ExaminationofBloodVessel

2017/11/25,1,Examination of Blood Vessels,2017/11/25,2,Introduction,Palpation of the pulseMeasurment of arterial blood pressureAuscultation of blood vessels,2017/11/25,3,Palpation of The Pulse,Radial artery is usually selectedPatients hand placed with the palm upwardPhysicians first three fingers on the radial arteryIndex finger nearest the heart,2017/11/25,4,Characteristics of The Pulse,RateIntensityType of waveRhythmTension,2017/11/25,5,RATE,-Pulse frequency (rapid or slow) Varies with age, sex, physical activity, emotional statusNormal range: 60-100bpm in adults; 90-120bpm in children,2017/11/25,6,Rate increase (tachycardia心动过速): severe anemia, high fever, massive hemorrhage(大出血), various types of cardiac arrhythmias, hyperthyroidism, and at times in congestive heart failure.,2017/11/25,7,Rate decrease (bradycardia心动过缓): increased intracranial pressure(颅高压), SSS, above AVB, hypothyroid(甲减), Digoxin(地高辛), etc,2017/11/25,8,Rhythm,The more common disturbances of rhythm can and should be detected by palpating the pulse.Auscultation of the heart is a more accurate method for determining the rhythm.Some of the more complex arrhythmias can be diagnosed only by EKG.,2017/11/25,9,Common irregular pulse:Sinus arrhythmia(窦不齐)Premature beat(早搏)Atrial fibrillation(房颤)Bigeminal pulse(二联律)Trigeminal pulse(三联律)Paroxysmal atrial, ventricular tachycardiaHeart block(传导阻滞),2017/11/25,10,Tension,The tension of pulse depends on the level of the arterial systolic pressure.,2017/11/25,11,Intensity,The intensity depends on the cardiac output, pulse pressure and the resistance of peripheral vessels.,2017/11/25,12,Pulsus magnus (bounding pulse): increased cardiac output , high pulse pressure, low resistance. aortic insufficiency, high fever, hyperthyroid,2017/11/25,13,Small pulse (thready pulse): decreased cardiac output , low pulse pressure, high resistance. aortic stenosis, heart failure, shock.,2017/11/25,14,Wave form,The arterial pulse starts at the instant aortic valve opens, results in an abrupt sharp rise in aortic pressure.During systole a large part of blood is temporarily stored in the proximal aorta.Once the aortic pressure reaches a peak it begins to fall, and blood continues its flow in the peripheral arteries in later systole and diastole.,2017/11/25,15,Normal pulse wave:Ascending limbPeakDescending limbsmall notch ( on the descending limb)Small notch (on the ascending limb),2017/11/25,16,2017/11/25,17,The upstroke is prompt and smooth, but the anacrotic notch is not palpable in most normal persons.The peak is rounded and smooth.The descending limb is more gradual and less steep.The dicrotic notch in most normal persons cannot be palpated but can be sensed as a change in the slope of the down stroke.,2017/11/25,18,Type of Wave,Abnormal pulse waveWater hammer pulse(水冲脉)Pulsus tardus(迟脉)Dicrotic pulse(重搏脉)Pulsus alternans(交替脉)Paradoxical pulse(奇脉)Asphygmia(无脉),2017/11/25,19,Water hammer pulse,A strong bounding pulse with a tall rapid ascending limb and an equally rapid descending limb. It is also called collapsing pulse.Due to increasing pulse pressure, it is Commonly found in AI, PDA, hyperthyroid and severe anemia.,2017/11/25,20,2017/11/25,21,Pulpus Tardus,A small weak pulse with a delayed systolic peakIt occurs in the presence of narrow pulse pressure, increased peripheral vascular resistance, low SV Common in aortic stenosis, mitral stenosis, LV heart failure after AMI.,2017/11/25,22,2017/11/25,23,Dicrotic Pulse,There are two impulses that are palpable during systole and diastole respectively.It usually occurs in the presence of high fever and typhoid(伤寒).,2017/11/25,24,2017/11/25,25,Pulsus Alternans,It is characterized by a regularly alternating pulse, in which every beat is weaker than the preceding beat.It is easy to be detected when the patient is sitting or standing.It is a valuable indication of left ventricular failure. Severe arterial hypertension.,2017/11/25,26,2017/11/25,27,Paradoxical pulse,A decrease in the amplitude or an actual imperceptibility of the pulse during inspiration.Commonly found in massive pericardial effusion, constrictive pericarditis, and severe pulmonary emphysema.,2017/11/25,28,Asphygmia,Severe shockPrimary arteritis of the aorta and its main branches (pulseless),2017/11/25,29,Consistency of Arterial Wall,Normally the wall of radial artery is soft and pliable In arteriosclerosis(动脉硬化), more resistance to compression by the palpating finger, and the vessel may be rolled easily between the examing digits.,2017/11/25,30,Measurement of Arterial Blood Pressure,Methods for measuring the blood pressure:Direct methodIndirect method,2017/11/25,31,Indirect Methods for Measuring BP,Patient arrangementPhysically relaxed and emotionally at easeThe patient may be sitting or lying in supine position.The arm should be at the heart level, relaxed, slightly fixed and support on a firm surface.,2017/11/25,32,Blood Pressure CuffDeflated before examWrapped evenly and firmly about the arm Distal margin of the cuff should be placed 2 to 3cm above the antecubital fossa,2017/11/25,33,2017/11/25,34,Korotkoff-Auscultatory Method,Beats become audible - the systolic pressureSound of beats become louderBlowing murmurSound of beats gradually diminishSound disappear - the diastolic blood pressure,2017/11/25,35,Definitions and Classification of Blood Pressure Levels,WHO (1999)Category systolic(mmHg) diastolic(mmHg)Optimal 120 80Normal 130 85High-normal 130-139 85-89 Hypertension 140 90Isolated systolic 140 90 hypertension,2017/11/25,36,Abnormal Blood Pressure,HypertensionHypotensionSignificant difference in two upper extremitiesSignificant difference in upper and lower extremitiesAbnormality in pulse pressure,2017/11/25,37,Hypertension,Essential hypertensionSymptomatic hypertension Renal causes, endocrine causes, etc,2017/11/25,38,Low Blood Pressure,Systolic pressure90mmHg diastolic pressure60mmHgDecrease in cardiac output : acute myocardial infarction, pericarditis with effusion, heart failure, following hemorrhageDecrease in peripheral resistance: septicemia(败血症), Addisons disease, drug intoxications,2017/11/25,39,Significant Difference in the Upper Extremities,Little or no significant difference Difference of pressure above 10mmHgPrimary arteritis(动脉炎) of the aorta and its main branches, obstruction of the innominate artery(无名动脉), aortic aneurysm,2017/11/25,40,Significant Difference in the Upper and Lower Extremities,Ordinarily the systolic pressure is slightly higher in the lower extremities than in the upper (2040mmHg)Most common in coarctation of the aorta (congenital narrowing),2017/11/25,41,Abnormality in Pulse Pressure,The pulse pressure is the difference between the systolic and diastolic pressures and normally amounts to 30 or 40mmHg.Pulse pressure increased:40mmHgatherosclerosis of the aorta(大动脉硬化), hyperthyroidism, aortic regurgitation(返流), arteriovenous fistula(动静脉瘘), severe anemia, PDA,2017/11/25,42,Pulse pressure decreased: 30mmHgAortic stenosis, hypotension, heart failure and massive pericardial effusion,2017/11/25,43,Auscultation of vein,Venous hum over the jugular vein(颈静脉): a soft low-pitched continuous murmur, decrease or disappear in supine position, especially in cases of marked anemiaLoud murmur heard over dilated vein in liver cirrhosis(肝硬化),2017/11/25,44,Auscultation of Arteries,Normal artery soundPistolshot soundDuroziers soundPathological sound: including systolic and continuous murmer,2017/11/25,45,Pistol-shot Sound,In aortic insufficiency, a loud first sound (pistol-shot sound)