoms ❖3, primary disease
•Common symptoms of heart disease——syncope
•Cause Cardiogenic Cardiac output block Arrhythmia
relative valvular insufficiency
shunt of large blood vessels or chambers of heart
intracardiac floaters
Heart murmurs mechanism
❖1.Blood flow speedy ❖2. Valvular lesions ❖3. Large blood vessels or cardiac enlargement ❖4. Shunt ❖5. Intracardiac floaters
•bottom
•apex •left edge of sternum and apex region
factors that affect S1
Integrity of atrioventricular valve Activity of atrioventricular valve Ventricular systolic rate(dp/dt)
replacement
gallop rhythm
❖mid-diastolic gallop ❖presystolic gallop ❖quadruple rhythm
opening snap
❖Meaning: mitral stenosis ❖ Mechanism
abnormal heart sounds after prosthetic valve replacement
Arrhythmia: sinus arrhythmia, premature beat, conduction block above II, atrial fibrillation
•S •S2
1
•normal
•bottom
•apex
•S1 enhance •S1 recede •S1 division
•• Left ventricular enlargement
• Left ventricular enlargement
Apex pulse: •lower-left shift •Apex pulse greater than 2 cm range:
•The apex : lifting type impulse •Cardiac dullness border: •lower-left enlargement
•cardiogenic： AP AMI Acute pericarditis Cardiac neurosis
•other
Common symptoms of heart disease——chest pain
•keypoints of inquiry ❖1, location ❖2, nature and degree ❖3, duration ❖4, incentive ❖5, reliever ❖6, radiation ❖7, accompanied symptoms
•Common symptoms of heart disease——dyspnea
•Cause
Cardiac factors: cardiac dysfunction, pericardial tamponade, etc. Non-cardiac factors: disease of respiratory system, disease of blood system, etc.
Cause: Central cyanosis: cardiovascular pulmonary
Mixed cyanosis: Cardiac dysfunction Abnormal hemoglobin derivant
Peripheral cyanosis: Relative increase of peripheral oxygen consumption Arterial ischemia
speedy blood flow
stenosis of valve opening or blood vessel
relative stenosis caused by ventricular enlargement or large blood vessels dilation
valvular insufficiency
factors that affect S2
Aortic and pulmonary artery pressure Integrity and elasticity of semilunar valve
• factors that enhance S2
P2 enhancement in: Pulmonary hypertension Pulmonary circulation congestion