ppt

Report
기본 의학 용어
의공학교실
박성근
table
1. 의학용어의 특징
2. 인체의 기본구조
3. 병리학적 검사분야
4. 방사선과학적 검사분야
5. 임상병리 검사분야
6. 핵의학 검사분야
7. 약물요법 분야
8. 소화기계질환 분야
9. 심혈관계질환 분야
10. 호흡기계질환 분야
11. 근골격계질환 분야
12. 신경 및 정신계질환 분
야
13. 비뇨기계 및 남성생식기
계질환 분야
14. 내분비계 및 여성생식기
계질환 분야
15. 피부과, 안과 및 이비인
후과질환 분야
16. 병원의 진료 편제
심장 및 대혈관
승모판 및 삼첨판
대동맥판막 및 폐동맥판막
aortic valve & coronary a. I
aortic valve & coronary a. II
관상동맥 조영 I
관상동맥 조영 II
해부학적 용어

vena cava: 대정맥






superior vena cava
(SVC): 상대정맥
inferior vena cava (IVC):
하대정맥
right atrium (pl. atria,
RA): 우심방
tricuspid valve: 삼첨판
pulmonic (pulmonary)
valve: 폐동맥 판(막)
pulmonary artery (PA):
폐동맥








pulmonary (pulmonic)
vein: 폐정맥
left atrium (pl. atria,
LA): 좌심방
mitral valve: 승모판
left ventricle (LV): 좌
심실
aortic valve: 대동맥 판
(막)
aorta: 대동맥
valve (leaflet): 판막(엽)
coronary a.: 관상동맥
심장 종단면
심장 단면도
심장 전도도 I
심장 전도도 II
sinoatrial node (SA
node, sinus node)
located in RA

autonomous
innervation


atrioventricular node
(AV node)
sympathetic n. (T1-4)
vagus n. (CN X)
located in
posteroinf. region of
interatrial septum
심장 전도도 III
AV bundle (bundle
of His)
located in ventricular
septum

Purkinje fiber
divides into two
bundle branches
located in the inner
ventricular walls

specialized
myocardial fibers that
conduct an electrical
stimulus
conduction pathway
conduction & ECG
심혈관계 질환 분야
heart wall structure






(inter)atrial septum:
심방중격
(inter)ventricular
septum: 심실중격
endocardium: 심내막
myocardium: 심근(층)
epicardium: 심외막
pericardium: 심막, 심
낭
conduction system




S-A (sinoatrial) node:
동결절
A-V (atrioventricular)
node: 방실결절
atrioventricular
bundle: 방실속
purkinje fiber: 퍼킨지
섬유
심혈관계 질환 분야
others



diastole: 확장기, 이완
기
systole: 수축기
blood pressure (BP):
혈압
심혈관계 질환 분야
증상 용어






angina pectoris: 협심
(증)
arrhythmia,
dysrhythmia: 부정맥
heart block: 심(장)블
록
bradycardia: 서맥
tachycardia: 빈박, 빈
맥
cardiac arrest: 심박동
정지






(heart, cardiac)
murmur: (심)잡음
cyanosis: 청색증
precordial pain: 흉통,
전흉부 통증
regurgitation: 역류, 부
전
stenosis: 협착
atresia: 폐쇄(증)
심혈관계 질환 분야

판막명 +
regurgitation,
insufficiency,
stenosis, atresia = 판
막질환 병명

e.g.,






aortic regurgitation: 대
동맥판막 부전증
aortic stenosis: 대동맥
판막 협착증
tricuspid regurgitation:
삼첨판막 부전증
tricuspid stenosis: 삼첨
판막 협착증
pulmonary atresia: 폐동
맥판막 폐쇄증
tricuspid atresia: 삼첨판
막 폐쇄증
ECG analysis
duration
ECG elements
analysis
P wave
atrial depolarization
QRS complex
the depolarization of
the right and left
ventricles.
PR interval
duration of conduction
from SA node to
ventricles
120 to 200 ms long.
ST segment
MI indicator
80 to 120 ms long
T wave
the repolarization
(or recovery)
of the ventricles
normal ECG
heart block I
types



SA nodal blocks
AV nodal blocks
infra-Hisian block
SA nodal blocks


absent P wave on an
ECG
subtypes




c.f., SA node
suppression: atrial
flutter, atrial fibrillation
AV nodal blocks

subtypes


Wenckebach (Mobitz I)
Mobitz II
exit block

1st degree AV block (PR
prolongation > 0.20 s)
2nd degree AV block
(one or more (but not
all) of the atrial
impulses fail to
conduct to the
ventricles)
3rd degree AV block
heart block II

2nd degree AV block


Wenckebach (Mobitz I):
prolongation of PR int.
on consecutive beats
followed by a blocked
P wave -> AV node dis.
Mobitz II: intermittently
nonconducted P waves
not preceded by PR
prolongation and not
followed by PR
shortening -> HisPurkinje sys. dis.

3rd degree AV block
(complete heart block):
impulse of the SA node
does not propagate to
the ventricles ->
ventricular escape
rhythm, i.e., P waves &
QRS complexes are
totally independent
infra-Hisian block

subtypes



Mobitz II
left bundle branch bl.
right bundle branch bl.
1st-degree AV block
2nd-degree AV block (Mobitz I)
2nd-degree AV block (Mobitz II)
2:1 block
3rd-degree AV block
heart block III

LBBB





supraventricular rhythm
QRS dur. => 120 ms
QS or rS in V1
monophasic R in I &
V6
RBBB





supraventricular rhythm
QRS dur. => 100 ms
(incomplete block)
QRS dur. => 120 ms
(complete block)
terminal R in V1
slurred S in I & V6
left bundle branch block
right bundle branch block
심혈관계 질환 분야
질환명




congenital heart
disease (CHD): 선천
성 심장질환
VSD (ventricular
septal defect): 심실중
격결손증
ASD (atrial septal
defect): 심방중격결손
증
PDA (patent ductus
arteriosus): 동맥관개
존(증)





tetralogy of Fallot
(TOF): 팔로사징[증]
TGA (transposition of
the great arteries): 완
전대혈관전위증
SBE (subacute
bacterial
endocarditis): 아급성
(세균성) 심내막염
myocarditis: 심근염
pericarditis: 심낭염,
심막염
congenital heart disease
hypoplasia


hypoplastic left heart
syndrome
hypoplastic right heart
syndrome
septal defects


obstruction defects



pulmonary valve
stenosis
aortic valve stenosis
coarctation of aorta
atrial septal defect
(ASD): patent
foramen ovale
ventricular septal
defect (VSD)
cyanotic defects


tetralogy of Fallot
transposition of the
great arteries
persistent ductus arteriosus
hypoplastic left heart syndrome
coarctation of aorta
ventricular septal defect
tetralogy of Fallot
transposition of the great arteries
infective endocarditis
acute



fulminant illness over
days to weeks (less
than about 6 weeks)
greater virulence
mainly
Staphylococcus
aureus
subacute



progresses slowly
over weeks and
months
low propensity to
hematogenously seed
extracardiac sites
mainly streptococci
infective endocarditis
Staphylococcus aureus
streptococci
심혈관계 질환 분야



rheumatic (valvular)
heart disease: 류마티
스[성] 심질환
acute rheumatic fever:
급성 류마트열
Kawasaki disease
(mucocutaneous
lymph node
syndrome): 가와사끼
질환 (피부점막림프절
증후군)





congestive heart
failure: 울혈성 심부전
coronary artery
disease: 관상동맥질환
ischemic heart
disease: 허혈성 심질
환
myocardial infarction:
심근경색
cardiomyopathy: 심근
(병)증
rheumatic heart disease I
acute rheumatic
fever


complication of a
respiratory infections
caused by the group
A streptococcus (GAS)
M-protein -> Ab that
cross-react with
autoantigens on
interstitial connective
tissue (endocardium,
synovium)


clinical Diagnosis: 2
major or 1 major + 2
minor
revised Jones’ major
criteria





pancarditis
migratory polyarthritis
subcutaneous nodule
erythema marginatum
sydenham chorea
(involuntary,
purposeless
movement)
rheumatic heart disease II

minor criteria







fever
arthralgia
raised ESR or CRP
leukocytosis
heart block ECG
evidence of Strep.
infection: elevated
antistreptolysin O titre
or DNAse
previous episode of
rheumatic fever or
inactive heart disease

treatment




aspirin high dose (100
mg/kg/day)
steroids for heart
involvement -> prevent
sequelae such as MS
monthly injections of
long-acting penicillin
for 5 yrs (if carditis ->
for 40 yrs)
continual use of low
dose antibiotics to
prevent recurrence
mucocutaneous lymph node
syndrome
Kawasaki disease


autoimmune disease
clinical diagnosis: 5
days of fever + 4 of 5
diagnostic criteria




erythema of the lips or
oral cavity or cracking
of the lips
rash on the trunk
swelling or erythema of
the hands or feet
red eyes (conjunctival
injection)



swollen lymph node in
the neck of at least 15
mm
cardiac complication
is of major concern:
coronary aneurysm
treatment




hospitalization
i.v. immunoglobulin
aspirin
steroid
erythema of lips & oral cavity
rash on the trunk I
rash on trunk II
rash on trunk III
swelling or erythema on
hands/feets
red eye
Kawasaki disease
coronary aneurysm in MCLS
ischemic heart disease



disease characterized
by reduced blood
supply to the heart
muscle
major cause:
coronary artery
disease
risk factors: age,
smoking,
hypercholesterolemia,
diabetes,
hypertension, male,
family history

signs and symptoms





medical treatment


angina pectoris
acute chest pain
myocardial infarction
heart failure
antianginal drugs:
nitrates, beta-blockers,
calcium channel
blockers
surgical treatment


PTCA
CABG
atherosclerosis
coronary artery disease
percutaneous transluminal
coronary angioplasty I
coronary artery bypass graft I
CABG III
heart failure I
cardiac output is
insufficient for the
body’s needs
classifications



left HF vs right HF
backward vs forward
low output vs high
output
LHF

symptoms & signs

(pulm. congestion)






dyspnea on exertion
orthopnea
paroxysmal nocturnal
dyspnea
rales (pulm. edema)
dullness of the lung
fields to percussion
(pleural effusion)
cyanosis (hypoxemia)
heart failure II

compromise of LV
forward function




(enlarged heart)


gallop rhythm
(valvular heart
disease): AS or MR


symptoms & signs

(systemic capillary
congestion)

apex beat
(increased bl. flow)


dizziness
confusion
cool extremities at rest
RHF
murmur



pitting peripheral
edema or anasarca
nocturia
ascites
hepatomegaly ->
jaundice, coagulopathy
NYHA Functional Classification
NYHA Class
Symptoms
I
No symptoms and no limitation in ordinary physical activity,
e.g. shortness of breath when walking, climbing stairs etc.
II
Mild symptoms (mild shortness of breath and/or angina) an
d slight limitation during ordinary activity.
III
Marked limitation in activity due to symptoms, even during le
ss-than-ordinary activity, e.g. walking short distances (20100 m). Comfortable only at rest.
IV
Severe limitations. Experiences symptoms even while at rest
. Mostly bedbound patients.
causes of CHF

in US







IHD: 62 %
smoking: 16 %
hypertension: 10 %
obesity: 8 %
diabetes: 3 %
VHD: 2 %
in Italy





IHD: 40 %
dilated CMP: 32 %
VHD: 12 %
hypertension: 11 %
others: 5 %

rarer causes







viral myocarditis
amyloidosis
HIV cardiomyopathy
systemic lupus
erythematosus
abuse of drugs such as
alcohol
pharmaceutical drugs
such as
chemotherapeutic
agents
arrhythmias
compensation of CHF
pitting peripheral edema
congestive heart failure
hepatic congestion I
hepatic congestion II
esophageal varix
chronic management of CHF
goals



to prevent the acute
decompensated HF
to counteract the
cardiac remodeling
to minimize symptom
medical Tx.



oral loop diuretics
beta-blockers
ACE inhibitors



angiotensin receptor
blockers
vasodilators
aldosterone receptor
antagonists in severe
cardiomyopathy
behavioral
modification


reduced salt & fliud
exercise when
tolerated
heart transplantation
심혈관계 질환 분야




hypertension: 고혈압
hypotension: 저혈압
paroxysmal atrial
tachycardia (PAT): 발
작성 상심실성 빈맥
ventricular
tachycardia: 심실성 빈
맥
검사, 치료 및 수술 용
어

(pericardio)centesis:
심낭천자





cardiac massage: 심
장 마사지
artificial pacemaker:
인공심박조율기
cardioversion,
defibrillation: 전기적
제세동
cardioverter,
defibrillator: 제세동기
24 hours Holter
monitoring
(ambulatory ECG): 24
시간 심전도
hypertension
Systolic pressure
Diastolic pressure
Classification
mmHg
kPa (kN/m2)
mmHg
kPa (kN/m2)
Normal
90–119
12–15.9
60–79
8.0–10.5
Prehypertension
120–139
16.0–18.5
80–89
10.7–11.9
Stage 1
140–159
18.7–21.2
90–99
12.0–13.2
Stage 2
≥160
≥21.3
≥100
≥13.3
Isolated systolic
hypertension
≥140
≥18.7
<90
<12.0
classification of hypertension
etiology of hypertension
essential HT




primary HT
no medical cause
90 – 95 %


secondary HT

renovascular HT


renal artery stenosis ->
HT
HT secondary to
other renal disorders


CRF
renal segmental
hypoplasia
HT secondary to
endocrine disorders


pheochromocytoma ->
adrenaline secretion
Cushing’s syndrome
etc.
other secondary HT



hormonal contraceptive
pregnancy
drugs: alcohol, NSAIDs,
steoids
nephron
million nephrons /
kidney
complication of HT
hypotension

etiology



hypovolemia:
hemorrhage,
insufficient fluid intake,
diarrhea, vomiting,
diuretics
decreased cardiac
output: congestive
heart failure,
myocardial infarction,
bradycardia, arrhythmia,
beta blockers
excessive vasodilation:
neurologic, sepsis,
acidosis, medications

symptoms



dizziness
fainting and/or seizures
treatment




volume resuscitation
blood pressure support:
norepinephrine
adequate tissue
perfusion: SvO2 > 70%
with additional pressors
address the underlying
problem: antibiotic,
stent, CABG, steroid
arrhythmia I
빈맥 vs. 서맥


tachycardia: > 100
beats/min
bradycardia: < 60
beats/min
common
classification

atrial


premature atrial
contractions (PACs)
wandering atrial
pacemaker




multifocal atrial
tachycardia
atrial flutter (230 – 380
beats/min)
atrial fibrillation (Afib)
junctional arrhythmias




supraventricular
tachycardia (SVT)
AV nodal reentrant
tachycardia
junctional rhythm
junctional tachycardia
arrhythmia II

atrioventricular


AV reentrant
tachycardia: WolffParkinson-White
syndrome, LownGanong-Levine
syndrome



heart blocks




premature ventricular
contractions (PVC)
accelerated
idioventricular rhythm
monomorphic
ventricular tachycardia
1st degree heart block
2nd degree heart block:

ventricular

polymorphic ventricular
tachycardia
ventricular fibrillation


Mobitz I or
Wenckebach
Mobitz II
3rd degree heart block
(complete heart block)
atrial flutter
atrial fibrillation
supraventricular tachycardia
(SVT)
ultra short acting AV nodal blocking agent
premature ventricular contraction
ventricular tachycardia (V-Tach)
ventricular fibrillation (V-fib)
심혈관계 질환 분야




EKG, ECG
(electrocardiogram,
electrocardiography):
심전도
echocardiography: 심
에코검사, 심장초음파
검사
electrophysiologic
study (EPS, EP study):
전기생리검사
cardiac
catheterization: 심도
자법, 심도자검사





interventional
catheterization: 중재
적 심도자검사
balloon coronary
angioplasty: 풍선 관상
동맥성형술
balloon valvuloplasty:
풍선 판막성형술
balloon angioplasty:
풍선 혈관성형술
heart-lung machine:
인공심폐 [장치], 심폐
기
echocardiography
echocardiography II
electrophysiologic study I
electrophysiologic study II
balloon valvuloplasty
heart-lung machine I
John H. Gibbon Jr., the
original designer and de
veloper of the heart-lun
g machine, performed th
e first successful openheart surgery on a patie
nt with congenital heart
disease on 6 May 1953.
심혈관계 질환 분야




heart transplantation:
심장 이식
artificial heart: 인공심
장
cardiopulmonary
resuscitation (CPR):
심폐소생술
coronary artery
bypass graft (CABG):
관상동맥 우회로 이식
(술)



coronary care unit
(CCU): 관동맥질환 집
중치료병동
intensive care unit
(ICU): 중환자실
postsurgical intensive
care unit (PICU): 수술
후 중환자실
heart transplantation I
first human heart transplant by
Surgeon Christiaan Barnard on
the 3rd December 1967.
18 days later the patient died fr
om double pneumonia
heart transplantation II
A comparison of the old
and new hearts of Dylan
Stork, the smallest heart
transplant recipient in th
e world. Dylan weighed
5.5 pounds (2.5 kilogra
ms) at the time of the op
eration. (Reproduced by
permission of Photo Res
earchers, Inc.)
korean total artificial heart
(KORTAH)
AbioCor total artificial heart I
AbioCor total artificial heart II
Tom Christerson surviv
ed for 17 months after
another AbioCor transp
lant
Cardiowest total artificial heart
(by Jarvik)
심혈관계 질환 분야
동맥, 모세혈관, 정맥
에 관한 용어







artery: 동맥
arteriole: 세동맥, 소동
맥
capillary: 모세혈관
venule: 세정맥, 소정맥
vein: 정맥
infarction: 경색형성,
경색[증]
ischemia: 국소빈혈,
허혈







arteritis: 동맥염
phlebitis: 정맥염
thrombophlebitis: 혈
전[성] 정맥염
aneurysm: 동맥류
arteriosclerosis: 동맥
경화[증]
atherosclerosis: 아테
롬성 [동맥]경화증
embolism: 색전증
심혈관계 질환 분야




thrombosis: 혈전증
varicose veins,
varicosity: 정맥류
embolectomy: 색전절
제[술]
thrombectomy; 혈전절
제술

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