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1、Common symptoms and signs of circulation system,Common symptoms of heart disease,Chest Pain,Dyspnea,Palpitation,Edema,Syncope,Cyanosis,Common symptoms of heart diseasechest pain,AP AMI Acute pericarditis Cardiac neurosis,Cause:,cardiogenic：,other,1,location,Common symptoms of heart diseasechest pain
2、,keypoints of inquiry,2,nature and degree,3,duration,4,incentive,5,reliever,6,radiation,7,accompanied symptoms,Cardiac factors:cardiac dysfunction,pericardial tamponade,etc.,Common symptoms of heart diseasedyspnea,Cause,Non-cardiac factors:disease of respiratory system,disease of blood system,etc.,O
3、thers:,1,acute or chronic2,relationship with position and movement 3,accompanied symptoms,Common symptoms of heart diseasedyspnea,keypoints of inquiry,heartthrob enhancearrhythmiatachycardiabradycardiaarrhythmiacardiac neurosis,Common symptoms of heart diseasePalpitation,Common cause:,1,precipitatin
4、g factor2,accompanied symptoms3,primary disease,Common symptoms of heart diseasePalpitation,keypoints of inquiry,CardiogenicCardiac output blockArrhythmia,Common symptoms of heart diseasesyncope,Other,Cause,1,Attack position2,Precipitating factor3,Symptoms before the attack4,Accompanied symptoms,Com
5、mon symptoms of heart diseasesyncope,keypoints of inquiry,Cardiogenic factors:cardiac dysfunctionpulmonary embolism,etc,Common symptoms of heart diseasecough,Cause,Non-cardiogenic factors:respiratory system diseasecentral cough,CauseSystemic edemacardiacnephrogenichepaticOther reasons,Common symptom
6、s of heart diseaseedema,Local edemaLocal inflammationVenous reflux obstruction,etc,1,Past history2,Starting position3,Accompanied symptoms,Common symptoms of heart diseaseedema,Keypoints of inquiry,Cause:Central cyanosis:cardiovascularpulmonary,Common symptoms of heart diseasecyanosis,Peripheral cya
7、nosis:Relative increase of peripheral oxygen consumptionArterial ischemia,Mixed cyanosis:Cardiac dysfunctionAbnormal hemoglobin derivant,1,Onset age2,Heart and lung disease history3,Accompanied symptoms,Keypoints of inquiry,Common symptoms of heart diseasecyanosis,Ventricular enlargement signsHeart
8、rate and rhythm changeHeart sound changeHeart murmurOther important signs,Heart sign,Left ventricular enlargement,Apex pulse:,Left ventricular enlargement,lower-left shift,greater than 2 cm,lifting type impulse,lower-left enlargement,Apex pulse range:,The apex:,Cardiac dullness border:,Right ventric
9、ular enlargement,Apex pulse:,Right ventricular enlargement,left-shift,Precordium:,lifting type impulse,Subxyphoid apex pulse:,common in pulmonary emphysema with right ventricular enlargement,Protrusion of precordium:,onset during childhood,Cardiac dullness border:,left enlargement,pear-shaped heart,
10、boot-shaped heart,mitral(valve)stenosis,aortic insufficiency,hydropericardium,upright positin,lying position,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,Arrhythmia:sinus arr
11、hythmia,premature beat,conduction block above II,atrial fibrillation,S1,S2,left edge of sternum and apex region,bottom,normal,S1 enhance,S1 recede,S1 division,apex,apex,bottom,factors that affect S1,Integrity of atrioventricular valveActivity of atrioventricular valveVentricular systolic rate(dp/dt)
12、,Mitral stenosisTachycardiaHigh CO,factors that enhance S1,Mitral valve insufficiencyAtrioventricular block level IMyocardial damage,factors that weaken S1,factors that affect S2,Aortic and pulmonary artery pressureIntegrity and elasticity of semilunar valve,P2 enhancement in:Pulmonary hypertensionP
13、ulmonary circulation congestion,factors that enhance S2,A2 enhancement in:HypertensionAortic atherosclerosis,P2 weakened in pulmonary valve lesionsA2 weakened in aortic lesions,factors that weaken S2,expiration,inspiration,general Splitting,fixed splitting,reversed splitting,1,2,1,A2P2,1,A2P2,1,A2P2
14、,1,P2A2,1,2,Extral sound,gallop rhythm opening snapabnormal heart sounds after prosthetic valve replacement,gallop rhythm,mid-diastolic galloppresystolic gallopquadruple rhythm,opening snap,Meaning:mitral stenosisMechanism,abnormal heart sounds after prosthetic valve replacement,speedy blood flow,st
15、enosis of valve opening or blood vessel,relative stenosis caused by ventricular enlargement or large blood vessels dilation,valvular insufficiency,relative valvular insufficiency,shunt of large blood vessels or chambers of heart,intracardiac floaters,Heart murmurs mechanism,1.Blood flow speedy2.Valv
16、ular lesions3.Large blood vessels or cardiac enlargement4.Shunt5.Intracardiac floaters,listenning content of cardiac murmur,locationtimeconduction of murmurtones of murmurloudness of murmurrelationship between murmur and breathing,position,movement or some drugs,Cardiac auscultation region,Systolic
17、murmurs strength classification,Level 1:weak noise,a very short time,unheard during the first few seconds,Level 2:weak noise,more easily heard,Level 3:noise of medium intensity,Level 4:a loud noise,often accompanied by tremor,Systolic murmurs strength classification,Level 5:very loud,shocking,unhear
18、d after taking stethoscope away from chest wall,all accompanied by tremor,Level 6:extremely loud,heard even with stethoscope a certaindistance away from chest wall,with strong tremor,cardiac murmur,mitral insufficiency,ventricular septal defect VSD,Aortic stenosis,pulmonary valve stenosis,aortic ins
19、ufficiency,mitral(valve)stenosis,patent ductus arteriosus PDA,conduction of murmur tones of murmur relationship between murmur and breathing,position,movement,differentiation between physiological and pathological murmur,Pericardial rub,other important sighs,Tremor,Peripheral vascular signs,The clin
20、ical significance of various cardiac tremor,Peripheral vascular sign,Water hammer pulseCapillary pulsationShooting sound,abnormal pulse,Water hammer pulse:,pulse rises rapidly,and suddenly falls,indicating pulse pressure increase，common in aortic incompetence.,Pulse deficit：,pulse rate slower than v
21、entricular rate,indicating atrial fibrillation.,abnormal pulse,Paradoxical pulse:,Pulse weaken obviously or disappear during inspiration.Suggesting pericardial effusion or constrictive pericarditis(cp).,Pulsus alternans：,Rhythm is normal,strong and weak pulse appear alternately,serious myocardial da
22、mage performance.,Mitral stenosis,auscultation:S1 enhancement in apex,and late diastole rumbling murmur,most clear in left decubitus,P2 hyperfunction or division,valve openning tone,percussion:pear-shaped heart,palpation:diastolic fine tremor in apex area,Inspection:mitral valve face,apex impulse le
23、ft-shift,Mitral insufficiency,auscultation:Apex rough blowing pansystolic murmurs,range is wide,conduct to left axillary or left shoulder angle,conduction,S1 abate,P2 hyperfunction,percussion:left enlargement of cardiac dullness border,palpation:lifting type impulse of the apex,Inspection:apex impul
24、se lower-left shift,Aortic stenosis AS,auscultation:A2 weaken or disappear,rough systolic murmur can be heard in aortic valve area,conducting to neck,Inspection:apex impulse lower-left shift,palpation:lifting type impulse of the apex,systolic tremor in aortic valve area,percussion:lower-left enlarge
25、ment of cardiac dullness border,Aortic insufficiency,Auscultation:Apex S1 abate,A2 weaken or disappear,sighing diastolic murmur can be heard in the second aortic auscultation area,conducting to the apex region,Inspection:apex impulse lower-left shift,range dispersed,Palpation:apex impulse lower-left
26、 shift,lifting type impulse of the apex,Percussion:lower-left enlargement of cardiac dullness border,boot-shaped heart,Peripheral vascular signs:capillary pulsation sign,water shock pulse,artery shooting tone,Ventricular septal defect VSD,Inspection:apex impulse normal or slight left shift,Palpation
27、:systolic tremor can be heard in sternal left edge 3rd and 4th intercostal space,Percussion:cardiac dullness border normal or slight enlargement,slight cardiac waist bulging,Auscultation:rough systolic murmur in sternal left edge 3rd and 4th intercostal space,P2 hyperfunction,middle diastolic murmur
28、 can be heard during large shunt,Patent ductus arteriosus,Inspection:apex impulse normal or slight left shift,Palpation:systolic tremor can be heard in sternal left edge 2nd intercostal space,it can be continuous,Percussion:cardiac dullness border normal or slight left enlargement,slight cardiac wai
29、st bulging,Auscultation:continuous machine murmur in sternum left edge 2nd intercostal place,P2 hyperfunction and division,Heart murmurs description should include：,locationperiodintensitynatureconductioninfluence of respiration、position and exercise,A,B,C,D,E,F,G,Signs of heart disease,Ventricular enlargementHeart rate and rhythm changeHeart sound changeHeart murmurAdditional sound,the relationship between Position and the murmur:mitral valve prolapse,conduction direction of murmur,
