The elderly's plump type myocardium disease symptom and _'s symptom of physical sign

The elderly's plump type myocardium disease, symptom and _'s symptom of physical sign
1.Symptom
Decisive factor of clinical manifestation, patient of HCM, lie in room obstruct at step, flow out dishes of the intersection of pressure and the intersection of steps and poor size and. Most patients have no symptom or only have a slight symptom, the not obstructing symptom person is light, the potential obstructing type is relatively heavy, obstructing symptom is most serious.
(1)The labour has difficulty in breathing: Mostly one of the main suits which HCM patient see at most. 90% of the patients breathe hard at fatigue, after sports, the old patient is more obvious. 31% patient popping to have difficulty in breathing night. With the complying with decline of the left room, press in latter stage of relaxation and the left room presses raising, lung extravasated blood to have something to do with. The patient can sit up straight symptoms such as breathing, weak, palpitation,etc. in later period.
(2)Angina pectoris: 70%- 80% of the patients often present atypical angina pectoris, but duration is relatively long, the intensity is relatively light, the Nitroglycerin can't be relieved. The myocardium oxygen demand that may be plump increases, the blood supply of coronary artery is relatively insufficient, result which is short of blood of the cardiac muscle exists for a long time.
(3)Faint:30%- 35% of the patients can stand suddenly or fainted after sports, could relieve by oneself, it can be patient's only main suit. The omen that about 1/3 of the patients faint and faint frequently or fainting, can relieve to last by oneself for a moment. But kindling of physical exertion or often excited. Because sympathetic nerve excited perhaps, left the intersection of room and contractile force strengthen, make relaxation issue full of quantity to be bad to aggravate, step and flow out one dish of pressure ranks and increase badly, the heart arranges blood volume to reduce, faint insufficient systemic circulation, cerebral artery blood supply. In addition, the complexity room shrinks before one, room tachycardia, the fast room is quiver,etc. to bring about the urgent sudden change in dynamics of blood flow, can also result in fainting.
(4)Die suddenly: HCM patient dying suddenly rate is relatively high, patients do not have symptom, but the unexpected death after the calm state or slight activity more at ordinary times. Or the heart stops suddenly after moving vigorously. The reason to die suddenly, think previously that mainly results from flowing out one and obstructing. Think that it is closely related to serious room arrhythmia to die suddenly in recent years, it is mainly quiver room tachycardia and room to die suddenly. The factor is as follows, that the height of dying suddenly endangers Family's history of fainting and dying suddenly, and disperse that the ventricle is plump and obvious, can bring out the speed on the room speed or room to check in electric physiology.
(5)In heart failure: The intersection of later period in HCM and myocardium fiber take, infarction, shrink and the intersection of relaxation and the intersection of function and obstacle, it is in heart failure that 7%- 15% of the patients can present. Appear out of breath, palpitation, can't flat lie, the intersection of liver and the intersection of swelling, lower extremities edema,etc. and congestive symptom and physical sign in heart failure.
2.Physical sign
Injection has the most common noise in later period in the coarse shrink of the district before the heart. Lie in the brestbone district or district in the heart among rib of left reason 3- 5 and with trembling. Diffuse to brestbone reason, belly and apex of the heart department. The sonority of the noise and size of duration, change with different conditions: In location, hold one's breath, foreign digitalis, different third hard of setting up after Epinephrine, Nitroglycerin fight early, myocardium contractile force is strengthened, after-load is reduced, while pressing difference to increase in the room, the noise is strengthened. While lying in the location, squating down, employing noradrenaline and receptor to block pharmaceuticals, myocardium contractile force subside, ago, increase, pigeonhole difference to reduce in the room by after-load, the noise is weakened. Apex of the heart beat, increase because of atrium sinistrum, left room below shift left, arrange blood, obstruct, can take shape " dual " together with following systolic phase Or " treble " Beat. The heart circle obviously expands, can hear and the third, the 4th heart sound. About 1/3 of the patients have the second sound to split. The half the number patient's apex of the heart department can hear and bicuspid valve backflow systolic phase noise, a few patients because the left room relaxation function is bad, it causes the bicuspid valve to present the drying noise in middle period of relaxation openly and slowly that the diastolic pressure increases. Because the interventricular septum increases thick, a ring of aorta slopes, some patients can also hear an early noise of relaxation of district of aorta.
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