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Jingdong book

心内科值班医生手册(第3版)

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本书是第三版,提供你处理值班时可能遇到的心脏疾患所需的指导。你可在本书中找到有关疾病床边诊断、心电图解释及其他重要内容。同时此书还包含了药物作用、适应证、不良反应以及常用心血管药物间的相互作用。本书结构新颖,图文并茂,内容实用,且反映了心血管内科领域的最新进展,具有很强的实用性。
Content Description

第三版《On call cardiology》提供你处理值班时可能遇到的心脏疾患所需的指导。你可在本书中找到有关疾病床边诊断、心电图解释及其他重要内容。同时此书还包含了药物作用、适应征、不良反应以及常用心血管药物间的相互作用。
第三版对前版进行了全面的修改,包括:
·新增一章——胸部X线影像解读,为此提供大量有意义的胸部X线影像图谱。
·用2种色彩加强心电图图谱的视觉效果。
·新增50张插图。
·更新参考目录,并附于各章节尾。
此书主要由三部分组成:
第一部分——引言,包括六个章节:第1章,值班期间诊断和处理问题的思路;第2章,关于值班会诊问题的记录;第3章,心脏疾病的胸外体格检查;第4章,心脏检查;第5章,心电图临床应用速成指南;第6章,胸部X线影像解读。欲正确处理值班时所遇各种心血管问题,须参考这些章节内容。
第二部分——患者相关问题:常见的值班时所遇的与患者相关的问题。每个问题的处理都应从它的起源着手,首先应在电话内询问相关问题,然后给出临时医嘱,以及医生到达患者床边后评估主要威胁患者生命的情况。此书使用以下结构进行阐述。
第三部分——附录,包括输液泵使用图表,SI单位转换表,心血管常用药物的适应证、使用剂量、不良反应和药物间的相互作用,美国心脏协会制定的心脏骤停处理流程。
Author Description

M.Gabriel Khan医生是Ottawa医院的心脏科医生,Ottawa大学医学副教授。Khan医生以一流的成绩毕业于贝尔法斯特皇后大学,获得医学学士、外科学学士学位。他曾被派到Ottawa总院担任临床教学系执业医师。目前是美国心脏病学会、美国医师学会、伦敦和加拿大皇家医师学会会员。他编写了第6版心脏药物治疗(Saunders,2003)、第2版目8童心电图解读(Saunders,2003)、心脏病和肺部疾病处理(Lea and Febiger,1993)、第2版心脏病诊断和治疗:一本实践入门手册(Humana Press,2005)、医学诊断和治疗(Lea and Febiger,1994)、心脏病发作、高血压和心脏药物(McClelland-Bantam Inc.,1990)、心脏疾患百科全书(Stoddart,1996)、心脏疾病百科全书(Academic Press,2006)。
Khan医生编写的书已被翻译成汉语、波斯语、法语、德语、希腊语、意大利语、日语、波兰语、葡萄牙语、俄语、西班牙语和土耳其语。他作为临床医师和教师具有良好的声誉,通过写作他已成为国际知名的心脏科医生。Khan医生非常乐于著书立说,就像喜爱他的高尔夫球运动一样。
Catalogue

引言
1值班期间诊断和处理问题的思路
2关于值班会诊问题的记录
3心脏疾病的胸外体格检查
4心脏检查
5心电图临床应用速成指南
6胸部X线影像解读
患者相关问题:常见值班会诊问题
7胸痛
8心肌梗死
9不稳定型心绞痛
10心包炎
11心脏填塞
12主动脉夹层
13低血压和心源性休克
14呼吸短促
15水肿
16咳嗽
17肺栓塞
18急性肺水肿
19充血性心力衰竭
20心悸与心律失常
21心动过缓
22发热伴心脏瓣膜杂音:心内膜炎
23高血压危象
24高血压
25晕厥
26心脏骤停
27深静脉血栓
28心脏杂音患者的评价和治疗
附录
A输液泵使用图表
BSI单位转换表
C 心血管常用药物
D 心血管药物的不良反应
E 心血管药物问的相互作用
F 药物索引
G 高级心血管生命支持(ACLS)流程指南
Book Abstract

第四心音
正常心跳中很少能闻及S4。S4通常提示心室的异常僵硬的病理性状态,使心房收缩增强以通过无梗阻的房室瓣将血流泵入僵硬的心室。使用钟型听诊器S4最佳听诊位置在心尖部或其内侧,患者取左外侧俯卧位。右心室的S4可在上腹部区闻及;房颤发生时无S4产生。
病理性状态产生S。奔马律的情况包括:
1.继发于高血压或其他原因的LVH,右心室肥厚,以及引起肺动脉高压的各种因素。
2.急性心肌梗死:超过60%的患者在急性心梗发生后的几天内可闻及S4奔马律;梗死区域的运动减弱或消失伴顺应性减弱。
3.心绞痛时,心肌缺血导致左心室显著僵硬,出现一过性S4。
4.梗阻性心肌病以及扩张性心肌病。
5.特发性心肌疾病引起的心肌浸润。
6.重度主动脉瓣狭窄伴高跨瓣压;可触及的S4常提示压力差大于75mmHg以及左心室舒张晚期压力约12mmHg。
7.肺动脉瓣狭窄。
偶尔地,S4融人S1鉴别S1可通过膜型和钟型听诊。S4最佳听诊为钟型,患者坐下或站起可使其消失。而S1分裂和喷射音无改变。分裂S1用膜型听诊最佳,因为分裂的前半部分为高调,与后半部分之间的间隙极短。用力按压膜型可使S4消失,但S1分裂不消失,S1加喷射音也不消失。在远离心尖部听诊S4强度减弱甚至消失。45岁以上的患者出现明显双S1极可能为房性奔马律。
喷射音
喷射音是紧跟在S1后的舒张早期杂音,是由狭窄但柔韧性尚可的半月瓣的开放引起的,或是进入扩张的主动脉或肺动脉的血流增多引起。喷射音在正常人中不易听到。膜型听诊为这些高调爆破音的最佳选择。在基底部此音比S1响,当基底部闻及S1变响时很可能是由喷射音引起的。喷射音与S1或分裂S1的第二成分相似。分裂S.的最佳听诊位置为胸骨缘左下处。主动脉喷射音在心尖部闻及最明显,但在胸骨左缘更响亮,与呼吸无关。肺动脉喷射音在胸骨缘左侧第二第三肋间隙处最明显,且深呼气时增强。
造成喷射音的原因包括:
1.主动脉瓣二瓣畸形伴或不伴狭窄。非并发形成的缩窄不会引起喷射音;反之,主动脉瓣缩窄患者出现喷射性杂音则提示为与二瓣畸形相关。
2.先天性主动脉瓣狭窄(瓣膜柔韧度好的获得性主动脉瓣狭窄)。
3.系统性高血压。
4.主动脉缩窄(多伴主动脉瓣二瓣畸形)。
5.主动脉瓣反流(血流增加)。
6.主动脉瘤。
7.肺动脉瓣狭窄(瓣膜柔韧)。
8.肺动脉扩张。
9.肺动脉高压。
10.Eisenmenger综合征。
11.肺静脉回流畸形。
收缩中晚期喷射音
多可在二尖瓣脱垂患者(MVP)中闻及。此喷射音可伴或不伴收缩中晚期收缩性杂音。这些尖锐高调的杂音用膜型听诊器听诊最佳。它们出现于脱垂的二尖瓣瓣叶和拉长的腱索最大做功时;当收缩期左室容量减少至一定程度时,瓣叶无法被拉紧而出现脱垂。其他因素包括心房或室壁瘤,左室游离壁瘤,和心房黏液瘤。
……

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