心脏体格检查视诊英文版课件.ppt

1,PhysicalExaminationofCardiovascularSystem,FORMBBSSTUDENTS,MaGuotian,M.D.ProfessorofCardiology,DepartmentofDiagnosticsTheFirstAffiliatedHospitalofGuangxiMedicalUniversity,2,GeneralConsideration,Duringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.,3,PhysicalExaminationofCardiovascularsystem,Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.,4,PhysicalExaminationofCardiovascularsystem,Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.,5,ReviewtheAnatomy,6,RoutineandTechniquesofPEoftheHeart,Patientsexposureandposition(sittingorlyingdown),withenoughlightandappropriatetemperatureFourparts:inspection,palpation,percussion,andauscultation,7,PartoneInspection,8,Inspection,Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.,9,ContentsofInspection,ThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium,10,MethodsofInspection,Inspecttheobverseside.Thenobversethepatientslateralsurface,11,ThoracicCageDeformity（inspection）,Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood,12,ThoracicCageDeformity（inspection）,suchascongenitalheartdiseaseandrheumaticheartdisease,withskeletalmoldingtoaccommodatecardiacenlargement.,13,ApicalImpulse（inspection）,Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.,14,ApicalImpulse（inspection）,NormalapicalimpulsePosition:leftborderofsternum,fifthintercostalspace,insidethemidclavicularline0.51.0cmRange:22.5cmindiameter,15,ApicalImpulse（inspection）,ApicalimpulsedisplacementChangesofintensityandareaofapicalimpulseInwardimpulse,16,ApicalImpulse（inspection）,Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture,17,ApicalImpulseDisplacement,Extra-heartfactors:Obesity,pregnancy,etc.causeelevationofdiaphragm,apicalimpulseshiftstooutwardandupward,atleftthe4thintercostalspaceoutsidemidclavicularline.,2019/12/16,18,可编辑,19,ApicalImpulseDisplacement,Extra-heartfactors:Abdominaldisease:abdominaltumor,alargenumberofascites,etc.elevationofdiaphragm,apicalimpulseshiftstooutwardandupward,20,ApicalImpulseDisplacement,Extra-heartfactors:Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.,21,ApicalImpulseDisplacement,Extra-heartfactors:Singlesidepleuralthickening,oradhesion,oratelectasisresultinmediastinumandheartshiftingtothesickside,andtheapicalimpulseshiftstothesickside,too.,aorticarch,LV,tothesickside,22,Normal,ApicalImpulseDisplacement,heartshiftstothehealthyside,Pleuraleffussionintheright,tothehealthside,23,ApicalImpulseDisplacement,CardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.,24,LeftVentricleEnlargement,Normal,LVenlargement,25,BothVentriclesEnlargement,Bothventriclesenlargement,Normal,26,ApicalImpulseDisplacement,BodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft23cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright12.5cm.,27,ApicalImpulse（inspection）,Changesofintensityandareaofapicalimpulse(1).Physicalconditions(2).Pathologicalconditions,28,PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity,ChangesofIntensityandAreaofApicalImpulse,29,Changesofintensityandareaofapicalimpulse,PathologicalconditionsEnhancedapicalimpulse:leftventricularenlargementhyperthyroidismfever,anemia,PathologicalconditionsWeakenedapicalimpulse:dilatedmyocardiopathy,hydropericardium,leftpleuraleffusion,pulmonaryemphysema,30,InwardImpulse,Inwardimpulse.Theapexdepressesfarfromthechestinsteadofstrikingthechestduringsystole.Broadbentssignisofvalueinthediagnosisofadherentpericardium.ItisalsoseeninRVH.,31,AbnormalPulsationsinPrecordium,Rightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.,PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess,32,AbnormalPulsationsinPrecordium,Inascendingorarchaorticaneurysm,onemaydetectsabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.,Pulmonaryhypertensionwithdilatationthepulsationinsystolemaybedetectedinleftsecondintercostalspacetotheedgeofsternum.,33,AbnormalPulsationsinPrecordium,M