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The main symptoms and signs

of common diseases of

circulatory system

1st Affiliated Hospital Liaoning Medical College

He Xin

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1、 Causes:

---RHD:rheumatic heart disease

---CHD:congenital heart disease

---Other reasons: senile retrograde

一、 Mitrial stenosis

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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 la

tediastolic ; crescendo ; rumbling; more clearly when the patient is lying on his left side

--opening snap may be auscultatory --accentuation of second pulmonary sound (P2↑), s

plitting --Graham Steel’s murmur (PV diastolic) --Maybe atrial fibrillation(late stage)

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二、 Mitral Insufficiency1、 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 Stenosis1、 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 Dyspn

ea, cough, fever, lassitudeShock

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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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