Download 3、Signs

The main symptoms and signs
of common diseases of
circulatory system
1st Affiliated Hospital
Liaoning Medical College
He Xin
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一、Mitrial stenosis
1、Causes:
---RHD:rheumatic heart disease
---CHD:congenital heart disease
---Other reasons: senile retrograde
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2、Symptoms
---cough
---hemoptysis
---dyspnea: dyspnea on exertion→
paroxysmal nocturnal dyspnea →
pneumonedema
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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
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---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)
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二、Mitral Insufficiency
1、Causes
---RHD / non-RHD
---acute/chronic
2、Symptoms
---fatigue
---palpitations
---dyspnea on exertion
---Left heart failure
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3、Signs :
---Inspection
apex beat is displaced downwards and to
the left
---Palpitation
--apical impulse forceful
--Heaving apex impulse
--Severe systolic thrill
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---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
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三、Aortic Stenosis
1、Causes
--- RHD
---Congenital
---Senile retrograde
2、Symptoms
palpitation ,dizziness, angina pectoris,
syncope, HF-dyspnea
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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
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---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
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四、Aortic Insufficiency
1、Causes
---RHD
---Non-RHD：congenital
prolapse
syphilis aortitis
arteriosclerosis
endocarditis
acute/chronic
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2、Symptoms
palpitation, dizziness, LHF
3、Signs
---Inspection
apical impulse to left and downwards
---Palpation
apex impulse to left and downwards
Heaving apex impulse
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---Percussion
--the area of cardiac dullness is
enlarged downwards and to the left
--the concave part of the heart is not
enlarged (boot shape)
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---Auscultation
--specific murmur
diastolic
sighing
aortic area
heard clearly sitting erect and forward
--Austin Flint murmur
relative MS
(rumbling mid-diastolic murmur)
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---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
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五、Pericardial effusion
1、Causes
infective and non-infective pericarditis
2、Symptoms
pain over the pericardial region
Dyspnea, cough, fever, lassitude
Shock
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3、Signs :
---Inspection
diminution in strength of the apex beat
or absence of the apex beat
jugular venous enlargement
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---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
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---Auscultation
--pericardial friction sound
--HR↑,diminution of intensity of cardiac
sound (S1/S2↓)
--pericardial knock may be heard
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4、Large effusion
---Jugular varicosity
---Liver enlargement
---Paradoxical pulse
---Pulse pressure ↓
---Kussmaul sign
---Ewart sign
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---Kussmaul sign
deep inspiration –jugular vein distension
---Ewart sign: left infrascapular region
vocal fremitus↑
dullness -- percussion
bronchovesicular breath sound--auscultation
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六、Heart Failure
1、Causes
myopathy ; ventricular load ↑
promote factors
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2、Symptoms
---LHF: fatigue, cough, frothy sputum
dyspnea(on exertion → orthopnea →
paroxysmal nocturnal ~)
---RHF: abdominal distension, oliguria,
nausea, vomiting
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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
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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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