Cardiology: General Introduction to Circulatory System (Section 1)
Definition and Meaning of Cardiology: The study of cardiology tells that circulatory system is composed of two parts, the heart and the blood vessels. Its function is to transport blood for the body, supply oxygen, nutrients and hormones to the tissue through the blood, and take away the metabolic waste in the tissue. The circulatory system performs these functions under the regulation of neurohumoral and other factors. In recent years, due to the acute infectious diseases and tuberculosis, there is satisfactory treatment obtainment. The number of deaths from circulatory diseases is now rising to the first or second place. Therefore, studying the knowledge of circulatory system diseases and improving the level of diagnosis and treatment of diseases are of great significance for protecting people’s health.
Anatomical and physiological points of the circulatory system in Cardiology
I. The Heart, in Cardiology
The heart is the engine of the entire blood circulation. Its main structure in cardiology consists of the following parts:
(A) Heart cavity
In cardiology, division of Human heart is into four heart cavities by the atrium, the ventricular septum and the atrioventricular valve. The two thin-walled, low-pressure atrial cavities, namely the right and left atria, mainly function to receive, store and transport blood returning to the heart from the systemic and pulmonary veins. The two thick-walled and high-pressure atrial cavities, namely, the right and the left ventricle. The function of these is to fully receive the blood from the atrium, immediately contract the ventricular muscles that the heart’s impulses cause and drain the blood into the pulmonary arteries and aorta and their branches. The blood is input into the lungs for gas exchange (oxygen uptake and carbon dioxide discharge ) and its delivery to the tissues takes place for metabolic needs.
(B) Cardiac wall
Cardiology says, cardiac wall composition is in three layers: endocardium, myocardium and epicardium. The inner and outer membranes are very thin, while the muscular layer is hypertrophic. The latter performs heart’s contraction.
1. There is close attachment of endocardium to the inner wall of the heart cavity. It consists of connective tissue containing elastic fibers and is composed of endothelial cells. It is smooth and bright. Each valve is made by folding the endocardium.
2. The epicardium is transparent and smooth and adheres closely to the surface of heart and the beginning of large blood vessels.
3. The myocardium is the main part of the heart wall and myocardial fibers compose it. The atrial muscles are thin and the ventricular muscle layers are thick. The separation of the two is by fibrous defects on the atrioventricular opening, so atria and ventricles can contract at different times. The composition of ventricular myometrium is with internal and external spiral muscles and circular muscles. Spiral muscles are longitudinal fibers, spiraling from the base of the ventricle to the apex of the heart, and then turning into the deep inner and outer spiral muscles that are perpendicular to each other.
Cardiology says, between layers, there are annular fibers. Its contraction shortens the transverse diameter of the heart cavity. The left ventricle contains a large number of annular muscles. Therefore, when ejection contracts, the transverse diameter shortens more and the longitudinal axis shortens. Compared with the right ventricle, it is rich in spirals. Muscles are shortened to a greater extent along the long axis during contraction, while the free margins only slightly toward the septum. In this way, the right ventricle adapts to pumping out an appropriate amount of blood overcoming low resistance. The left ventricle adapts to high-pressure pumping.
(C) Central Fibrous Body
The central fibrous body of the heart is the scaffold of the entire heart (which firmly connects the atrial and ventricular muscles and the valve tissues), including connective tissue, chordae and valves. Its function is to control the direction of blood flow.
II. Aorta, in Cardiology
The aortic root and the corresponding part of the aortic valve three and a half months of the aortic valve bulge out of the aortic sinus, the left, right and posterior sinus, respectively. If aneurysms (aneurysmal tumors) occur there, they can often break into the adjacent heart , pulmonary artery or pericardium. If the right sinus artery often breaks into the right heart, especially the right ventricle.
Between the left part of the aortic arch and the pulmonary artery, an arterial catheter is connected during the embryonic period. After birth, this catheter is closed to become an arterial ligament. If it is not closed after birth, it is clinically referable as an arterial duct open. The narrowing of the aorta between the left subclavian artery and the arterial catheter is mostly congenital. The narrowing below the arterial catheter is mostly acquired.
III. Coronary Artery, in cardiology
It is the first branch artery of the aorta, which is the nutritional blood vessel of the heart cavity. The left and right coronary arteries open in the left anterior and right anterior sinuses of the aortic sinus, respectively.
(A) The left coronary artery is divisible into two branches, the anterior descending branch and the left-hand branch. The forward descending branch curve is curved, and the end slightly exceeds the apex to reach the plantar surface. It has branches such as the anterior branch of the left ventricle, the left conical branch and the left septal anterior artery. It supplies blood to the anterior wall of the left ventricle and some of its side walls, anterior septum and apex. The left and right cone branches sometimes kiss into a ring, and collateral circulation can form when the coronary artery has blockage.
The left circumflex branch walks in the coronary sulcus and has curvature in an arc to the left to the zygomatic plane. The branches are the left ventricular blunt limb, posterior left ventricle and left atrial branch. Blood supply goes to to the left ventricle blunt limb, the lateral wall and the posterior wall and the left atrium.
(B) The right coronary artery iliac branch includes the right ventricular sharp limb, the posterior right ventricle, the posterior left ventricle, the posterior descending branch, the posterior septal branch and the right atrial branch. In addition to supplying blood to the right ventricle, the right coronary artery often supplies blood to the posterior wall (condylar surface) of the left ventricle and the latter half of the interventricular septum. The blood supply to the sinoatrial node and the atrioventricular node is mostly from the right coronary artery and a little from the left coronary artery.
- Sharp edge
- Blunt edge
- Right atrial appendage
- Left atrial appendage
- Pulmonary artery trunk
- Superior vena cava
- Inferior vena cava
- Right ventricle
- Left ventricle
- Pulmonary artery cone
- Left coronary artery
- Anterior descending branch
- Left circumflex branch
- Conical branch- Left
- Left anterior ventricular branch
- Right ventricular obtuse limb
- Posterior left ventricular branch
- Right coronary artery
- Sinus node branch
- Right atrial branch
- Ventricular sharp limb – Right
- Right ventricular posterior branch
- Left ventricular posterior branch
- Posterior descending branch
Atherosclerotic plaques occur predominantly in the left anterior descending coronary artery, 1/3 of the right coronary artery or the proximal end of the left circumflex branch. When atherosclerotic plaques and other blood vessels with obstructions can cause ischemia and necrosis of the blood supply site of this branch.
IV. The cardiac conduction system, in Cardiology
Cardiac Conduction System consists of myocardial fibers with higher excitability and conductivity. This includes sinoatrial node, nodal bundle, atrioventricular node, atrioventricular bundle, bundle branch and Purdue fiber.
(1) Sinoatrial Scab Location
Cardiology tells that the location of sinoatrial scab is at the entrance of the right superior atrium vena cava. It is a structure of blood vessels, nerves, and muscles. There are pacing cells and transition cells. Here, the pacing cells have the highest impulse distribution frequency and are the starting point of the entire myocardial activity.
(2) Conduction Pathways
There are three conduction pathways between the nodal node sinus node and the atrioventricular node. In cardiology, they are referable as the anterior, middle and posterior node bundles. The anterior node bundle separates into a room bundle called the Bachamnn bundle to connect the left and right atria, sinoatrial node and atrioventricular node. Among the three nodule bundles, the former nodule bundle is the shortest, so under normal circumstances, impulse is easy to conduct through this bundle first.
(3) Atrioventricular scabs location
The location of Atrioventricular scabs is behind and below the right wall of the atrial septum. The upper end is connected to the three knot bundles, and the lower end continues to the atrioventricular bundle. The AV node is the only pathway for normal conduction between AVs. The atrioventricular junction area includes a coronary sinus area, an atrioventricular node, and a junction area between the atrioventricular node and the atrioventricular bundle. The occurrence of many arrhythmias is closely related to the abnormal conduction function in the atrioventricular junction.
(4) Atrioventricular bundle (Hie’s bundle)
Conductive fibers have gradual arrangement in a bundle at the lower part of the atrioventricular node, and continue down into the atrioventricular bundle.
(5) The left and right bundles of the atrioventricular bundle
These are divisible into left and right branches on the interventricular septum. The left bundle branch descends to the upper and middle ventricular septum and is divided into two groups of fibers, which are referable as anterior superior and posterior. Under branch, the anterior superior branch has fan-shape and has distribution in the anterior half of the ventricular septum and the anterior side wall of the left ventricle. The posterior inferior branch has fan-shaped and has distribution in the second half of the ventricular septum and the left ventricular diaphragm. The right bundle branch is smaller than the left bundle branch and travels along the right side of the interventricular septum and is distributed to the entire right ventricle.
(6) The branches of the left and right bundle branches of the Platts fiber
These are divisible into numerous conductive fibers of mesh-shape under the endocardium, namely, Platts fibers. Its ends are connected to ordinary myocardial fibers.
V. Neurohumoral regulation of blood circulation, in Cardiology
Cardiovascular nerve branches are equipped with sympathetic and parasympathetic nerves. If the sympathetic nerve is excited, the adrenergic receptor can make the heartbeat faster and stronger and shrink the surrounding blood vessels. The parasympathetic nerve excites through the acetylcholinergic receptor, which can slow the heartbeat and expand the surrounding blood vessels. But in coronary circulation in contrast, there are abundant baroreceptors in the aortic arch and carotid sinus, and arterial pressure can be adjusted by reflection.
Humoral regulation is mainly through the action of hormones, such as increased adrenal medulla secretion during stressful labor. This causes corresponding changes in hemodynamics, such as vasoconstriction and increased blood pressure. In the aforementioned neurohumoral regulation mechanism, the cerebral cortex plays a leading role.
VI. Electrophysiology of cardiac activity, in Cardiology
Myocardial cells get stimulation by external stimuli or impulses from adjacent cells, which reduces the degree of polarization of the membrane. When the threshold potential (-1Cmv) reaches, the fast sodium channels opens up. A large amount of Na + floods into the cell, and the intracellular potential rises sharply to + 30mv. When the potential in the membrane rises to -55mv, the slow calcium channels open, and the Ca2 + flow is small, which has little effect on the “0” phase.
When the potential in the membrane rises to -10mv, the chloride channels open, CI －Inflow and frequent K + extravasation, the former is the main one, which reduces the potential in the membrane and becomes the action potential “1” phase. This is, since Ca2 + influx and K + extravasation are roughly balanced. The potential difference between the membrane inside and outside is close to zero, showing Isopotential state, formation of action potential “2” phase smooth wave.
After time shift K + outflow increases the action potential gradually decreases, to -55mv, slow calcium channels close and fast potassium channels open, forming action potential “3” phase; Phase “4” cells show a diastolic state after repolarization. There is too much Na + in the cell, activates ATPase, pumped out Na + and switched back to K +. At the same time Ca2 + exchanges with extracellular Na +. The “4” phase potential is stable, and non-autonomous cells were all Fast response electricity. The phase 4 diastolic phase of the autonomic cells is automatically depolarized. The shorter the autopolarization duration is, the higher the autonomy is, and the resting potential is small. It is -70mv. There is no fast Na + inflow.
When the threshold potential reaches -55mv, the slow calcium channel is opened and the depolarization forms a slowly rising low amplitude action potential curve. This is referable as “slow response potential”. When the “quick-response potential” decreases due to disease or drugs, the fast sodium pore inactivation turns into a “slow-response potential”. At this time, the self-discipline increases. At the same time, the “0” phase rise speed slows down. The potential difference between the adjacent and resting cells is small. The conductivity is slowed and reentry is easy to form. Arrhythmia appears.
Diagnosis of circulatory diseases in Cardiology
I. History of cardiovascular disease
In Cardiology study, patients with cardiovascular diseases often have the following symptoms:
These are a common symptom at the beginning of heart disease. It is a feeling of heartbeat discomfort. It is more common in arrhythmia or heart failure, and it can also be seen in hyperdynamic circulation.
Pulmonary stasis, that left ventricular insufficiency causes, often induces dyspnea. It usually starts with labor dyspnea and improves after rest. With the development of the disease, paroxysmal dyspnea at night, the patient is forced to breathe, can not lie flat, often accompanied by cough or even hemoptysis. In severe cases, pulmonary edema may occur.
The location of chest pain caused by angina is mostly behind the sternum, showing a tightening sensation or suffocation, and radiating to the left upper limb or neck, etc. Mostly, physical activity, emotional excitement or satiety causes this which lasts 1- 5 minutes and rarely for more than 15 minutes. Chest pain caused by acute myocardial infarction lasts for a long time, about half an hour to several hours, and the onset can be independent of activity. Others such as acute pericarditis and pulmonary embolism can also cause chest pain, which can be identified by combining the incidence, signs and other examinations.
This is a common manifestation of right ventricular dysfunction, and the location of cardiogenic edema is closely related to body position. For example, early edema of right heart failure is seen in the lower extremity. It is often obvious in the evening after activity during the day and disappears after a rest overnight. .
Patients with mitral valve stenosis, pulmonary infarction or left heart failure with pulmonary stasis often have hemoptysis, congenital heart disease with left-to-right shunts, and hemoptysis when there is excessive pulmonary blood flow and / or pulmonary hypertension .
(6) Severe arrhythmia
Severe arrythmia caused by severe arrhythmias such as atrioventricular block, sinus arrest, paroxysmal ventricular tachycardia, ventricular flutter, ventricular fibrillation, etc. with a high degree of halo, transient clinical loss of consciousness and convulsions. This is referable as Adams-Stokes syndrome.
Asteris a manifestation of hypoxia. When the reduced hemoglobin in the capillaries exceeds 5g / dl, the clinical manifestations of cyanosis. Patients with congenital heart disease with right-to-left shunt or heart failure due to pulmonary stasis or hypoventilation may have central cyanosis or shock. Patients with right heart failure due to slow peripheral blood flow and tissues taking too much oxygen from the blood. Causes peripheral cyanosis.
In addition, it is advisable to know whether the patient has a history of rheumatic fever, upper respiratory tract infection, arthritis, hypertension, diabetes, chronic bronchitis, etc. It is also advisable to know the diagnosis and treatment of his or her diagnosis, which is useful as a reference for further diagnosis and treatment.
II. Physical examination
A systematic physical examination is the most basic and important means of diagnosing cardiovascular disease and some can make a diagnosis based on physical signs alone. In the physical examination of patients with cardiovascular system diseases, in addition to still following the normal operations, the following aspects need to pay attention to:
(A) Heart Enlargement and its nature
Cardiology advises to check whether the heart is enlarged and the nature of the enlargement. The methods of vision, palpation and percussion can be used to determine whether the heart is enlarged. For example, when the left ventricle has enlargement, the heart is enlargement to the lower left. When the right ventricle is hypertrophic or enlarged, the heart boundary expands to the left without expanding downward. When the left ventricular volume load increases (such as aortic valve or mitral valve insufficiency), the apical pulsation is mostly diffuse. If aortic valve stenosis causes left ventricular hypertrophy, when resistance load increases, a strong lifting pulse can be touched at the apex.
(B) Fine Tremor
It is advisable in cardiology to know whether the heart has a fine tremor or not. If the fine tremor is touched, it is often expressed as an organic lesion. Mitral valve stenosis can touch the diastolic fine tremor in the mitral valve area, and the main and pulmonary stenosis can be in the second intercostal space on the right margin of the sternum and second in the left margin of the sternum Intercostal tremor touches systole.
(C) Nature of Heart Sounds
Pay attention to the nature of heart sounds during auscultation, with or without murmurs, additional sounds and arrhythmia.
1. In cardiology it is advisable to pay attention to the intensity of the heart sounds
There is need to gauge whether the heart sounds are split, and whether there are third and fourth heart sounds. Such as mitral valve stenosis often accompanied by first heart sounds, pulmonary hypertension is often accompanied by pulmonary heart valve area second heart sound enhancement. Atrial septal defect may have a fixed second heart sound split. The appearance of the third heart sound can be a normal physiological phenomenon, but it can also occur in severe myocardial damage or heart failure. This is referable as ventricular galloping law, which is a pathological phenomenon and has clinical significance.
The appearance of the fourth heart sound often indicates ventricular muscle dysfunction, increase in ventricular diastolic pressure or decrease in compliance, strong atrial contraction and blockage in ventricular filling to produce the fourth heart sound.
2. Cardiology advises to note the presence of additional sounds:
The systolic jet sound is often caused by mild to moderate stenosis of the main and pulmonary valves and dilation of the main and pulmonary arteries. Hearing sounds during middle or late contractions often indicate mitral valve prolapse and the appearance of pericardial throb sounds, suggesting the presence of constrictive pericarditis.
3．Cardiology advises to check with or without heart murmur:
Heart murmur is of great significance in the diagnosis of heart disease. Diastolic murmur often indicates organic heart disease. However, the presence of systolic murmurs does not necessarily indicate heart disease. Its indication should be on the basis of loudness, nature, duration of the murmur and the presence or absence of conduction. If fine tremor accompanies it, this can be definitely organic, and most of the systolic murmurs of grade 3 and above are also organic.
In addition, auscultation can also find arrhythmia, and found that pericardial friction sound can be diagnosed as acute pericarditis.
(D) Examination of blood vessels
The examination of blood vessels can provide information for the diagnosis of cardiovascular disease, as advisable in cardiology. For example, a positive hepatic jugular vein reflux test is a manifestation of early right heart failure. By observing the height of jugular pulsation, the degree of venous pressure increase can be estimated. The pulse strength of the limbs is not equal, and the significant asymmetry of blood pressure indicates Takayasu arteritis or embolic vasculitis. Strange veins indicate pericardial effusion or constrictive pericarditis. Alternating pulses are early signs of left heart failure.
(E) Performance of other parts
The performance of other parts can sometimes provide clues to the diagnosis of heart disease. Such as rheumatic fever, the skin can be found with circular erythema or subcutaneous nodules. When lipid metabolism is abnormal, the skin can have yellow tumors. Patients with infective endocarditis may have skin or mucosal bleeding points, and may have fever, heart noise and spleen enlargement.
III. Laboratory inspection
Commonly used methods are: Rheumatoid tests such as anti-streptolysin O, C-reactive protein, mucin, etc . Serum myocardial enzymes, such as lactase dehydrogenase and its isoenzymes, aspartate aminotransferase, phosphocreatine kinase and its MB isoenzymes and its subtypes. Determination of blood lipids with lipid metabolism disorders, such as cholesterol, triglycerides, high-density lipoprotein, etc.
Determination of urinary catecholamines and VMAs in patients with hypertension.
Pressure measurement, blood pH and alkali residual measurement.
Sserum sodium, potassium, chlorine, calcium, magnesium and other electrolyte measurements.
In recent years, new technologies such as radioimmunoassay are in use to measure serum myoglobin and myocardial myosin light chain to assist in the diagnosis of acute Myocardial infarction and guided treatment.
IV. ECG examination
It is the most useful method for diagnosing arrhythmia. It is also very valuable for diagnosing myocardial infarction, insufficient coronary blood supply, myocarditis and pericarditis. For myocardial infarction, not only a clear diagnosis but also the location and extent of the infarction can be determined, as well as understanding whether the condition is acute, subacute or old. The electrocardiogram can also reflect the high or low blood potassium and calcium and the toxic effects of drugs such as quinidine, digitalis and antimony on the myocardium. The electrocardiogram shows that right ventricular hypertrophy or atrial hypertrophy has certain clinical diagnosis of heart disease.
Electrocardiogram is an important diagnostic method. However, there are limitations such as the inability to determine the cause and location of heart disease. In addition, normal ECG cannot rule out heart disease. On the contrary, abnormal ECG does not mean that heart disease must exist. Therefore, the ECG examination must be in combination with the clinic to make a correct diagnosis.
V. Chest X-ray examination under Cardiology
It can help judge whether the heart and the atrioventricular cavity are enlarged, understand the heart, aorta and hilar pulsation, as well as pulmonary congestion or pulmonary stasis, etc. The wave counting photography is helpful for the diagnosis of pericardial lesions and aneurysms.
VI. Mechanical map
Including heart sounds, apex beats, carotid beats and ECG recordings. In some cases, it can help determine what is seen by physical examination. For example, heart sounds can help determine whether there are additional sounds during the occurrence of heart sounds or murmurs. Can help identify the nature of the lesion. Measure the systolic time interval to determine the left ventricular systolic function. For example, the left ventricular ejection time (LVET) is the period from the start of the carotid wave to the notch. The electromechanical contraction time (QA2) is the time from the QRS wave to the second heart sound artery valve component, and the pre-spray time (PEP) is QA2 minus LVET.
When left ventricular insufficiency, the pre-spray time is prolonged and the left ventricular spurt time is shortened, so the PEP / LVET ratio increases. Measuring the systolic time interval is helpful to determine left ventricular systolic function in patients with coronary heart disease and cardiomyopathy.
Measurement of various phases of the left ventricle during the cardiac cycle
Left ventricular phase measurement during cardiac cycle
QA2: electro-mechanical contraction time.
LVET: left ventricular ejection time.
IRP: isovolumetric diastole.
RFP: rapid filling period.
SFP: Slow filling period.
This is the use of ultrasound scanning technology to display on the phosphor screen ultrasound waves through various layers of the heart such as the pericardium, myocardium, endocardium, ventricular septum, valves and aorta, as a reflection of the heart and large blood vessels. Of Diastolic and Valve Switches. M-type and B-type echocardiography is currently in use for mitral and aortic stenosis and insufficiency, tricuspid stenosis, mitral valve prolapse, idiopathic hypertrophic aortic stenosis and atrial myxoma.
The diagnosis of pericardial effusion, atrial and ventricular septal defects is of great value. In addition, use echocardiography to measure the size of the chamber and ventricle, calculate cardiac output, ejection fraction, etc. to understand left ventricular function. In recent years, color Doppler blood flow imaging has been used to detect the regurgitation of valvular insufficiency and the shunt of congenital heart disease, which has improved the quality of disease diagnosis.
VIII. Radionuclide inspection
Cardiovascular radionuclide tests can be roughly divisible into two categories i.e. cardiac function tests and cardiac imaging tests.
(i) CFT or Cardiac function tests: This includes cardiac radiographs, cardiac nuclear stethoscopes, and gate radiography. Cardiac radiography is a simple method for nuclide to check heart function. Cardiac radiography can be traceable by using a general functional instrument, and the cardiac output and stroke volume is obtainable through graphic analysis and calculation. The nuclear stethoscope method is a single-probe scintillator dedicated to cardiac function measurement. It is usable to quickly measure the left ventricular ejection fraction, ventricular end-diastolic capacity, and end-systolic volume, etc., with subsequent circuit devices, electrocardiographs and microprocessors.
Multiple heart function parameters: The gate circuit r imaging method uses a gate circuit triggering device to control the shutter of the r camera to display the cardiac blood pool image and radioactivity count value of a predetermined interval in the cardiac cycle, and the cardiac cycle is simply divisible into unsystolic and diastolic. After the two images are processed by an electronic computer, cardiac function indexes such as left ventricular ejection fraction can be displayed on the fluorescent screen, and the motion of the wall can be understood through the images to locate local lesions.
(ii) Cardiac Imaging: This includes myocardial imaging, cardiac large vessel blood pool imaging (static) and radionuclide cardiovascular dynamic imaging.
1. Cardiac imaging is currently divisible into two categories.
(i) Myocardial “cold area imaging”. Normal myocardial cells have selective uptake of certain alkaline ions (such as 43 potassium, 131 cesium, 201 gadolinium, etc.), so as to obtain radiological images of normal myocardium. Density is not only proportional to the amount of myocardial blood perfusion, but also related to the functional status of myocardial cells. When local myocardial blood flow is impaired, myocardial cells are necrotic or scar tissue is formed, that is to say local radiation sparseness or defect.
(ii) Myocardial “hot zone” imaging of freshly infarcted myocardial tissue selectively accumulates certain radionuclide-labeled compounds (such as 99m -pyrophosphate), showing radioactive concentration, while surrounding normal Myocardium does not develop.
2. Cardiac blood pool imaging
After the expert injects a certain radionuclide-labeled protein or red blood cells into a vein, the blood vessel wall is not penetrated for a short period of time, and it is evenly mixing and circulation takes place in the heart and the large blood vessel pool. Scanning or radiography can display the scan of the heart or large blood vessels. The shape and size of the vascular cavity and its relationship with surrounding tissues. This method is usable as a preliminary diagnostic method for cardiac cavity and vascular disease.
3． Radionuclide cardiovascular dynamic imaging
A short “half-life” nuclide is used for rapid “ballistic” intravenous injection. When the nuclide passes through the cardiopulmonary and large blood vessels, use a scintillation camera and an imaging recording device to perform rapid continuous photography, so as to obtain dynamic imaging of the nuclide through the various chambers, chambers and lungs of the heart cavity at different phases . Using an electronic computer to analyze a series of images, you can understand the hemodynamic changes of the heart, understand the elapsed time of each segment of the central circulation and display the anatomical structure of the large blood vessels in the thorax. This is so as to make a preliminary for some congenital or acquired heart disease diagnosis.
IX. Cardiac catheterization and selective cardiovascular angiography
Examination of the right or left heart catheter, by measuring the pressure in each heart cavity and large blood vessels, measuring the oximetry or indicator dilution curve and observing whether the catheter is pushed into the abnormal pathway. It is useful for diagnosis of congenital cardiovascular disease and heart valve disease and estimating the extent of the disease can help. Cardiovascular angiography and film-recorded angiography through cardiac catheters can further understand the pathological changes and functional changes of the heart and large blood vessels.
Left ventricular angiography can observe the presence of segmental wall motion abnormalities and understand left ventricular function. Selective coronary angiography can clarify the degree and location of coronary artery stenosis and provide a basis for determining treatment options. The use of catheters with electrodes can be used to perform Heath beam electrocardiography.
Heath beam electrocardiogram is helpful for the location of conduction block, clarifying the mechanism of arrhythmia, and distinguishing ventricular premature beat from supraventricular premature beat with differential conduction. The use of a cardiac catheter with a microphone can record the heart sound map to determine where the heart sound occurs. A ballooned floating catheter can be used to monitor hemodynamic changes. Catheters with a thermistor can be used to directly measure cardiac output. Endocardial myocardial biopsy through cardiac catheters can provide diagnostic clues to those who are clinically difficult to diagnose.
X. Dynamic ECG
Continuous monitoring of patients with 24-hour ECG using special equipment can improve the detection of ST segment changes and arrhythmias that are not found during a single ECG recording. This is of great value in the diagnosis of coronary heart disease and arrhythmia.
XI. Heart vector illustration
It is the projection of the space vector ring composed of the trajectories of the vertices of the comprehensive heart vector at each instant of the entire cardiac cycle on 3 perpendicularly intersecting planes (frontal, lateral and transverse). Cardiac vector diagrams are of certain help to the understanding of various figures of the electrocardiogram. These have certain value in the diagnosis of ventricular hypertrophy, bundle branch block, pre-excitation syndrome and myocardial infarction.
XII. Other inspection methods
In recent years, such as the analysis and recording of ventricular late potentials, spectrum analysis, etc. have been used to predict the severity of arrhythmia, which is helping the diagnosis of coronary heart disease.
- History of cardiovascular disease
- Physical examination
- Laboratory inspection
- ECG examination
- Chest X-ray examination
- Mechanical map
- Radionuclide inspection
- Cardiac catheterization and selective cardiovascular angiography
- Dynamic ECG
- Heart vector illustration
- Other inspection methods
Diagnosis of circulatory system diseases
Cardiovascular disease condition estimation and treatment is correct. On the basis of correctness and completeness of the diagnosis, in cardiology, a complete diagnosis should include the following aspects.
A. The cause of diagnosis
Common causes according to cardiology are:
i. Congenital cardiovascular disease, such as atrial septal defect
ii. Infectious cardiovascular disease, such as subacute bacterial endocarditis
iii. Connective tissue disease, cardiovascular disease, such as rheumatic heart valve disease and systemic lupus erythematosus.
iv. Atherosclerosis, such as coronary atherosclerotic heart disease
v. Hypertension and secondary hypertension, such as renal artery stenosis
vi. Endocrine cardiovascular disease, such as hyperthyroidism
vii. Anemia heart disease
viii. Pulmonary heart disease and so on.
B. Anatomy diagnosis
According to cardiology the site of the lesion should be stated:
i. Where the congenital cardiovascular disease is deformed, such as open arterial ducts and pulmonary valve stenosis
ii. Endocardial diseases such as endocarditis (subacute or acute) and valvular disease (valvular stenosis (Or incomplete closure)
iii. Pericardial disease: such as acute pericarditis or chronic constrictive pericarditis
iv. Coronary artery disease, such as coronary arteriosclerosis, embolism or thrombosis
v. Myocardial disease such as myocarditis, cardiomyopathy, myocardial infarction, etc.
vi. Cardiac tumors, such as atrial myxomas, iliac vascular lesions, such as aortic sinus tumors.
C. The pathophysiology diagnosis
i. Heart failure (acute or chronic)
ii. Peripheral circulation failure (shock)
iii. Angina pectoris
iv. Alzheimer’s syndrome
v. Hyperdynamic circulation
vi. Arrhythmia such as sinus tachycardia, bradycardia or irregularity, Premature pulsation, paroxysmal tachycardia, atrioventricular block, atrial (ventricular) flutter or fibrillation, pre-excitation syndrome, etc.
D. Cardiac function diagnosis
According to cardiology it is advisable dividing heart function into four levels according to subjective symptoms that patients produce at different levels of activity:
Level 1: Cardiovascular disease. But all activities are unrestricted and asymptomatic.
Level 2: Capable of general light physical activity. But heavier physical activity can cause heart dysfunction such as palpitations and shortness of breath.
Level 3: There is no discomfort at rest. But there is performance of heart insufficiency when doing light activities.
Level 4: Any activity is symptomatic, even when bed rest, there are symptoms of cardiac insufficiency, such as palpitations, dyspnea and inability to lie flat.
In order to fully understand the condition, in addition to the above four aspects of the diagnosis of cardiovascular disease, it is advisable to include complications such as cerebral embolism. For example, “Rheumatic heart disease, mitral valve stenosis and insufficiency, rheumatic activity, second degree of heart failure, third-order heart function, concurrent atrial fibrillation, cerebral embolism, and left hemiplegia. This is a complete diagnosis. To estimate the prognosis, guided treatment is valuable.
Advances in Cardiology research on circulatory diseases
In recent years, cardiology has made great progress in the aspects of the circulatory system disease mechanism, diagnostic techniques and prevention measures.
Basic research on cardiovascular disease has entered the molecular, cellular, and genetic levels. It is common to use gene probes to explore the etiology, pathogenesis and diagnosis of diseases, such as the application to the etiology of hypertension and hyperlipidemia. With the development of biochemical separation technology, micro-analysis methods and molecular biology, it is seen that the heart, blood vessels, endothelial cells and blood cells have important secretory functions. They secrete a large number of humoral factors and vasoactive substances such as atrial natriuretic peptide and renin.
Angiotensin-aldosterone, prostacyclin I2, endogenous digitalis, cardiac growth factor and various peptides (calcitonin gene-related peptide, bradykinin, antiarrhythmic peptide, etc.), regulate cardiovascular, respiratory blood. Many physiological functions such as coagulation, water and salt. And found that the tissue renin-angiotensin-aldosterone (RAA) system plays an important role in the long-term regulation of the cardiovascular system. There are in-depth studies on LDL in the process of atherosclerosis. Atherosclerotic plaques and thrombi are caused by the interaction of blood vessel walls and blood components in a very complex form.
The use of new diagnostic instruments will improve the level of diagnosis of circulatory diseases. The application of magnetic resonance imaging in the diagnosis of cardiovascular diseases has proven to be excellent in the diagnosis of the following six categories of diseases. Such as:
i. ischemic heart disease, especially old myocardial infarction and wall tumors
ii. all types of primary cardiomyopathy, especially hypertrophy
iii. pericardial disease
iv. cardiac tumors
v. congenital heart disease
vi. thoracoabdominal aortic disease and deformity.
SPECT and PET
In recent years in cardiology, great progress is taking place in the application of myocardial imaging in cardiovascular diseases. The application of single photon electronic computed tomography (SPECT) and positron emission computed tomography (PET) is used for the diagnosis of coronary heart disease and the evaluation of the extent of the disease. Efficacy estimates and prognosis provide reliable non-invasive methods. Myocardial imaging can also be used for the diagnosis and differential diagnosis of cardiomyopathy, myocarditis, pulmonary heart disease, sugar heart disease, hypertension and heart disease. Recent developments in ultrasound technology include: intravascular ultrasound catheters that can directly observe intravascular lesions and doppler flow probes that can estimate blood flow.
Advances in treatment under cardiology, thrombolytic therapy and treatment of acute myocardial infarction are being further studied with new thrombolytic drugs to observe and compare the effects, the effects of drugs on the mortality of acute myocardial infarction and how to reduce reperfusion injury. For interventional treatment, coronary stenosis has been successfully applied with percutaneous balloon dilatation coronary angioplasty (PTCA) since 1977.
In order to solve long stenosis and mild calcified lesions, in recent years: laser angioplasty, drill catheter, cutting catheter Advent. In order to solve the restenosis after PTCA, a trial stent is used to expand the narrowed blood vessels. Balloon dilation is currently used in addition to dilating and narrowing the coronary arteries, and also to relieve the stenosis of the pulmonary, aortic, and mitral valves, saving some patients from surgery.
Progress in diagnosis and treatment of arrythmia
The diagnosis and treatment of arrhythmia, in cardiology, are also making great progress. The average signal ECG can more effectively detect patients at high risk of sudden death. Electrophysiological drug tests provide useful methods for the selection of curative antiarrhythmic drugs. Electroablation, radiofrequency ablation non-drug treatment of arrhythmias is being applicable clinically. The development of anti-tachyarrhythmic instruments such as buried pacemakers, automatic defibrillators and other electronic instruments is in the trial and improvement stage in the clinic.
Heart Failure (Section 2)
Chronic Heart Failure
Pathogenesis and pathophysiology
Laboratory and other inspections
Acute Heart Failure
Classification of Arrhythmias
I. Classification by Pathophysiology
Clinical heart rate changes Classification
Mechanism of arrhythmia
a. the mechanism of tachyarrhythmia
b. the mechanism of bradycardia
Sinus tachycardia (Sinustachycardia)
Atrial flutter and atrial fibrillation
Ventricular flutter and ventricular fibrillation (Ventriculer Flutter and Ventriculer Fibrillation)
Chronic sinus arrhythmia
Sinus bradycardia (SinusBradycardia)
Sick Sinus Syndrome (SSS)
Escape Beat and Escape Rhythms
Atrioventricular Block (Atrioventricular Block)
Intraventricular Block (IntraventricularBlock)
Clinical application of commonly used antiarrhythmic drugs
a. antiarrhythmic drugs and their classification
b. commonly used antiarrhythmic drugs
c. the issues that should be paid attention to when using antiarrhythmic drugs
Section 4 Rheumatic Fever
Section 5: Chronic Rheumatic Valvular Disease
Section 6 Infective Endocarditis
Acute Infective Endocarditis
Subacute Infective Endocarditis
Section VII: Hypertension
Section 8: Atherosclerosis and Coronary Atherosclerotic Heart Disease
Angina Pectoris (AnginaPactoris)
Section 9: Congenital Cardiovascular Diseases
Atrial septal defect (Atrial Septal Defect)
Ventricular septal defect (Ventricular Septal Defect)
Arterial Duct (Patent Ductus Arteriosus)
Pulmonary artery stenosis (Pulmonry stenosis)
Tetralogy of Fallot
Section 10: Myocardial Disease
Section 11: Pericarditis
Subacute exudate constrictive pericarditis
Section 12: Syphilitic Cardiovascular Disease
Cardiogenic Sudden Death
Section 14: Non-rheumatic mitral regurgitation disease
Mitral Valve Prolapse Syndrome, Barlow’s Syndrome
Papillary Muscle Dysfunction (Insuficiency of the papillary Muscle)
Calcification of Mitral valvular Ring
Myxoma of the Heart
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