heart disease
Introduction
Introduction to heart disease Heart disease is a general term for heart disease, including rheumatic heart disease, congenital heart disease, hypertensive heart disease, coronary heart disease, and myocarditis. First, congenital heart disease 1. May be related to the mother's early pregnancy or medication. 2. Related to heredity. Second, acquired heart disease 1. Coronary heart disease: smoking and diabetes, high blood pressure and other causes of sclerosing stenosis, blood flow is blocked, easy to make myocardial hypoxia and damage. 2. Hypertensive heart disease: Arterial hypertension leads to left ventricular hypertrophy, and pulmonary hypertension leads to right ventricular hypertrophy. Third, rheumatic heart disease: chronic rheumatic heart disease mainly caused by gradual disease of heart valve after rheumatic fever infection. Fourth, pulmonary heart disease: due to chronic bronchitis, emphysema and other pulmonary hypertension, resulting in right ventricular hypertrophy or failure. 5. Cardiomyopathy: myocardial changes such as metabolism or hormonal abnormalities, sometimes alcoholism, and drugs also cause myocardial changes. 6. Cardiac tumors: Most of them are benign tumors. Myxoma is the most common, and primary cardiac malignancies are rare. basic knowledge The proportion of illness: 0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: heart failure, cerebral infarction
Cause
Heart disease
Cholesterol (20%):
Cholesterol is too high, and the chance of suffering from heart disease is three times higher than that of ordinary people, because too much cholesterol in the body will accumulate in the blood vessels, making the blood vessels narrower and obstructing blood circulation.
Smoking (15%):
Smokers are two and a half times more likely than ordinary people because nicotine or tobacco chemicals in cigarettes can damage the blood vessels of the heart. If blood vessels crack, cholesterol will accumulate.
Blood pressure (10%):
High blood pressure, two and a half times more than the chance of ordinary people, high blood pressure will cause vasoconstriction.
Diabetes (10%):
Women with diabetes have twice the chance of having heart disease than the average person, and 50% more men.
Obesity (15%):
Excessive obesity, because obesity leads to high blood pressure, high blood fat, diabetes, and these diseases can cause heart disease.
Emotion (10%):
Life is tense, nervousness makes arrhythmia, endocrine disorders, affecting heartbeat, stimulating heart attack, normal heart is bigger than fist, pumping blood through the circulatory system. The heart beats an average of 100,000 times a day and pumps about 2,000 gallons of blood back and forth. If you calculate the life of 70 years old, your heart rate can reach 2.5 billion times.
Prevention
Heart disease prevention
Precaution
First, lose weight. Obese people have a much higher proportion of heart disease than normal weight, especially those with "apple-shaped" body (waist-hip obesity). As long as the elderly lose 3-5 kilograms, the heart condition will be greatly improved. At the same time, experts warn the fatter old man, do not expect to become a super model at once, to gradually achieve the purpose of weight loss through balanced diet and exercise.
Second, eat less egg yolk. A normal-sized egg yolk contains about 200 mg of cholesterol. If the elderly have higher cholesterol, they can only eat up to two egg yolks a week.
Third, more exercise. A moderate exercise for 20 minutes a day can reduce the risk of heart disease by 30%, and the quickest effect is best.
Fourth, quit smoking. Smokers are twice as likely to suffer from heart disease as non-smokers. The study found that after 2-3 years of smoking cessation, the risk of heart disease fell to the same level as non-smokers.
Fifth, pay attention to diet. In normal life, insist on eating low-fat foods, such as lean meat and low-fat dairy products.
Sixth, moderate drinking. Drinking 3-9 glasses of wine a week is appropriate for the heart. But be careful not to be greedy, because excessive drinking can cause heart disease.
Seventh, beware of diabetes. People with diabetes have four times more heart disease than others. Therefore, the elderly should have regular physical examinations and early detection and early treatment of diabetes.
Eighth, control emotions. Grumpy, unable to control themselves in the event of an emergency, it is also easy to induce heart disease.
Complication
Heart disease complications Complications, heart failure, cerebral infarction
Common complications:
Heart failure, pulmonary infarction, cerebral infarction, myocardial infarction, sudden death, pulmonary heart disease, multiple organ failure, etc. Room septal defect, ventricular septal defect and patent ductus arteriosus are often prone to pneumonia, prone to heart failure, Fallot's quadruple syndrome can often be complicated by cerebral thrombosis, brain abscess.
Symptom
Symptoms of heart disease Common symptoms Chest pain with chest tightness, palpitations, exertional dyspnea, palpitations, edema, small fingers, unexplained pain, rounded fossa, uncomfortable, chest pain, tachycardia, heart murmur, less blood
1. Coronary heart disease
The clinical classification is divided into five types: occult, angina pectoris, myocardial infarction, heart failure (ischemic cardiomyopathy), and sudden death. The most common type is angina pectoris, the most serious of which are myocardial infarction and sudden death.
2. Rheumatic mitral stenosis
Patients with a longer course of disease often present flushing cheeks in the cheeks, mild purpura in the lips, called the mitral valve face, the anterior region of the anterior region can be raised, the left sternal border can be lifted to the right ventricular systolic pulsation, and the heart sounds may be Left enlargement, auscultation examination of the apex area can be heard of mitral stenosis caused by diastolic middle-end rumbling-like murmur, small valve mouth, mitral valve transvalvular pressure difference is greater diastolic noise, left lateral murmur Most obvious, often accompanied by diastolic tremor, apical area can hear the first heart sound hyperthyroidism and the short slap sound when the valve opening is open, the anterior valvular leaflet leaf elasticity and activity are better, the first heart sound hyperthyroidism and open shot The loudness of the sound is obvious. The anterior leaflet of the mitral valve is thickened and the hard change is obvious. If the activity is lost, the first sound of the apex is weakened, and the open slap is not heard. The apical area is still audible. To the systolic murmur, often transmitted to the midline. The second tone of the pulmonary valve area can be accompanied by mild division, pulmonary hypertension, pulmonary artery and annulus enlargement. The left sternal border of the sternum can be heard after the first heart sound of the 2, 3 intercostal systolic jet sounds. Reduced or disappeared when inhaling, there is a soft and high-pitched ventilated diastolic early-middle murmur (Graham-Steell murmur) produced by relative pulmonary valve insufficiency in fashion, enhanced at the end of inhalation, weakened during exhalation, and three The apex of the sternal insufficiency can be seen in the 4th and 5th ribs of the sternal border. The systolic murmur can be heard, the inhalation is enhanced, the exhalation and Valsalva action are relieved, the atrial fibrillation case is irregular, and the right heart failure can be found in the lung. The bottom of the Luoyin, hepatomegaly, lower extremity edema, there are fashionable ascites signs, and cases of embolism showed central nervous system symptoms or motor dysfunction of limbs.
Tricuspid regurgitation
The natural course and symptoms of mitral regurgitation depend on the severity of reflux, compliance with the left atrium, and concurrent pulmonary hypertension, and whether there is a combined heart and coronary artery disease. Combined with its pathophysiological changes, the following symptoms may be present:
(1) Left ventricular compensation period: the asymptomatic period is longer. Before the occurrence of left ventricular failure (left heart failure), there may be several years or even more than 10 years of asymptomatic period. Occasional activity caused by increased cardiac output and increased apex beats caused by mild palpitations.
(2) Left ventricular failure period: Once left heart failure occurs, the condition often develops rapidly. The main symptoms of chronic mitral regurgitation include:
1 Cardiac blood output reduction: Insufficient visceral and limb blood supply caused by low cardiac output caused by left heart failure, manifested as fatigue, fatigue, dizziness, etc. after activity.
2 pulmonary congestion symptoms: manifested as labor dyspnea. Mild pulmonary congestion often occurs during heavy physical exertion and strenuous exercise; moderate and severe pulmonary congestion may present with paroxysmal nocturnal dyspnea and sitting breathing. However, the incidence of acute pulmonary edema and hemoptysis is less common in patients with chronic mitral regurgitation than in simple mitral stenosis.
3 palpitations: often due to decreased cardiac output caused by compensatory heart rate, or due to concomitant arrhythmia, such as atrial fibrillation or premature contraction.
4 other:
A. Mild and moderate mitral regurgitation is complicated by infective endocarditis: there may be corresponding clinical symptoms.
B. Severe left ventricle and left atrium enlargement may have left chest pain and swallow discomfort.
(3) right ventricular failure period: involving the right ventricle and right heart dysfunction, may have upper abdominal fullness, liver pain, loss of appetite, oliguria, lower extremity edema.
4. Tricuspid stenosis
Symptom
(1) Simple tricuspid stenosis can cause right atrial failure and signs of systemic congestion.
1 fatigue: the blood flow through the tricuspid valve is reduced, leading to a decrease in cardiac output.
2 There is pulsating discomfort in the neck: the jugular vein is obviously pulsating.
3 gastrointestinal congestion: causing loss of appetite, nausea, vomiting or belching.
(2) Tricuspid stenosis and mitral valve disease at the same time: the presence of tricuspid stenosis can alleviate the symptoms of pulmonary congestion caused by mitral stenosis. Therefore, when there is mitral stenosis and dyspnea (labor or nighttime paroxysmal dyspnea) is not obvious, it suggests the possibility of tricuspid stenosis.
2. Signs
(1) The heart sounds are shifted to the right.
(2) Some patients may have diastolic fine tremor in the tricuspid valve area.
(3) Auscultation:
1 Tricuspid valve diastolic murmur: heard a weaker, low-frequency and soft diastolic middle and late rumbling murmur between the 4th and 5th intercostals of the left sternal border to the midline of the sternum, and the enhancement before systole was not obvious. The murmur is enhanced at the end of deep inspiratory, called Carvallo sign, due to the increase in blood flow to the right heart during inhalation, resulting in increased blood flow rate and blood flow through the narrow tricuspid valve. The mitral stenosis murmur does not increase during inhalation, but increases in deep exhalation, which is caused by an increase in left ventricular circulation.
2 tricuspid valve area can be heard tricuspid valve open sound: 0.04 ~ 0.06s after S2, enhanced when inhaling.
3 Tricuspid valve area S1 can be hyperthyroidized: When the valve is significantly calcified or the activity is significantly reduced, S1 can not be hyperthyroidized.
(4) A large jugular vein a wave: due to the strong contraction of the right atrium to the tricuspid valve of the sinus rhythm; when the atrial fibrillation, the jugular vein shows obvious V waves. In severe pulmonary hypertension and right ventricular hypertrophy, due to the decreased compliance of the right ventricle, the blood flow filling resistance of the right atrium returning to the right ventricle is increased, and the a-wave of the jugular vein is increased. When there is no right ventricular hypertrophy and a large jugular wave a wave, it is a characteristic sign of tricuspid stenosis.
(5) jugular vein engorgement: liver enlargement, positive liver neck reflow test, lower extremity edema, and even peripheral hair cyanosis.
(6) Rheumatic tricuspid stenosis: When multiple valvular lesions are present, both mitral and/or aortic valve murmurs may be present.
V. Pulmonary artery stenosis
Clinical manifestation
The ratio of male to female is about 3:2, and the age of onset is mostly between 10 and 20 years old. The symptoms are closely related to pulmonary stenosis. Patients with mild pulmonary stenosis are generally asymptomatic, but gradually appear with age. It is characterized by poor labor endurance, nausea and shortness of breath after fatigue and fatigue. Severe stenosis may have dizziness or fainting episodes. In advanced cases, symptoms of right ventricular dysfunction, hepatomegaly and lower extremity edema may occur, such as coexisting room septum. Defects or patent fossa are not closed, showing cyanosis and clubbing (toe) at the mouth or toe.
2. Signs
Most of the patients are well-developed. The main sign is that the third to fourth ribs on the left sternal border can hear the III-IV loud and rough jet-like systolic murmur, which is transmitted to the left neck or the left subclavian region. The most loud noise can be heard. Exposure to systolic tremor, the intensity of the murmur varies with the degree of stenosis, blood flow velocity, blood flow and chest wall thickness, the second heart sound in the pulmonary valve area is often weakened, the patient with stenosis of the funnel is narrow, and the murmur and tremor are generally in the left third or At the fourth intercostal space, the intensity is lighter, and the second heart sound of the pulmonary valve area may not be alleviated, and sometimes even split. In patients with severe pulmonary stenosis, the right ventricular hypertrophy can be seen to bulge forward in the left sternal border. In the anterior region of the anterior region, the pulsation of interest can be seen and the tricuspid valve is closed due to the relative closure of the tricuspid valve. A systolic murmur, when a right-to-left shunt occurs in the blood flow in the atrium, a purpura-like finger (toe) may appear on the patient's lips and the toes of the extremities.
Infective endocarditis
(1) fever is the most common, the heat type is variable, the most irregular, can be intermittent or relaxation type, accompanied by chills and sweating, or only low fever, body temperature is mostly 37.5 ~ 39 ° C Between 3% and 15% of patients with normal or lower than normal temperature, more common in elderly patients with embolism or fungal aneurysm rupture caused by cerebral hemorrhage or subarachnoid hemorrhage and severe heart In the case of dysuria and uremia, antibiotics, antipyretics and hormones have not been used before the diagnosis of this disease.
(2) 70% to 90% of patients have progressive anemia, sometimes reach the severity, and even the most prominent symptoms, anemia causes general malaise, weakness and shortness of breath, patients with longer duration often have systemic pain, possibly due to toxicity Hypertension or embolism in various parts of the body, joint pain, low back pain and myalgia are more common at the onset, mainly involving the gastrocnemius and thigh muscles, tendons, wrists and other joints, but also multiple joint involvement, if the disease Serious bone pain should be considered due to periostitis, subperiosteal hemorrhage or embolism, embolization of aneurysms caused by bone or bone aneurysms.
(3) The clinical manifestations of elderly patients are more variable. Fever is often misdiagnosed as respiratory tract or other infections. Heart murmurs are often mistaken for senile degenerative valvular disease and neglected. Some may have no fever and heart murmur. , mental changes, heart failure or hypotension, prone to neurological complications and renal insufficiency.
(4) The main signs are that the original heart disease can be heard or the original normal heart is murmur. The change in the nature of the noise during the course of the disease is often caused by anemia, tachycardia or other hemodynamic changes. About 15% of patients started with no heart murmur, and there was murmur during treatment. A few patients did not have murmur until 2 to 3 months after treatment. Occasionally, there was no murmur after treatment for many years. In subacute infective endocardium In the inflammation, right heart valve damage is not common, 2/3 of the right heart endocarditis, especially those who invade the tricuspid valve, the neoplasms proliferate in the endocardium of the ventricular wall and aortic atherosclerotic plaque When you are on, you can also have no noise, but the latter is rare.
(5) The defects of skin and mucous membranes, linear bleeding under the nail bed, Osler knot, Janeway lesions and other skin lesions have decreased significantly in the past 30 years. The defect is that the toxin acts on the capillaries to increase the fragility and rupture. Or due to embolism, Changcheng group can also appear individually, the highest incidence, but has been reduced from 85% to 19% to 40% before the application of antibiotics, more common in the eyelid membrane, oral mucosa, chest and back of the hands and feet It lasts for several days, reappears after disappearing, and its center can be whitish. However, the microscopic embolism caused by cardiopulmonary bypass can also cause ocular sub-membrane hemorrhage. Therefore, some people think that the center is grayish and the sputum is more important than the yellow one. Systemic purpura can occur, the characteristics of the underlying nail bed is linear, the distal end does not reach the front edge of the nail bed, the pressure can be painful, the incidence of Osler knot has dropped from the past 50% to 10% to 20%, It is purple or red, slightly higher than the leather surface. The smuggling is about 1~2mm, and the larger one can reach 5~15mm. It occurs mostly on the palm of the finger or the end of the toe. The size of the fish or the sole of the foot may have tenderness and often last. 4 to 5 days to fade, Osler knot is not Unique to the disease, can also occur in systemic lupus erythematosus, typhoid, lymphoma, small painful hemorrhagic or erythematous lesions of 1 to 4 mm in diameter in the palm and sole of the foot, called Janeway damage, sickle Fingers (toes) are now rare. Retinopathy has the most bleeding, is fan-shaped or round, may have a white center, and sometimes only a round white spot on the fundus is called the Roth point.
(6) The spleen often has mild to moderate swelling, soft and tenderness, and the incidence of splenomegaly has been significantly reduced. For unexplained anemia, refractory heart failure, stroke, paralysis, peripheral arterial embolism, Progressive obstruction of the valve mouth and displacement of the valve, avulsion, etc. should pay attention to whether the disease exists, in patients with recurrent pneumonia, followed by liver, mild jaundice and finally patients with progressive renal failure, even Without heart murmur, the possibility of infective endocarditis on the right side should also be considered.
Seven. Chronic pulmonary heart disease
1. Pulmonary and cardiac function compensation period: The cardiac function compensation is generally good in this period, and the lung function is in the partial compensation stage, mainly the performance of chronic obstructive pulmonary disease, namely chronic cough, cough, wheezing, and can feel guilty after the activity. Shortness of breath, difficulty in breathing, and decreased labor endurance, and symptoms of hypoxia such as cyanosis. Physical examination showed obvious signs of emphysema, such as barrel chest, lung fistula, unvoiced sound, auscultation, respiratory sounds generally weakened, often heard dry and wet voice. Although the right ventricle is enlarged, it is often difficult to shed due to the presence of emphysema, and the heart sound is far away. The second tone of the pulmonary valve area (this sign can also be due to emphysema is not obvious), suggesting the presence of pulmonary hypertension. The systolic pulsation can be seen under the xiphoid process. The systolic murmur can be heard in the tricuspid valve area. The heart sound of the auscultation is stronger than the apex of the heart, and there is more suggestion of right ventricular hypertrophy and enlargement. In some cases, the intrathoracic pressure is increased due to severe emphysema, which hinders the reflux of the vena cava, and the jugular vein can be filled. Because the diaphragm is lowered, the lower edge of the liver can be touched under the ribs, which is similar to the signs of right heart dysfunction, but this When the venous pressure is not significantly increased, the liver is not blood stasis, the anteroposterior diameter does not increase, and there is no tenderness, which can be identified.
2. Lung and heart function decompensation: The main clinical manifestations of this period are respiratory failure and heart failure. Most patients have respiratory failure and then heart failure. There are also a few patients who may have no heart failure or heart failure.
(1) Respiratory failure: Acute respiratory infection is the most common cause. See the respiratory failure article for its clinical features.
(2) Heart failure: mainly due to right heart failure, a small number of patients may have acute pulmonary edema or heart failure, and arrhythmia may also occur.
Examine
Cardiac examination
Heart disease check
The items that should be checked during the physical examination of patients with heart disease include medical examination, blood pressure, electrocardiogram, blood lipids, blood sugar, liver and kidney function, and blood routine. Because ECG can only be used for short-term static recording, patients with heart disease should do the following checks as appropriate.
(1) Holter, also known as long-range electrocardiogram
Provides information on the subject's full-day dynamic ECG activities. Effectively supplementing the deficiencies of conventional ECG, not only can you obtain ECG data for 24 hours or even 48 hours in a row, combined with the patient's activity diary, you can also determine the relationship between the patient's symptoms, activity status and medications and changes in ECG.
Application range:
1. Judgment of the nature of symptoms such as palpitations, chest pain, dizziness, and syncope.
2. Qualitative and quantitative diagnosis of arrhythmia.
3. Qualitative, quantitative and relative localization diagnosis of myocardial ischemia.
4. Patients with myocardial infarction were followed up for prognosis evaluation after discharge.
5. Select the indication for the installation of a pacemaker and assess the function of the pacemaker.
6. Anti-arrhythmia and evaluation of the efficacy of anti-ischemic drugs.
(2) ECG exercise load test ECG exercise load test
It is a diagnostic method for early coronary heart disease. Although it has a certain proportion of false negatives and false positives compared with coronary angiography results, it is still recognized as an important clinical examination because of its convenience, non-invasiveness and safety. means. Among them, the treadmill exercise test is the most widely used exercise load test method.
Applicable to:
1 Differential diagnosis of patients with atypical chest pain or suspected coronary heart disease.
2 to assess the cardiac load capacity of patients with coronary heart disease.
3 Evaluation of the drug or surgical treatment of coronary heart disease.
4 Conduct an investigation and screening test for epidemics of susceptible patients with coronary heart disease.
This check is not appropriate for the following situations:
1 acute myocardial infarction or myocardial infarction combined with ventricular aneurysm.
2 unstable angina.
3 heart failure.
4 moderate to severe valvular heart disease or congenital heart disease.
5 acute or severe chronic diseases.
6 patients with severe hypertension.
7 acute pericarditis or myocarditis.
8 pulmonary embolism.
9 severe aortic stenosis.
10 people with severe disabilities who cannot exercise.
(3) Echocardiography (commonly known as cardiac B-mode ultrasound)
Echocardiography uses the characteristics of radar scanning technology and acoustic reflection to display the reflection of ultrasonic waves through the layers of the heart on the screen to form a gray-scale image, so as to observe the morphological structure and pulsation state of the heart and large blood vessels, and to understand the atrioventricular contraction. The rules of diastolic and valve closure and open activity provide clinically valuable reference materials. Echocardiography has diagnostic value for the following heart diseases:
1 valvular heart disease (mitral stenosis and / or regurgitation, mitral valve prolapse; tricuspid and aortic stenosis and / or regurgitation).
2 myocardial lesions (myocardial infarction, especially the discovery of ventricular aneurysm; idiopathic cardiomyopathy, dilated cardiomyopathy with heart cavity dilatation, hypertrophic cardiomyopathy with cardiac wall thickening as the main manifestation).
3 congenital heart disease (can observe the atrioventricular septal defect, large blood vessel translocation and blood shunt).
4 coronary heart disease.
5 hypertensive heart disease.
6 Others: thickening and accumulation of pericardium, tumors in the heart and beside the heart, such as intracardiac myxoma, myocardial tumors, beside the heart (mediastinal) tumors.
(4) Examination items that should be paid attention to when taking drugs, such as long-term oral anticoagulants such as warfarin, in order to avoid bleeding, it must be tested.
1 clotting time (CT)
2 The plasma prothrombin time ratio (PTR) may be selected to be maintained at 1.5 to 2.0, or an international normalized ratio (INR), which is preferably maintained at 2.0 to 3.0.
Patients who take long-term use of aspirin or eclipse and other platelet function inhibitors must:
1 bleeding time (BT), so that the results are maintained 1.5 times before treatment is appropriate.
2 platelet count (PC), the result is maintained at (50 ~ 60) 109 / L is appropriate.
3 platelet aggregation test (PAgT), the results are preferably reduced to 50% before treatment.
Diagnosis
Diagnosis of heart disease
With medical history and physical examination, doctors usually can basically determine whether the subject has heart disease. Diagnostic tests are used to confirm the diagnosis, determine the extent and prognosis of the disease, and help to develop a treatment plan.
Medical history and physical examination
The doctor first asks if there are symptoms that may indicate heart disease, such as chest pain, shortness of breath, lower extremity edema, and palpitations. Then learn if there are other symptoms, such as fever, weakness, fatigue, anorexia, and discomfort. These symptoms may also be related to heart disease. The next step is to understand the past infections, exposure to chemicals, drugs, alcohol and tobacco, family and work environment, and recreational activities. The doctor will also ask the family members if there are patients with heart disease or other diseases and if the subject has other diseases that affect the cardiovascular system.
In the physical examination, pay attention to weight, general condition and whether there are pale, sweaty and lethargy. Heart disease can affect a patient's mood and their own feelings about health. Pale or blemishes may indicate anemia or hypoperfusion (which may be due to lung disease, heart failure, or various circulatory diseases), so it is important to observe skin color.
Through the percussion of the carotid artery, the radial artery, the elbow artery, the wrist artery, the abdominal aorta, the inguinal artery, the artery, the radial artery, and the dorsal artery of the foot, it is estimated whether the blood flow is sufficient and whether the sides are symmetrical. Measure blood pressure and body temperature. These abnormalities all contribute to the diagnosis of heart disease. Since the jugular vein is directly connected to the right atrium of the heart, it is an indication of the blood flow pressure and volume entering the right heart, so the doctor should check the jugular vein condition. During the examination, the subject is required to be in a lying position, and the upper body is raised at an angle of 40 degrees to the ground plane. Sometimes, the subject can also be lying, sitting or standing.
The doctor presses the ankle, the calf, and sometimes the lower back skin to examine the edema of the subcutaneous tissue. Use an ophthalmoscope (an instrument used to check the condition of the inside of the eye) to examine the blood vessels and nerves of the retina (the photosensitive film located on the inner surface of the back of the eye). Patients with hypertension, diabetes, atherosclerosis, and heart valve bacterial infection often have fundus abnormalities.
Observe the chest, determine whether the respiratory rate and respiratory movement are normal, and then use your fingers to gently buckle the chest wall (diagnosis) to determine whether the lungs are fully filled with air; percussion also helps determine the presence of pericardial or pleural effusion. With the aid of a stethoscope, the doctor can determine if the airway is clear and if there is any fluid leakage in the lungs due to heart failure.
The doctor placed his hand on the chest wall to determine the size of the heart and the type and intensity of each contraction. Occasionally, tremors caused by abnormal, disordered blood flow between the blood vessels or the heart chamber can be felt by the tip of the finger or the palm of the hand.
Using a stethoscope, you can hear different sounds due to the opening and closing of the heart valve. Blood disorder (turbulence) caused by abnormal valve or heart structure can produce characteristic sounds (murmurs). Typical turbulence occurs when blood flows through a narrow or leaky valve. Not all heart diseases produce murmurs, and not all murmurs indicate the presence of heart disease. Cardiac murmurs are common in pregnant women due to the normal increase in blood flow. In infants and children, harmless murmurs often occur due to faster blood flow and smaller cardiac structure. Even in elderly individuals without severe underlying heart disease, turbulence is apt to occur due to the gradual hardening of the vessel wall, valves, and other tissues.
Place the stethoscope on the surface of the arteries and veins, sometimes with murmurs, which may indicate a narrowing of the blood vessels or an abnormal passage between the blood vessels.
The examination of the abdomen to determine if there is a liver enlargement caused by the main venous congestion of the heart. Abdominal bulging caused by effusion often indicates heart failure. The pulse and aortic pulsations should also be checked.
Diagnostic examination
Many exams can help you get a quick, accurate diagnosis. These techniques include: electrical examination, X-ray, echocardiography, magnetic resonance imaging (MRI), positron emission tomography (PET), and cardiac catheterization.
Most cardiac examinations are less dangerous, but as the complexity of the examination technique increases and the severity of the patient's heart disease increases, the risk of examination increases accordingly. The risk of major complications such as stroke, myocardial infarction, or death from cardiac catheterization and angiography is approximately 1 in 1000. The risk of myocardial infarction or death from exercise testing is approximately 1 in 5,000. The risk of radionuclide testing is only due to the very small amount of radioactive material received. In fact, the dose of these rays is still smaller than the amount of X-ray radiation.
Diagnosis basis of hypertensive heart disease
(1) has a history of long-term hypertension; (2) only the general symptoms of hypertension in the heart function compensation period; when the heart function is not fully compensated, symptoms of left heart failure may occur, and the light person may only have difficulty breathing after exertion. In severe cases, there is a sitting breathing, cardiogenic asthma, and even acute pulmonary edema; patients with chronic disease may develop right heart failure and eventually lead to total heart failure; (3) physical examination found that apical beats are enhanced, the heart is down to the left Expanded, the second heart sound in the aortic valve area can be metallic, and the pulmonary aortic auscultation area can have a second heart sound hyperactivity due to pulmonary hypertension.
Diagnosis of rheumatic heart disease
Relying on medical history, symptom manifestation and detailed physical examination, electrocardiogram, echocardiography, X-ray, etc., have a great help in the diagnosis of rheumatic heart disease. Some patients also have a cardiac catheter if necessary, and a cardiac angiography can confirm the diagnosis.
Echocardiography is the most sensitive and accurate for the changes of left atrial enlargement caused by rheumatic valvular heart disease. The detection rate is high and the diagnostic coincidence rate is high. Echocardiography can also observe the lesions of various valves and their attachments during rheumatic heart disease. The diameter and area of the valve opening are measured to determine whether there is a combined valvular disease, whether there is a wall thrombus in the atria, and the hemodynamics and cardiac function changes can be understood. The clinical diagnosis and treatment including the surgical procedure are selected. It has important guiding significance.
Heart disease self-diagnosis
When the following phenomena occur in your life, it is recommended to have a heart check to detect heart disease early and take effective preventive measures:
There are palpitations, fatigue, shortness of breath, etc. during physical activity, or a feeling of difficulty breathing.
When you are tired or nervous, you suddenly have chest pain or chest tightness and pressure.
There is a pulse overspeed, too slow, short or irregular.
Suddenly awakened during sleep or nightmares, feeling guilty, chest tightness, poor breathing, need to sit up for a while to get better.
I feel difficulty breathing, chest tightness or chest pain during sex.
Feeling heart, chest tightness or chest pain when eating a meal, cold, smoking, watching a movie or TV with a tight mood.
In public places, it is easy to feel chest tightness, poor breathing and insufficient air.
When you go upstairs, you are more likely to feel guilty and anxious than before.
Suddenly there was a palpitations, dizziness, blackness in front of me, and the feeling of falling.
Children's ability to move is worse than their peers. They feel guilty, short of breath, fatigue, and cyanosis.
Minor work after a cold is also palpitating, tired, or a little faster when you walk.
Sudden chest discomfort and fainting on the ground, or the feeling of "dead" immediately.
Sleeping at night when the pillow is low, it is difficult to breathe, and you need to sleep high.
There is swelling of the lower extremities.
The finger or the end of the toe appears hypertrophy and deformation.
Abnormal colors such as cyanosis and dark red appear on the face, lips and nails.
There is an abnormal sound in the heartbeat when you are resting, or there is a tremor when you grasp the heart of the chest wall.
palpitations, dizziness, shortness of breath or edema during pregnancy.
Left shoulder pain does not heal for a long time.
