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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 = 판막질환 병 명
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) 심내막 염 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
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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