1. 1 The main symptoms and signs of common diseases of circulatory system 1 st Affiliated Hospital Liaoning Medical College He Xin

2. 2 1 、 Causes: ---RHD:rheumatic heart disease ---CHD:congenital heart disease ---Other reasons: senile retrograde 一、 Mitrial stenosis

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4. 4 2 、 Symptoms ---cough ---hemoptysis ---dyspnea: dyspnea on exertion→ paroxysmal nocturnal dyspnea → pneumonedema

5. 5 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

6. 6 ---Auscultation --the first sound (S1)↑ --diastolic murmur :apical area; localized; mild and latediastolic ; crescendo ; rumbling; more clearly when the patient is lying on his left side --opening snap may be auscultatory --accentuation of second pulmonary sound (P2↑), splitting --Graham Steel’s murmur (PV diastolic) --Maybe atrial fibrillation(late stage)

7. 7 二、 Mitral Insufficiency 1 、 Causes ---RHD / non-RHD ---acute/chronic 2 、 Symptoms ---fatigue ---palpitations ---dyspnea on exertion ---Left heart failure

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9. 9 3 、 Signs : ---Inspection apex beat is displaced downwards and to the left ---Palpitation --apical impulse forceful --Heaving apex impulse --Severe systolic thrill

10. 10 ---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

11. 11 三、 Aortic Stenosis 1 、 Causes --- RHD ---Congenital ---Senile retrograde 2 、 Symptoms palpitation,dizziness, angina pectoris, syncope, HF-dyspnea

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13. 13 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

14. 14 ---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

15. 15 四、 Aortic Insufficiency 1 、 Causes ---RHD ---Non-RHD ： congenital prolapse syphilis aortitis arteriosclerosis endocarditis acute/chronic

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17. 17 2 、 Symptoms palpitation, dizziness, LHF 3 、 Signs ---Inspection apical impulse to left and downwards ---Palpation apex impulse to left and downwards Heaving apex impulse

18. 18 ---Percussion --the area of cardiac dullness is enlarged downwards and to the left --the concave part of the heart is not enlarged (boot shape)

19. 19 ---Auscultation --specific murmur diastolic sighing aortic area heard clearly sitting erect and forward --Austin Flint murmur relative MS (rumbling mid-diastolic murmur)

20. 20 ---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

21. 21 五、 Pericardial effusion 1 、 Causes infective and non-infective pericarditis 2 、 Symptoms pain over the pericardial region Dyspnea, cough, fever, lassitude Shock

22. 22 3 、 Signs : ---Inspection diminution in strength of the apex beat or absence of the apex beat jugular venous enlargement

23. 23 ---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

24. 24 ---Auscultation --pericardial friction sound --HR↑,diminution of intensity of cardiac sound (S1/S2↓) --pericardial knock may be heard

25. 25 4 、 Large effusion ---Jugular varicosity ---Liver enlargement ---Paradoxical pulse ---Pulse pressure ↓ ---Kussmaul sign ---Ewart sign

26. 26 ---Kussmaul sign deep inspiration –jugular vein distension ---Ewart sign: left infrascapular region vocal fremitus↑ dullness -- percussion bronchovesicular breath sound--auscultation

27. 27 六、 Heart Failure 1 、 Causes myopathy ; ventricular load ↑ promote factors

28. 28 2 、 Symptoms ---LHF: fatigue, cough, frothy sputum dyspnea(on exertion → orthopnea → paroxysmal nocturnal ~) ---RHF: abdominal distension, oliguria, nausea, vomiting

29. 29 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

30. 30 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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32. 32 THANK YOU !