Physical diagnosis Palpitation 水
Physical Diagnosis Palpitation
Introduction Palpitation is an unpleasant awareness of the heart beating, not necessary associated with organic heart sease Mechanism Heart contractility: Augmentation Heart rhythm: Regular Irregular Heart rate: normal> fast or slow
Introduction Palpitation is an unpleasant awareness of the heart beating, Not necessary associated with organic heart disease. Mechanism Heart contractility: Augmentation Heart rhythm: Regular Irregular Heart rate: Normal fast or slow
Etiology I. Forceful Contraction of Heart 1. Physiological type strenuous physical effort sudden emotional tension use of coffee. tea. alcohol. tobacco and some rugs Pathological type 1). Ventricular hypertrophy Hypertensive heart disease Rheumatic heart disease 2) Disorders causing augmentation of cardiac output Anemia, High fever, Hyperthyroidism Hypoglycemia, Pheochromocytoma
Etiology I. Forceful Contraction of Heart 1. Physiological type — strenuous physical effort — sudden emotional tension, — use of coffee, tea, alcohol, tobacco and some drugs 2. Pathological type 1). Ventricular hypertrophy — Hypertensive heart disease, — Rheumatic heart disease, 2). Disorders causing augmentation of cardiac output — Anemia, High fever, Hyperthyroidism, Hypoglycemia, Pheochromocytoma
II. Cardiac arrhythmias Tachycardia: tachyarrhythmia paroxysmal tacycardia atrial flutter atrial fibrillation. 2. Bradycardia: bradyarrhythmia high degree av block SICK Sinus syndrome and so on O 3. Premature beat of heart I. Cardiac neurosis Disturbance of autonomic nervous system, and no organic lesion in heart, Chief symptoms are palpitation and those of anxiety state Menopausal Syndrome yndrome of increased B-adrenergic receptor responsiveness
II. Cardiac arrhythmias. 1.Tachycardia: tachyarrhythmia — paroxysmal tacycardia, — atrial flutter, — atrial fibrillation, 2. Bradycardia: bradyarrhythmia — high degree AV block, — sick sinus syndrome and so on. 3. Premature beat of heart III. Cardiac neurosis Disturbance of autonomic nervous system, and no organic lesion in heart, Chief symptoms are palpitation and those of anxiety state. — Menopausal syndrome, — Syndrome of increased -adrenergic receptor responsiveness
Approach to Patients with Palpitation History 1. Use of coffee, tabacco, alcohol, drugs etc 2. Onset and duration of palpitation 3. Anxiety state 4. Accompanied symptoms Precordial pain Organic heart disease or Cardiac neurosis Anemia or fever: may be the cause of palpitation +Weight loss, sweating Hyperthyroidism
Approach to Patients with Palpitation History 1. Use of coffee, tabacco, alcohol, drugs etc; 2. Onset and duration of palpitation; 3. Anxiety state; 4. Accompanied symptoms + Precordial pain: Organic heart disease or Cardiac neurosis + Anemia or fever: may be the cause of palpitation + Weight loss, sweating : Hyperthyroidism
Physical examination Heart rate Rhythm Murmurs Laboratory examination Electrocardiography(ECG) Echocardiograph Ambulatory ECG(Holter Monitoring
Physical examination — Heart rate, — Rhythm, — Murmurs Laboratory examination — Electrocardiography (ECG), — Echocardiography — Ambulatory ECG (Holter Monitoring)
Physical Diagnosis Cyanosis y
Physical Diagnosis Cyanosis
Definition of cyanosis a bluish color of skin and mucous membranes, in lips, nail beds and malar eminences, caused by increased amount of reduced hemoglobin(Hb)or abnormal Hb derivatives in blood
Definition of cyanosis A bluish color of skin and mucous membranes, in lips, nail beds and malar eminences, caused by increased amount of reduced hemoglobin(Hb) or abnormal Hb derivatives in blood
Mechanisms of cyanosis Caused by absolute increase of amount of reduced Hb in blood, usually 5g/dl(capillary) The higher the hemoglobin concentration The greater tendency toward cyanosis gdI 20 18 16 15 口 Total Hb 12 □R-Hb 10 8 b orm Polycythemia Anemia
15 5 20 5 5 5 0 2 4 6 8 10 12 14 16 18 20 Total Hb R-Hb Normal Polycythemia Anemia g/dl Mechanisms of Cyanosis Caused by absolute increase of amount of reduced Hb in blood, usually > 5g/dl (capillary) The higher the hemoglobin concentration, The greater tendency toward cyanosis
Clinical Classification Etiology True Cyanosis(increased amount of reduced Hb) Central Type Peripheral Type Mixed Type Cyanosis due to abnormal Hb derivatives Methemoglobinemia Sulfhemoglobinemia
Clinical Classification & Etiology True Cyanosis (increased amount of reduced Hb) — Central Type — Peripheral Type — Mixed Type Cyanosis due to abnormal Hb derivatives — Methemoglobinemia — Sulfhemoglobinemia