⼼臟期中

梁懷⽂
1. ⼼⾳S1:房室瓣關閉/⼼⾳S2:主動脈瓣肺動脈瓣關閉
2. Aortic regurgitation
1. LV dilatation肥⼤
2. 出現在diastolic舒張期
3. PND , orthopnea
3. Aortic stenosis
1. LV hypertrophy
2. Angina , syncope
3. 出現在systolic(ASS)
4. 可以開⼑替換瓣膜
4. Mitral regurgitation
1. 出現在systolic
2. Radiation: to axilla
3. 可以開⼑替換瓣膜
5. Mitral stenosis
1. Rheumatic heart disease 99%女性易發⽣
2. ⼆尖瓣鈣化
3. 感染性⼼內膜炎
4. LV dilatation＆hypertrophy
5. Palpitation (40% Af in MS)
6. Right heart failure:周圍⽔腫
7. 出現在diastolic舒張期
8. Opening snap: abrupt opening of mitral lea et
9. Hockey-stick sign
10. Fish mouth
11. Meds: Anticoagulation: warfarin
6. Cardiomyopathy ⼼肌病變
1. 遺傳性
2. 導致⼼肌增⼤或使其比普通的更厚、更堅硬
3. 4種
1. Dilated cardiomyopathy
1. 酒精、重⾦屬、古柯鹼
2. 癌症藥物
3. 過去幾個⽉的併發症懷孕
4. 感染（⼼肌炎）
2. Hypertrophic cardiomyopathy
3. Restrictive cardiomyopathy
4. Stress cardiomyopathy
7. Myocarditis
1. symptoms-Acute myocarditis / fulminant myocarditis:triad(發燒、快速惡化、⾎流動⼒
學補償）
2. ⾎流動⼒學補償－低⼼率輸出、肺⽔腫、傳導出問題、⼼室⼼律不整
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 8. Pericardial uid
1. 穩定⼼臟
2. 保護⼼臟
3. 預防過度擴張
9. Acute pericarditis
1. 症狀
1. T = Trauma, Tumor
2. U = Uremia
3. M = Myocardial infarction
4. O = Other infection (viral, Tb)
5. R = Rheumatic, Radiation
2. 發燒、不適、肌⾁痛
3. 尖端痛，咳嗽吞嚥痛
4. 原因：腎毒、腫瘤
10. Pericardial e usion⼼包膜積液
1. 類型
1. serous-黃清液滲出性（ CHF、腎衰竭 ）
2. 化膿性
3. 出⾎性感染-感染和惡性腫瘤
2. 病因
1. 發炎：感染、免疫過程（⾃體免疫疾病）
2. 惡性腫瘤：因阻塞導致⼼包液引流減少
3. 非感染性狀況：
1. CHF：靜⽔壓增加
2. 甲狀腺功能低下：⽑細⾎管通透性增加
3. 肝硬化：⾎漿膠體滲透壓降低
3. 創傷：⼼包膜腔出⾎
4. 主動脈剝離
5. 症狀：呼吸困難、 吞嚥困難、聲⾳沙啞
6. mu ed heart sounds
7. 處理：不要⽤利尿劑！！！
11. Tumor
1. 良性Myxoma(ball valve e ect)
2. 惡性Angiosarcoma

洪尉欽
Atherosclerosis粥狀硬化
1. Intro
1. ⾎管壁tunica media 有smooth muscle & elastin
2. 慢性但有些⼈超過30會急速惡化
3. atheromas斑塊堆積
2. 流⾏病學：⼗⼤死因、減少壽命、⾼開發國家比較嚴重US>Japan
3. 致病機制
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 1. 內⽪受傷：trauma、⾼⾎壓、發炎、toxins、菸草
2. Hyperlipidemia : LDL bad 會增加⾎管通透性，氧化後會與macrophage（Monocytes 因⾎
管通透性變⾼後會跑到內⽪底下變macrophage）形成foam cells、刺激growth factors、
cytokines
3. SMC 增⽣：⾎塊凝集。PDGF、growth factor 、TNF-alpha 上升。NO刺激
4. Atherosclerosis timeline

5. Risk factors
1. 先天：男>女、家族遺傳
2. 後天：
• ⾎脂異常（LDL⾼，HDL低）
• ⾼⾎壓
• 糖尿病
• 代謝症候群
• Hyperhomocysteinemia ⾼同型半胱氨酸⾎症
• 吸煙
• 女⽣有estrogen
6. Symptoms
1. ⼼：⼼肌梗塞、angina
2. 腦：中風sudden numbness or weakness
3. 四肢
1. 周邊動脈阻塞疾病Peripheral Arterial Occlusion Disease（PAOD）
2. 休息可緩解症狀
3. 對知覺不敏感
 4. gangrene
4. 不舉
5. 當動脈粥狀硬化使頸動脈或腦動脈變窄，這可能會導致transient ischemia attack 短暫性腦
缺⾎發作或中風
6. 腎：影響腎臟
7. Aneurysms動脈瘤 ⾎管壁變薄
7. Tests and diagnosis
1. Blood test
2. Electrocardiogram (ECG), Chest X ray
3. Ankle-brachial index, treadmil test, thallium
4. CTA 電腦斷層 or MRA 核磁共振
5. Angiogram⾎管攝影
8. Prevention
1. Primary prevention未發⽣過:戒菸、Statin
2. Secondary prevention:
1. Anti-platelet ( Aspirin, clopidogrel, Ticagrelor, prasugrel )
2. Anti-coagulation ( warfarin, heparin, Anti-Xa, Anti-IIa)
3. Blood pressure control: angiotension-converting drug eluting stent, Bioresorbable
vascular sca old)
4. artery bypass surgery
5. angiotension receptror blocker, Calcium channel blocker, and beta blocker,
thiazine diuretic , alfa-blocker, vasodilator
6. Statin, Ezetamide, PCSK9 inhibitor, feno brate, sh oil
3. 氣球擴張術
Ischemia Heart disease=Coronary artery disease (CAD)
1. 定義
1. 左冠狀動=左前降+左迴旋
2. ACUTE CAD：STEMI、NSTEMI、Unstable angina
3. Chronic stable angina is the typical manifestation of ischemia heart disease in nearly
half patients with CAD
2. 病因
1. CAD result from luminal obstruction is usually caused by atheromatous
2. 流向⼼臟的⾎液會減慢或停⽌。這會導致胸悶、胸悶、疼痛、呼吸困難、氣短
3. 先天性冠狀動脈異常、⼼肌橋接、⾎管炎、放射治療、可卡因使⽤、主動脈瓣狹窄、肥厚型
⼼肌病變、冠狀動脈痙攣
3. 病⽣理
1. 表現：acute coronary syndrome ( ACS), stable angina, CHF, sudden cardiac death,
and silent ischemia
2. Angina:Stable/unstable/variant
3. 男性發⽣率⾼但女性發⽣死亡率⾼
4. Framingham Risk Score : 測試發⽣CAD機率
4. 症狀
1. Typical angina has three features:
a: substernal chest discomfort or heaviness
b: precipitated by stress
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 c: relieved by rest or nitroglycerine (NTG sl)
2. Atypical angina has two of these three features
3. Dyspnea
5. 診斷
1. CCS
1. Class I – Angina with strenuous activity最嚴重
2. Class II – angina with mild activity (walking less than two blocks or one ight of
stairs)
3. Class III –angina that occurs with any activity or at rest 40
4. Class IV – angina with moderate activity
2. S3 gallop、頸靜脈升⾼、周圍⽔腫
3. ECG、運動壓⼒測試、❤ 超、thallium、angiography、MRA、CAA
4. 肺⽔腫:butter y shape
5. MSCT-看鈣化
6. 治療
1. Anti-platelet ( Aspirin, clopidogrel, Ticagrelor, prasugrel )
2. Beta blockers
3. ACE inhibitors(ARB)
4. AT2為較好接受器
5. 利尿劑
6. CCB
7. Statins

說明
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