心脏听诊听些啥

心脏听诊是体格检查的重要组成之一。近年来，尽管心电图和一些先进的影像学检查（例如超声心动图、CT血管造影、磁共振等）临床上已广泛应用，但心脏听诊仍是心脏物理检查不可或缺的内容。心脏听诊内容包括心率、心律、心音和杂音，其中后两者更为重要。     

现代多媒体技术在心脏听诊教学中的应用

心脏听诊是诊断学教学中的重点和难点，传统的教学方法存在下列弊端：心脏杂音听诊病源减少、教患矛盾增加、学生听诊学习难度较大等；现代多媒体教学法相对具有下列优势：（1）减少临床需要实际听诊患者人数，有助于解决心脏杂音病源下降的问题；（2）缓解日益激化的教患矛盾；（3）有助于循序渐进教学；（4）能反复温习，有助于熟悉或掌握心脏听诊体征等。相信随着现代多媒体技术的不断发展，其在心脏听诊教学中的应用会越来越多。将现代多媒体技术和传统的教学法有机结合起来，必将大大提高心脏听诊教学的质量。     

《全科医师心血管病学》出版

由北京大学人民医院心脏中心郭继鸿教授主编,刘梅颜博士等副主编的《全科医师心血管病学》一书近日已由人民军医出版社出版发行。全书共15章,397千字,16开本,254页。本书详细介绍了全科医师在社区医疗服务中,面对心血管疾病及相关慢病的管理、诊断、治疗过程中所承担的任务,强调社区环境中对患者持续地服务和管理。重点阐述了全科医师在心血管疾病等慢病的防治中应该掌握的基本技能、急症识别与处理、常见心血管病等多种疾病并存时的用药难点解答及心血管疾病的康复治疗等。本书的编写坚持了“符合全科医师的需求,将心血管病专业的新进展融人全科医师的需要”的宗旨。     

《全科医师心血管病学》出版

由北京大学人民医院心脏中心郭继鸿教授主编,刘梅颜博士等人为副主编的《全科医师心血管病学》一书近日已由人民军医出版社出版发行。全书共15章,397千字,16开本,254页。本书详细介绍了全科医师在社区医疗服务中,面对心血管疾病及相关慢病的管理、诊断、治疗过程中所承担的任务,强调社区环境中对患者持续地服务和管理。重点阐述了全科医师在心血管疾病等慢病的防治中应该掌握的基本技能、     

再次强调心脏听诊

作者认为在过去数年中,通过听诊、心音描记、心导管检查及超声心动图·的研究结果,极大地丰富了我们对正常与病理性心脏听诊的了解。但遗憾的是过于强调了无创性甚至创伤性的心脏诊断性研究,而忽视了对物理检查发现去作细心的评价。 如何才能从听诊获得较大的效益呢仑首先反复传授心脏听诊是极为重要的。近年来,高精度扩音器和同时显示的心音图描记的发展,已大大地改善了教学技巧。然而,医生对患者     

应用仿真模拟教学与临床病例相结合培训基础技能的效果观察

新的医学模式转变,对医学和护理教育提出了更高的要求。医疗和护理是实践性较强的学科,掌握基础技能是医学生进入临床必备的条件。为了将理论和实践更好的结合起来,使学生尽快掌握基本技能,我们引进了多媒体临床技能综合培训系统,以学习心脏听诊为例,在心脏解剖、基础听诊、鉴别听诊三部分学习中与传统培训方法进行比较,结果显示应用仿真模拟教学更有助于学生掌握理论知识,掌握心脏听诊技能,提高学习效果和自信心。学生对仿真模拟培训的学习方法满意度高。     

《全科医师心血管病学》出版

由北京大学人民医院心脏中心郭继鸿教授主编,刘梅颜博士等副主编的《全科医师心血管病学》一书近日已南人民军医出版社出版发行。全书共15章,397千字,16开本,254页。本书详细介绍了全科医师在社区医疗服务中,面对心血管疾病及相关慢病的管理、诊断、治疗过程中所承担的任务,     

如何提高心脏听诊教学质量

心脏听诊教学是心血管疾病教学的难点之一,也是临床医生必须具备的基本技能之一,下面谈谈作者在临床教学中的一些经验,期望对临床医学生学习心脏听诊提供一些帮助。     

某市社区全科医师对心肺复苏新知识掌握情况调查

目的通过对晋中市城区内33家社区服务中心(站)394全科医师的心肺复苏(CPR)新知识掌握情况调查,旨在了解社区全科医师对心肺复苏新知识掌握情况,为针对性地培训提供资料和依据。方法针对各社区服务中心(站)全科医师,采用闭卷考试和自行设计的调查表的方法对《2010版国际心肺复苏指南》中的胸外心脏按压深度、频率;胸外心脏按压与人工呼吸比例;AED能量选择,成人及儿童气管插管的号数等部分问题进行调查,并进行χ2检验。结果社区医师们对心肺复苏新理论掌握普遍较差,回答正确率为13%~68%;不同文化程度、不同职称组的测试结果差异有统计学意义(P<0.05);对CPR知识培训需求率高(93.71%)。结论晋中市城区全科医师CPR知识普遍缺乏,社区全科医师的继续教育应引起各级医疗卫生管理部门的高度重视,特别是CPR知识的基层培训亟待加强。     

心尖区功能性舒张期杂音的鉴别(附五例误诊病例分析)

随着心脏听诊技术的普遍提高,心音图、特别是超声心动图的广泛应用,功能性二尖瓣狭窄的检出率大大提高了。由于听诊的局限性,单凭心脏听诊的结果来诊断心脏病是片面的,容易做出错误的结论,常易把功能性二尖瓣狭窄误诊为风湿性心脏病二尖瓣狭窄,现将误诊病例报告分析如下(见附表)。     

米力农治疗重症难治性心力衰竭疗效及预后观察

目的探讨米力农治疗重症难治性心力衰竭的疗效及预后。方法对9例难治性心力衰竭患者利用米力农治疗的临床资料加以分析。结果 9例患者中有效率达100%,其中8例患者双肺湿啰音消失,双下肢水肿消退,以平卧并能下床独立行走。对其进行3个月的回访,其中未复发6例;复发再次入院2例;1例患者心脏横径增大,突发心脏猝死。结论米力农仅限于重症难治性心力衰竭患者完善各项治疗措施后症状仍不能控制时短期应用。     

Differences between pathological and physiological cardiac hypertrophy: novel therapeutic strategies to treat heart failure

1. In general, cardiac hypertrophy (an increase in heart mass) is a poor prognostic sign. Cardiac enlargement is a characteristic of most forms of heart failure. Cardiac hypertrophy that occurs in athletes (physiological hypertrophy) is a notable exception. 2. Physiological cardiac hypertrophy in response to exercise training differs in its structural and molecular profile to pathological hypertrophy associated with pressure or volume overload in disease. Physiological hypertrophy is characterized by normal organization of cardiac structure and normal or enhanced cardiac function, whereas pathological hypertrophy is commonly associated with upregulation of fetal genes, fibrosis, cardiac dysfunction and increased mortality. 3. It is now clear that several signalling molecules play unique roles in the regulation of pathological and physiological cardiac hypertrophy. 4. The present review discusses the possibility of targeting cardioprotective signalling pathways and genes activated in the athlete's heart to treat or prevent heart failure.     

老年肺心病患者并发心律失常相关危险因素分析

目的 探讨老年慢性肺源性心脏病（肺心病）患者并发心律失常的相关因素,为合理防治提供依据.方法 回颐性调查我院108例老年肺心病患者,对80例并发心律失常病例（观察组）与28例未并发心律失常病例（对照组）进行Logistic回归分析.结果 108例患者中,合并心律失常80例,发生率74.3%.房性心律失常最多,占41.2% 其次是窦性心动过速,占26.2% 第3是室性心律失常,占8.8%.单因素及多因素Logistic逐步回归分析显示,合并冠状动脉粥样硬化性心脏病（冠心病）和/或高血压疾患、低氧血症、心力衰竭、肺部感染、酸碱失衡、电解质紊乱对并发心律失常的影响差异有统计学意义（P＜0.05）.结论 加强老年肺心病患者并发心律失常的监控,针对危险因素早期预防和治疗.     

Serum cholesterol and coronary heart disease: Auckland general practitioners' attitudes and practices in 1986

The relationship between elevated serum cholesterol and coronary heart disease, is now generally accepted as being causal. To examine current attitudes and practices regarding the treatment of high serum cholesterol, questionnaires were sent to a randomly selected sample of general practitioners in the Takapuna health district during 1986. The response rate among the 92 doctors in general practice at the time of the study was 80%. The majority of general practitioners (82.5%) believed that there was a casual relationship between high serum cholesterol and coronary heart disease and that reducing levels would help prevent coronary heart disease. Almost all general practitioners (96%) were screening some groups of patients for high serum cholesterol, with most screening those with symptomatic coronary heart disease or associated risk factors, and 15% screening all patients. Although almost 90% of general practitioners had patients on diet therapy and one third had patients on drug treatment, there was wide variation in attitudes regarding the serum cholesterol levels meriting dietary or drug treatment. This suggests that there is still considerable confusion as to when and how to treat high cholesterol levels and that specific national guidelines for the detection and management of high serum cholesterol are required as part of a comprehensive programme to prevent coronary heart disease.     

Left atrial myxomas--a case report.

A 49-year-old woman presented with symptoms of congestive cardiac failure. Cardiac auscultation revealed a crunching sound difficult to characterise in addition to a pansystolic murmur maximally audible in the 4th left intercostal space. The ausculatory findings varied from day to day but were unaffected by posture or exercise. A clinical impression of left atrial myxoma was confirmed by two dimensional echocardiography which revealed a well circumscribed mass almost completely filling the left atrium with a pedicle attached to the interatrial septum. The patient's cardiac failure improved with conservative management using frusemide and digoxin. The patient, however, refused cardiac surgery which is the definitive management of this disease.     

江门市新会区872例新生儿先天性心脏病临床分析

目的了解广东江门市新会区新生儿早期心脏彩超筛查结果、本地区先天性心脏病类型分布及其临床特点。方法 2009年12月至2011年5月本院新生儿科医生在门诊或住院部进行体格检查和心脏听诊,发现有心脏杂音或青紫者的新生儿由超声科医生进行彩色超声心电图检查。结果研究期内共筛查先天性心脏病患儿872例,其中男405例,女467例。本组新生儿心脏疾病以卵圆孔未闭、动脉导管未闭、室间隔缺损、三尖瓣关闭不全以及房间隔缺损为多见,其发生率分别为61.75%、18.88%、16.75%、13.54%和10.69%。结论新生儿科先天性心脏病的早期筛查在临床是切实可行的,有必要将心脏彩超列为产前及生后早期心脏常规筛查项目,并在基层医院推广。     

The cardiac gap junction: a potential therapeutic target in the treatment of heart disease

Cardiac gap junctions have been implicated in maintaining cardiac conduction and function. In cardiac disease, expression of connexin 43, the most abundant ventricular gap junction protein, is markedly abnormal, a process termed gap junction remodeling. To date, however, the gap junction has not been directly targeted therapeutically in cardiac disease states. Therefore, we have developed novel and complementary experimental models to investigate whether loss of connexin 43 expression in the heart can be directly linked to the arrhythmic and functional complications of heart disease. In this article, we discuss how data from connexin 43 conditional and chimeric knock-out mice support the hypothesis that gap junction remodeling is a key molecular feature underlying the high incidence of sudden arrhythmic death and exacerbating the ventricular dysfunction associated with acquired heart disease.     

ANIMAL MODELS OF CARDIAC DISEASE: Potential Usefulness for Studying Health Effects of Inhaled Particles

Cardiac disease is one of the major causes of morbidity and mortality worldwide and is the leading cause of death in the United States. Epidemiologic studies have shown a close association between morbidity and mortality from cardiac disease, primarily in persons already affected, and with modest increases in levels of air pollution. At present, no mechanisms are known by which inhaled air pollutants interact with the heart to cause death. Thus, animal models of cardiac disease are needed to study possible interactions between inhaled pollutants and the heart and the resultant morbidity and mortality. Very little research in animals has been conducted in this area, and appropriate animal models must be carefully selected. The purpose of this review is to examine several potential animal models and to discuss their advantages and disadvantages in the study of cardiac disease and air pollution.     

Animal models of cardiac disease: potential usefulness for studying health effects of inhaled particles

Cardiac disease is one of the major causes of morbidity and mortality worldwide and is the leading cause of death in the United States. Epidemiologic studies have shown a close association between morbidity and mortality from cardiac disease, primarily in persons already affected, and with modest increases in levels of air pollution. At present, no mechanisms are known by which inhaled air pollutants interact with the heart to cause death. Thus, animal models of cardiac disease are needed to study possible interactions between inhaled pollutants and the heart and the resultant morbidity and mortality. Very little research in animals has been conducted in this area, and appropriate animal models must be carefully selected. The purpose of this review is to examine several potential animal models and to discuss their advantages and disadvantages in the study of cardiac disease and air pollution.