Changes in blood vessel pulsation or waveform

Introduction The so-called peripheral vascular sign refers to a change in the pulsation or waveform of a blood vessel that is found when examining a surrounding blood vessel under certain disease conditions. The clinically common peripheral vascular signs have the following manifestations: 1. Capillary pulsation syndrome: gently press the end of the patient's finger with a finger, or gently press the lip membrane with a clean glass piece. If you see red and white alternating rhythmic microvascular pulsation, called capillary Vascular pulsation. 2, water hammer pulse (water hammer pulse) water pulse is also called the sinking pulse, fast pulse or Corrigan pulse. During the examination, the patient's arm is raised above the head and gripped on the palm of the hand. It can be felt that the patient's burning arterial pulsation suddenly drops, and is very powerful, called edema. 3, alternating pulse (pulsus alternans) alternating pulse is a normal rhythm and strong and weak pulse, which is a manifestation of myocardial damage. 4. Dicotic pulse The normal pulse wave has a repeated rising pulse wave during its descending period, but it is lower than the first wave and cannot be touched. In some pathological conditions, this wave is increased and can be touched, called the tremor pulse, that is, one systolic phase can touch two pulse beats. 5. Paradoxical pulse The phenomenon that the pulse is obviously weakened or even disappeared during inhalation is called odd pulse. The insignificant odd pulse can only be found when auscultating blood pressure, that is, the original heard pulse sound weakens or disappears during inhalation, or the systolic pressure decreases by 1.33 kPa or more during the inspiratory period compared with the expiratory period. 6. The bound pulse The pulse is a pulse with normal shape and large amplitude. When the blood vessels are palpated, the pulse can be found to be strong and large. 7, small pulse (small pulse) fine pulse refers to the normal shape and small amplitude pulse, contrary to the Hong pulse, the pulse is weak and small at the time of palpation, also known as thready pulse. 8. Pistol shot sound Normally, two sounds corresponding to the first heart sound and the second heart sound can be heard in the carotid artery or the subclavian artery, but not in other arteries. In the pathological case, the chest piece of the stethoscope is lightly placed on the cerebral artery or femoral artery of the patient, and the sound of "Kiichi, Kayi" can be heard, which is called a gunshot sound. 9. The chest piece of the Duroziez dual-tone stethoscope is placed on the root of the femoral artery of the patient to hear the double sound of contraction and echo that occurs with the contraction of the heart, called the Duroziez double tone.

Cause

Causes of changes in vascular beats or waveforms

Etiology classification

1, aortic valve insufficiency.

2. Patent ductus arteriosus.

3, aortic stenosis.

4, constrictive pericarditis and acute pericarditis.

5. Coronary atherosclerotic heart disease.

6, hypertensive heart disease.

7, obstructive hypertrophic cardiomyopathy.

8, hyperthyroidism.

9, anemia.

10, fever.

11, shock.

mechanism

Because of the multiple manifestations of peripheral vascular signs, the mechanism of action is not the same, leading to the most common disease of peripheral vascular signs of aortic valve insufficiency. When the aortic valve is insufficiency, the heart's compensatory contraction is enhanced, so that during the systole, there is enough blood to shoot the aorta or even the small arteries, so that the systolic blood pressure rises, the pulse is strong and powerful, and the flood veins appear. In the diastolic phase, due to aortic regurgitation, a large amount of blood in the aorta is refluxed to the left ventricle, causing compensatory contraction of the aorta, arterioles, and capillaries, thus the difference between arterial systolic pressure and diastolic blood pressure. Increase, form a series of peripheral vascular signs such as water pulse, gunshot sound, Duroziez double tone and capillary pulsation.

When there are some diseases such as shock and aortic stenosis, the cardiac output is decreased, and fine veins may appear. The small blood vessels are reduced due to insufficient circulating blood volume, which is caused by ventricular contraction. The result, a manifestation of myocardial damage, is seen in severe hypertensive heart disease and coronary atherosclerotic heart disease. The mechanism of the odd pulse is more complicated, which is common in pericarditis and is an important sign of pericardial tamponade. Under normal circumstances, the amount of blood in the pulmonary circulation increases during inhalation, but the perfusion of the systemic circulation to the right heart also increases accordingly, so the blood volume of the pulmonary circulation to the left heart does not change significantly, so that the pulse size changes are not obvious.

However, when the pericardial tamponade, although the amount of lung and blood increased during inhalation, due to ventricular diastolic restriction, the amount of blood circulation to the heart can not be increased correspondingly, resulting in a decrease in the blood volume of the pulmonary circulation to the left heart, and the amount of left ventricular ejection is also reduced. To make the pulse weaker or even inaccessible, that is, to form a strange pulse.

Unexpected arterial catheter, aortic insufficiency, obstructive hypertrophic cardiomyopathy and other diseases may appear severe stroke, which is related to various factors such as decreased peripheral vascular tone and reduced weekly resistance.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) blood test

Examination of changes in vascular beats or waveforms

First, medical history

The medical history is very important for the diagnosis of the disease. A detailed history will help us understand the development of the disease, so as to make a rough estimate of the cause and guide us to further examine and diagnose the disease. Peripheral vascular signs are most common in patients with aortic regurgitation. These patients are often rheumatic heart disease, have a history of rheumatic fever, have a younger onset, and often have mitral valve disease. Congenital aortic regurgitation is rare in clinical practice and can occur in infants and young children. The syphilitic aortic regurgitation was once extinct in China, but it has increased in recent years. These patients have a history of smelting; when asking about medical history, they should be careful and careful to avoid misdiagnosis.

A few cases of peripheral vascular signs are also seen in patent ductus arteriosus, thyroid dysfunction, anemia and hypertensive heart disease, pericarditis, myocardial disease, these diseases have their corresponding medical history characteristics, the collection of medical history should be targeted, in the heart There are several, targeting the characteristics of the disease to help diagnose the disease.

Second, physical examination

A physical examination should be performed after detailed medical history to further help us diagnose the disease. Patients undergoing aortic insufficiency can experience diastolic sigh-like murmurs in the aortic valve area during physical examination. When combined with mitral and tricuspid valve lesions, murmurs can be heard at the corresponding site. In patients with Marfan syndrome, aortic valve regurgitation, in addition to hearing aortic valve area murmur, this type of patient can also find that his body is tall and slender, the finger (toe) refers to the longer than usual, " Spider finger (toe).

Hypertensive heart disease, coronary atherosclerotic heart disease and obstructive hypertrophic cardiomyopathy and other heart disease patients with peripheral vascular signs, often suggest that patients with cardiac dysfunction in the presence of physical examination, in addition to increased blood pressure, heart enlargement and In addition to low-pitched heart sounds, there may be signs of heart failure such as jugular vein engorgement and lower extremity edema.

The murmurs of patients with aortic stenosis and patent ductus arteriosus have their own characteristics, which are not difficult to find when examining. Cardiac tamponade can be found in patients with constrictive gingivitis, and a series of features such as widening of the eyelids, binocular vision, thyroid enlargement, and fine tremors of the hands can be found in the physical examination of patients with hyperthyroidism. Performance, according to this is not difficult to make a diagnosis.

In short, in the physical examination, careful and careful inspection should be carried out in order to avoid missing important signs and delay the disease, which is not conducive to the diagnosis of the disease.

Third, buy a laboratory inspection

laboratory

Inspection can aid in diagnosis. Patients with aortic regurgitation and aortic stenosis, suspected to be rheumatic, can carry out a series of tests for anti-streptolysin "O", erythrocyte sedimentation rate, C-reactive protein, etc.; suspected syphilitic aortic valve insufficiency A serum syphilis response test can be performed. Patients with coronary atherosclerotic heart disease and hypertensive heart disease often have elevated blood lipids; elevated thyroxine levels in patients with hyperthyroidism; peripheral blood red blood cell count and decreased hemoglobin in anemia patients are helpful for further diagnosis disease.

Fourth, equipment inspection

After the above-mentioned tests, we have a clear diagnosis of the disease itself. In order to further determine the nature of the disease, especially for some diseases that are still not clear after the above examination, we need to carry out the device examination. Among them, echocardiography is of great value in the diagnosis of diseases. Echocardiography can not only make a correct judgment on the cause, but also understand the severity of the disease itself, whether there are complications, and guide our treatment. Therefore, in the current clinically very common echocardiography, the rational application of this test is necessary for the diagnosis of the disease.

Differential diagnosis

Symptoms of vascular pulsation or waveform changes

First, aortic valve insufficiency

Aortic regurgitation is the most common cause of peripheral vascular signs, and most of the surrounding vascular signs can be seen in this disease. Therefore, when the presence of peripheral vascular signs is found clinically, the possibility of this disease should be first thought of. There are many reasons for aortic regurgitation, and the following are common:

(a) rheumatic aortic valve insufficiency

The disease accounts for about 2/3 of the cause of aortic regurgitation, often with mitral valve disease, and more coexist with aortic stenosis. Patients with rheumatic aortic regurgitation are more common in men, and their compensation period is longer, so the symptoms appear later. Light can be without any symptoms, or only the heart and sputum head strong pulsation and other symptoms, severe and advanced patients often have fatigue, shortness of breath, nighttime paroxysmal dyspnea and other left ventricular dysfunction. In patients with large aortic regurgitation, the diastolic blood pressure is significantly reduced, resulting in insufficient coronary perfusion, which can cause angina pectoris, and the effect of nitroglycerin is poor. The common peripheral vascular signs of this disease include: the de novo of the sputum pulsation (Depressor Musset), capillary pulsation, water pulse, gunshot sound, Duroziez sign, etc., found in patients with chronic disease, acute disease is not obvious. Cardiac auscultation can be found in high-profile diastolic qi dysfunction in the diastolic period. It is easy to hear when the seat is leaning forward and deep exhaled. The aortic valve auscultation area is more obvious. Severe reflux can be heard in the apex of the apex and the middle and late rumbling of the diastolic murmur. , that is, Austin Flint murmur. The chest X-ray shows that the left heart is enlarged, with the left ventricle as the heart. When there is left heart failure, pulmonary congestion can occur. A common change in ECG is left ventricular hypertrophy with strain. Echocardiography has a high sensitivity to the diagnosis of this disease. Color Doppler flow imaging can be used on the ventricular side of the aortic valve to detect high-speed jets in the full diastolic phase, and the severity can be judged. When echocardiography is unable to determine the degree of reflux and the patient is in need of surgical treatment, aortic angiography can also be used to determine the degree of reflux.

(two) infective endocarditis

Infective endocarditis can occur in both valvular heart disease and normal heart valves. When the aortic valve is involved, the infective neoplasm destroys or perforates the leaflets, and the leaflets are prolapsed due to impaired support structures or the neoplasms block between the leaflets, causing aortic regurgitation. Infective endocarditis is divided into acute and subacute forms. The latter is more common, that is, subacute infection endocarditis. The onset of this disease is slow. The most common symptoms in the early stage are Fever, mostly between 37.5-39 ° C, with fatigue. It was pale and anorexia. The fever can be relaxation heat and heat retention, or irregular fever, and individual patients can be accompanied by chills. Most patients have enlarged spleen and some have a finger (toe). The characteristic manifestation of this disease is that the original nature of the heart's rational noise changes or a new pathological murmur occurs. The typical heart murmur is a rough musical murmur called the seagull. Heart failure is common and is the cause of death in this disease. In addition, some patients may have embolic complications, such as cerebral embolism, renal embolism, spleen embolism, mesenteric artery embolization or limb arterial embolism, etc., there may also be skin or tick blood points, usually the size of the needle, the center is pale, pressed Does not fade, disappears after a few days, but often recurs. Sometimes the patient may have an Osler knot or a Janeway knot in the palm or foot. The former is purplish red, slightly higher than the skin, with obvious tenderness, and the latter is not obvious.

The diagnosis of infective endocarditis depends on blood culture. In order to improve the positive rate, it should be checked continuously for at least 4-6 times. Each time 10-15 ml of blood is taken, special cultures such as anaerobic bacteria and mold are needed to improve the diagnosis rate. Blood culture results were most common with Staphylococcus aureus, followed by hemolytic streptococcus and meningococcus.

More than 90% of patients with this disease have increased erythrocyte sedimentation rate. Blood routine examination may have mild to moderate anemia. The number of white blood cells may be normal or high. Urine routinely shows proteinuria, hematuria and bacteriuria. Atrioventricular block can occur in the electrocardiogram. Echocardiographic abnormal echoes of neoplasms can be seen in the heart valve or the wall of the heart chamber.

(three) syphilitic aortitis

About 30% of syphilitic aortitis has aortic regurgitation. The patient has a history of smelting, and the onset is slow, but progressively worse. In the early stage, there may be symptoms such as shortness of breath and heart repair. Some patients may have angina pectoris. Cardiac examination revealed that the heart was enlarged to the left and the apex of the apex was enhanced. The aortic valve auscultation area could smell double-phase murmurs. The apex of the opposite flow could smell Austin Flint murmur, sometimes in the third and fourth intercostals of the left sternal border. Hearing the diastolic music and murmur. Peripheral vascular signs are obvious. X-ray examination showed that the left ventricle was enlarged in the shape of a shoe, and the ascending aorta showed a limited expansion. Echocardiography showed that the aortic diastolic two-wave distance was >1 mm, the anterior mitral valve had a diastolic fine tremor, and the ascending aorta had a significantly larger inner diameter without aortic stenosis and other valvular lesions. The serum syphilis response was positive.

(4) Marfan's syndrome

Marfan syndrome is an autosomal dominant connective tissue disease that invades the bones & parts and heart. It is also called "one heart and one eye syndrome". The disease is not common in clinical practice. The patient has a clear family history. There is no symptoms in the early stage, and exhaustive shortness of breath, palpitations, and progressive heart failure occur in the late stage. 30%-60% of patients with Marfan syndrome have aortic regurgitation. In addition to the general signs of aortic regurgitation, such as increased pulse pressure, aortic valve murmur and peripheral vascular signs, such patients can also find their bones and eye special performance. Skeletal changes are mainly slender, especially the fingers and toes are more slender, called "spider finger (toe)", lordosis, joints are overstretched, can have chicken breasts and other performance. The eye changes are mainly the complete dislocation or subluxation of the congenital lens. The above two manifestations can exist at the same time as the heart changes, or they can exist partially. Cardiac ultrasonography is an important method for diagnosing this disease. It mainly changes the aortic roots significantly, the aortic wall becomes deeper, and sometimes the ascending aortic aneurysm-like changes are formed. The left ventricular enlargement mitral valve can be characterized by lengthy length. Leaf prolapse, but also with a sandwich aneurysm. The aortic root of the disease is significantly dilated, similar to the echocardiogram of syphilitic aortic regurgitation. The difference is that the latter lesion is limited to the aorta, linear calcification, and the aortic valve area is also louder, and the second heart sound is hyperactive. Significant, drumming.

(5) Congenital malformations

A common type of aortic valve insufficiency due to congenital malformation is the bicuspid aortic valve. One of the leaves has a gap or a large and long leaf that is prolapsed into the left ventricle, resulting in childhood. Aortic regurgitation. Less common congenital malformations with ventricular septal defect with a leaflet prolapse, congenital lesions, perforation, etc. can lead to aortic regurgitation. Aortic valve closure caused by congenital malformation can be found in infants and young children. In addition to the performance of aortic valve insufficiency, echocardiography can also be found in other congenital cardiovascular diseases.

(6) Others

Other diseases such as severe hypertension, coronary atherosclerotic heart disease, anemia cardiomyopathy, ankylosing spondylitis, etc. can cause chronic aortic regurgitation, leading to the appearance of peripheral vascular signs, but these diseases have their The performance of the primary disease, and generally the peripheral vascular signs appear in the late stage of the disease. Diseases that cause acute aortic regurgitation, such as dissection aneurysms, prosthetic valve rupture, and trauma, generally have no obvious peripheral vascular signs.

Second, patent ductus arteriosus

Patent ductus arteriosus is a common congenital cardiovascular disease with a prevalence that is second only to atrial septal defect. The arterial catheter is a passage between the continuous descending aorta of the fetus and the trunk of the pulmonary artery. It is usually closed within one year after birth. If this period is exceeded, it is the patent ductus arteriosus. In the early stage, because the aortic pressure is higher than the pulmonary artery pressure, regardless of the systolic or diastolic phase, the blood flows from the aorta into the pulmonary artery, so continuous machine-like murmurs can be heard in the second intercostal space on the left sternal border. In the late stage, due to the presence of pulmonary hypertension, right-to-left shunt can occur. At this time, the patient may have cyanosis, and the lower body is more obvious than the upper body. The diastolic phase of the auscultation continuous murmur is partially weakened or disappeared. In patients with patent ductus arteriosus, peripheral vascular signs appear mainly as water-pulsing veins. In addition, there may be capillary pulsation signs and gunshot sounds. Due to the large flow rate, such patients have continuous murmurs in the near apex. A mid-diastolic murmur can also be heard in the valve area, which is difficult to hear in patients with pulmonary hypertension.

Electrocardiogram in patients with patent ductus arteriosus with peripheral vascular signs often showed left ventricular hypertrophy and deep Q wave in the left ventricle. High R wave and T wave. X-ray examination showed pulmonary congestion. Echocardiography shows an abnormal pathway between the descending aorta and the main pulmonary artery.

Typical arterial catheters are not difficult to diagnose, but care must be taken to distinguish them from congenital primary pulmonary artery septal defects. The latter's heart murmur. Hemodynamic-electrocardiogram and X-ray findings were similar to patent ductus arteriosus, but the prevalence was much lower than that of patent ductus arteriosus, and the location of continuous cardiac murmur was lower, mostly located on the third rib of the left sternal border. In the meantime, there is no open arterial catheter for echocardiography, and the diagnosis depends mainly on it. Angiography has been performed, and it can be seen that the ascending aorta and the main pulmonary artery are simultaneously developed in the patient.

Third, aortic stenosis

Peripheral vascular stenosis often occurs as a fine vein, which is caused by a decrease in cardiac output and a small pulse pressure. The normal aortic valve area is about 3C?, patients with mild aortic stenosis often have no obvious symptoms. When the valve area is obviously narrow, especially <1C?, the cardiac output is significantly reduced, and the residual blood volume at the end of the left ventricular systole. Increase, diastolic blood filling increased, at this time there are breathing difficulties, angina, and even syncope triad, severe heart failure or death.

The main signs of aortic stenosis are systolic jet murmurs in the aortic valve area, which are rough, loud, and widely conductive. They can be transmitted to the carotid arteries, sternum, and apex of both sides, but the murmur is loudest in the aortic valve area. Higher, sometimes the sound of a heart sound is often normal, the second heart sound weakened or even disappeared in the severely narrow, or the second heart sound reverse split. In addition, there are ascending apical beats, systolic tremor in the aortic valve area, and enlargement of the heart sounds to the left.

The electrocardiogram of this disease often shows left ventricular hypertrophy with secondary ST-T changes and left atrial enlargement, and may have conduction block or ventricular arrhythmia. X-ray examination showed an increase in the left atrium, and pulmonary congestion in the advanced stage. Echocardiography is an important method for diagnosing this disease. It can not only show the degree of aortic stenosis, but also help to find the cause, and can estimate various indicators such as stroke volume and heart chamber size. When echocardiography cannot determine the degree of stenosis, conditional patients may have cardiac catheterization or coronary angiography to understand the condition, determine the prognosis, and guide treatment.

According to the above various manifestations, aortic stenosis is easier to diagnose, but these are the common manifestations of aortic stenosis. Due to the different causes of aortic stenosis, in addition to the above commonalities, there are special manifestations, which are described as follows:

(a) rheumatic aortic stenosis

This disease is the most common type of aortic stenosis, accounting for l/4 of rheumatic heart disease. Simple rheumatic aortic stenosis is clinically rare, with most patients with aortic regurgitation and mitral valve damage. Therefore, in addition to fine veins, patients with this disease often have peripheral vascular signs of aortic regurgitation such as Duroziez double tone, gunshot sound and so on. Auxiliary examination has an increase in erythrocyte sedimentation rate and an increase in anti-streptolysin "O". In addition to aortic stenosis, echocardiography can also have aortic regurgitation and mitral valve disease. In addition, the age of onset of this disease is relatively light, mostly young and young, with a history of rheumatic fever, these characteristics are helpful for diagnosis.

(2) Congenital malformations

Stenosis caused by congenital aortic valve malformation includes the following two forms:

1, congenital two-lobed calcified aortic stenosis This disease is a common cause of isolated aortic stenosis in adults, due to congenital two-leaf valve malformation. There is often no aortic stenosis at birth, and later turbulence due to deformity causes fibrosis and calcification of the leaflet base, eventually leading to stenosis. Echocardiography can confirm the disease.

2, congenital aortic stenosis congenital aortic stenosis has two manifestations, one is congenital single-leaf flap, very rare, there is stenosis when appearing, the age of onset is small, mostly under 15 years of age, performance For simple aortic stenosis. Another rare congenital aortic stenosis is the narrowing of the junction of the two-leaf and three-lobed flaps at birth. The diagnosis of this disease depends on echocardiography.

(C) degenerative senile calcific aortic stenosis

This disease is a common cause of simple aortic stenosis in the elderly over 65 years old. The murmur is loudest at the apex of the apex, and the tone is high and pleasant. Because rheumatic aortic stenosis often combined with mitral valve damage, mitral regurgitation and systolic murmurs may occur when mitral regurgitation occurs, which is easily confused with this disease. The difference is that the former murmur is very loud and rough at the apex of the heart, and the disease murmur is rough at the bottom of the heart, and the age of the two is different. Echocardiography is important for the identification of the two.

(4) Others

Other rare such as rheumatoid arthritis with nodular thickening of the valve leading to aortic stenosis may have rheumatoid arthritis, such as morning stiffness, rheumatoid factor positive and facet joint deformation; in addition, fungal Infective endocarditis and systemic lupus erythematosus can form stenosis caused by sputum obstruction of the aortic valve. At this time, except for echocardiography, the performance of the primary disease is more valuable for diagnosis. Big.

4. Constrictive pericarditis and acute pericarditis

When acute pericarditis produces a large amount of pericardial effusion, peripheral blood vessels such as odd veins and alternating veins may appear. The common symptoms of patients with this disease are pain in the precordial area and difficulty in breathing. In particular, the latter is a prominent symptom when a large amount of pericardial effusion occurs. The patient may have a sitting breathing, a shallow and rapid breathing, and may also have dry cough, fever, etc. symptom. The main signs are jugular vein engorgement, decreased systolic blood pressure, small pulse pressure, and increased heart circumference, low heart sound and distant. X-ray examination showed that the heart shadow expanded to the sides, spherical or flask-like, and the heart beat weakened. The electrocardiogram can appear as a low voltage and electrical alternation of the QRS complex, and the ST segment is lifted downward by the archback, but there is no Q wave. Echocardiography is a simple and easy way to diagnose this disease. It can clearly show that there is a dark area outside the heart, and the amount of fluid and its distribution can be estimated. Acute pericarditis can be divided into several types according to its etiology, and the following types are common:

(a) acute non-specific pericarditis

The cause of the disease is related to viral infection and allergic reactions that occur after infection. The onset is rapid, but the amount of pericardial effusion is less, the pericardial friction sound is obvious, and there is no obvious peripheral vascular sign. The disease has a good prognosis and can heal itself.

(two) tuberculous pericarditis

Tuberculous pericarditis often spreads from mediastinal lymph node tuberculosis, tuberculosis or pleural tuberculosis. In addition to the general manifestations of pericarditis, patients often have symptoms of tuberculosis such as fever and fatigue.

(c) neoplastic pericarditis

Mostly, the systemic tumor is metastasized to the pericardium. In a few cases, it is found in primary pericardial mesothelioma. It is characterized by a large amount of bloody pericardial effusion that is rapidly produced, and tumor cells can be found.

(four) suppurative pericarditis

Often secondary to pneumonia, empyema, sepsis and other diseases, with high fever as the main performance. Diagnosis mainly relies on pericardial puncture, showing a large amount of purulent effusion.

(5) Post-heart injury syndrome

This type often occurs after cardiac trauma surgery or acute myocardial infarction, and may be related to autoimmunity. Generally, fever and acute pericarditis appear in two weeks or months after heart injury, and there is self-limiting.

If the above-mentioned acute pericarditis is not treated in time, especially tuberculous pericarditis, it is easy to change into constrictive pericarditis. At this time, due to the adhesion, thickening and hardening of the visceral and parietal layers of the pericardium, the relaxation of the heart is limited, the patient may have different degrees of difficulty in breathing, fatigue, and diarrhea, liver area may also occur due to venous return obstruction. pain. The main signs are hepatomegaly. Jugular vein engorgement, ascites, edema of both lower extremities, and odd veins are more obvious. Under the X-ray examination, the size of the heart shadow can be normal, but the left and right heart edges become straight, the superior vena cava is dilated, and sometimes the pericardial calcification is visible. ECG shows QRS complex low voltage* wave low or inverted. Echocardiography has a certain auxiliary effect on the diagnosis of this disease, showing thickening of pericardium and weakening of left ventricular activity. Right heart catheterization showed elevated atrial, right ventricle, pulmonary capillary wedge pressure, equal level, right atrial pressure curve showing M or W waveform, increased a, v wave and deepened Y wave and normal X wave Formed, the right ventricular systolic pressure increased slightly, and showed a plateau wave shape.

5. Coronary atherosclerotic heart disease

Coronary atherosclerotic heart disease often shows alternating veins in the appearance of peripheral vascular signs, which is a manifestation of myocardial damage. The disease is a common clinical cardiovascular disease, and the incidence rate has increased year by year in recent years. The majority of patients are over 50 years old. The most common symptom is angina pectoris, which is characterized by paroxysmal sternal or anterior palpebral crushing pain, which lasts for several minutes and is relieved after rest or with nitrate preparations. Can also be manifested as myocardial infarction, arrhythmia and heart failure, and some patients without any symptoms, only found in the electrocardiogram examination of myocardial ischemia, known as "hidden coronary heart disease", a few lesions can even fall to death . Loss of diagnosis is easier. Electrocardiogram showed myocardial ischemia, ST-T changes, sometimes atrioventricular or bundle branch block, arrhythmia and other changes. Patients with a history of myocardial infarction may have pathological Q waves and specific staring and T wave abnormalities. In the onset of angina pectoris, there may be a depression of 0.1 mV or more, and the T wave may be pseudonormalized. For patients who have no abnormal performance in the usual ECG and who are highly suspicious of the disease, exercise stress test can be performed, and the positive person can diagnose the disease. X-ray examination showed no characteristic changes, and sometimes the heart was enlarged. Radionuclide examination can show myocardial perfusion defects in the ischemic area with high sensitivity. Coronary angiography clearly shows the location and extent of coronary stenosis.

Through the above examination methods, combined with some auxiliary examinations such as increased blood lipids, high blood viscosity, etc., the diagnosis of this disease is not difficult to establish. Echocardiography also has a certain value for the diagnosis of this disease. It can be found that the wall activity is weakened and uncoordinated. Especially in patients with this disease, there are many heart failures, and echocardiography can also be observed. The size of the ventricular chamber and the contraction and diastolic dysfunction of the heart to understand the severity of the condition

Sixth, hypertensive heart disease

Patients with hypertensive heart disease may have alternating veins in the presence of heart failure. The disease is diagnosed and the lake is difficult. The patient has a long history of hypertension. Physical examination revealed that the apex beat was shifted to the left and left, and it was a lifting pulsation. The heart was expanded to the left to enlarge the second heart sound in the aortic valve area. X-ray examination showed that the heart was enlarged and booted. Electrocardiogram showed left ventricular hypertrophy and strain. Echocardiography can be found on the left, the ventricular chamber is enlarged, the wall is thickened, and sometimes the mitral valve is incompletely closed. It is worth noting that due to the existence of heart failure, the patient's blood pressure can also be significantly increased. At this time, the disease can be diagnosed in combination with the medical history and the above-mentioned various examinations to avoid misdiagnosis and delay of the disease.

Seven, obstructive hypertrophic cardiomyopathy

Obstructive hypertrophic cardiomyopathy has often been referred to as idiopathic hypertrophic aortic stenosis in the past. The main lesions are located in the lower atrial septum of the aortic valve and are markedly hypertrophic. The etiology of this disease is not very clear, about 1 has a clear family history, it is considered to be related to heredity, is an autosomal dominant hereditary disease, and some people think that it is related to catecholamine metabolism abnormalities, high blood pressure, high-intensity exercise and other factors. Some patients may have no symptoms, but may be cooked to death. The characteristic symptoms are syncope and chest pain. The heart is enlarged, the apex can be heard and the systolic murmur is the third and fourth intercostal systolic murmurs on the left edge of the sternum. More louder and more rough, this noise is functional, and the murmur-enhanced X-ray examination with nitroglycerin shows an increase in the heart. The electrocardiogram showed left ventricular hypertrophy, and pathological Q waves appeared in II, III, aVF, aVL or V4, V5. Echocardiography is of great significance for the diagnosis of this disease. It can be shown that the interventricular septum is a hundred-symmetric hypertrophy, and the outflow tract portion protrudes into the left ventricle. The peripheral vascular sign of obstructive hypertrophic cardiomyopathy is a severe venous pulse, and the carotid wave is bimodal. The diagnosis of this disease depends on echocardiography. In addition, cardiac catheterization can show a pressure difference between the left ventricular cavity and the outflow tract, the difference is greater than 2.66 kPa, and the Brockenbrough phenomenon is positive (ie, in a room with complete compensatory interval) When premature beats, the heartbeat increases after premature beat, the intraventricular pressure rises, but the obstruction is also aggravated due to the increased contractile force, so the intra-aortic pressure is reduced, etc., which is also of great value for the diagnosis of this disease. This can also be distinguished from aortic stenosis.

Eight, hyperthyroidism

In patients with hyperthyroidism, due to increased pulse pressure, peripheral vascular signs such as flood veins, water impulses, and capillary pulsation may occur, especially in patients with hyperthyroidism, in addition to the above peripheral vascular signs. Symptoms such as chest tightness, palpitations, and shortness of breath may occur. Physical examination may include signs such as increased heart rate, first heart sound hyperactivity, arrhythmia, and enlarged heart, which may be confused with other heart diseases that cause increased pulse pressure. The difference is that the patients have different degrees of swelling of the thyroid gland, and there are high metabolic syndrome, such as heat, sweating, weight loss, polyphagia, etc., and their serum T3, T4 and anti-T3 can be increased. Performance, diagnosis is not difficult to determine.

Nine, anemia

Patients with severe anemia have a significant reduction in hemoglobin content, and hypoxia is more serious. At this time, the heart is compensatoryly dilated to meet the body's need for oxygen, resulting in a phenomenon of "high-row and low-resistance", increased pulse pressure, and capillary pulsation. Peripheral vascular signs such as water and veins. There are many reasons for anemia. The common manifestation is that the skin mucous membrane is pale. Patients may have palpitations, shortness of breath, loss of appetite and headache, insomnia, and inattention. Anemia is a symptom, often a manifestation of a disease of the whole body. Therefore, in addition to the necessary laboratory tests and bone marrow examination to determine the type of anemia, it is necessary to actively find the cause and determine the primary disease so as not to delay the disease. Affect the diagnosis and treatment.

Ten, fever

Some patients with high fever and long-term fever may have peripheral vascular signs such as Hongmai and Zhongbo. Fever is still a symptom of a disease, and there are many diseases that cause fever.

Eleven, shock

Fine blood vessels can occur during shock due to reduced circulating blood volume.

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