Pulmonary venous and capillary pressures ↑ Pulmonary congestion and edema Pulmonary hypertension Right heart failure
2010 Clinical Diagnostics
Dyspnea
Pathophysiology
17
Percussion
Cardiac dullness becomes pear-shaped.
18
梨形心，x ray film
左房增大（左前斜位）
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Auscultation
➢ Mid and late diastolic crescendo rumbling murmur in apical area
Percussion
The area of cardiac dullness shifts to left and downwards at first, then to right later
2010 Clinical Diagnostics
Auscultation:
★ In apical area, harsh blowing
➢LA pressure↑ ➢Pulmonary circulation pressure↑ ➢Right heart failure
dilation
hypertrophy
failure
10
Symptoms dyspnea: is defined as an abnormally uncomfortable awareness of breathing. That is shortness of breath, difficulty in breathing / labored breathing.
volume load of LV ↑ compensatory LV dilation
2010 Clinical Diagnostics
When volume load of LV continuously increasing LV end diastolic pressure and LA pressure increase Left heart failure
➢ cough ➢ hemoptysis
• If orthopnea causes awakening during the night and is relieved by sitting, it is called paroxysmal nocturnal dyspnea.
• Shortness of breath even in the upright position and cough with pink frothy sputum (粉红色泡沫痰) in pulmonary edema.
➢ Apex beat displaces to left because of right
ventricular hypertrophy.
二尖瓣面容
16
Palpation
Diastolic thrill over apical area .
tiny vibration, small shaking
Main Symptoms and Signs of Common
Cardiovascular Diseases
1
Outline
Valvular Heart Disease
Mitral Stenosis (MS) Mitral Regurgitation / Insufficiency (MR / MI) Aortic Stenosis (AS) Aortic Regurgitation / Insufficiency (AR / AI )
Pulmonary congestion and edema (肺淤血和肺水肿)
Pulmonary hypertension Right heart failure
Pathophysiology
➢compensatory dilation of LA ➢compensatory LV dilation ➢left heart failure ➢Right heart failure
2010 Clinical Diagnostics
AS
Aortic Stenosis (AS)
secondary to pulmonary regurgitation, can be heard
in pulmonary valve area.
肺动脉瓣区 吹风样 舒张早期 杂音 “二
狭”导致
肺动脉压增高、肺动脉扩张 引起
肺动脉瓣 相对性关闭不全 所致的 功能性杂音 . 21
Mitral Regurgitation (MR)
27
MR
Symptoms
Early Stage ------ asymptomatic
Late Stage ------ heart failure ➢ Palpitation ➢ Cough ➢ Exertional dyspnea ➢ Fatigue / very great tiredness
Etiology ★ Mainly rheumatic fever, ★ mitral valve prolapse ,
infective endocarditis , calcification , ischemic heart disease with papillary muscle dysfunction, et al.
Moderate MS: -------- orifice <1.5 cm2 PVP↑, PCWP↑, ——→ interstitial edema means LV pressure of 25 mm Hg
Severe MS ------ orifice <1 cm2 PAP↑ —→ RV overload —→ RV failure
Etiology
• Mainly caused by rheumatic fever.
• Others caused by senile calcification or congenitally bicuspid valve .
图 主动脉瓣和冠状动脉开口示意图
Aortic stenosis(AS)
(heart in diastole: vie« ed ir0m base wah aria emo•ec
Mitral Stenosis (MS)
Predominantly caused by rheumatic fever.
6
mitral valve area
MS
normal MVA
mild
moderate
24
Pathophysiology
MR
In MR
Systole
part of blood in LV returns to LA
Diastole
LV receives normal content both regurgitant
of blood
more blood and pressure ↑ in LA compensatory LA dilation
AS
AS is the obstruction of blood flow across the aortic valve.
Normal cross-sectional area 3.0cm2 ＜ 1.0cm2， cross-sectional pressure﹥5 mmHg
shows clinical signs.
(secondary to ↓cardiac output )
2010 Clinical Diagnostics
MR
Physical Signs
Inspection
Apex beat displaced to left and downwards
Palpation
Apex beat displaced to left and downwards, heaving apex beat, hyperdynamic cardiac impulse
20
Auscultation
➢ Accentuated S1 over apical area
➢ Opening snap
➢ S2 Splitting or accentuated
➢ Graham Steell murmur
A high-pitched decrescendo diastolic murmur
It is a subjective symptom. It is one of the principal symptoms of cardiac and pulmonary disease.
11
Symptoms
➢ dyspnea
exertional dyspnea, dyspnea on rest, paroxysmal nocturnal dyspnea, orthopnea pulmonary edema
Pathophysiology
Cross-sectional area of the mitral valve orifice ↓ Rate of blood flow across the mitral orifice ↑ Left atrial pressure ↑ Dilation of LA
Heart Failure Pericardial Effusion
2010 Clinical Diagnostics
Valves of Heart
valve annulus / valve ring valve leaflet / cusp