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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 Patient sexposureandposition sittingorlyingdown withenoughlightandappropriatetemperatureFourparts inspection palpation percussion andauscultation 7 PartoneInspection 8 Inspection Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax 9 ContentsofInspection ThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium 10 MethodsofInspection Inspecttheobverseside Thenobversethepatient slateralsurface 11 ThoracicCageDeformity inspection Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood 12 ThoracicCageDeformity inspection suchascongenitalheartdiseaseandrheumaticheartdisease withskeletalmoldingtoaccommodatecardiacenlargement 13 ApicalImpulse inspection Apicalimpulsemainlyresultsfromtheleftventricularcontraction whenLVcontracts theapicalknocksatthecorrespondentpositionofanteriorchestwall resultinginintercostalimpulseoutwardmovement 14 ApicalImpulse inspection NormalapicalimpulsePosition leftborderofsternum fifthintercostalspace insidethemidclavicularline0 5 1 0cmRange 2 2 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 18 ApicalImpulseDisplacement Extra heartfactors Abdominaldisease abdominaltumor alargenumberofascites etc elevationofdiaphragm apicalimpulseshiftstooutwardandupward 19 ApicalImpulseDisplacement Extra heartfactors Leptosome severelypulmonaryemphysema Thenapicalimpulseshiftstoinwardanddownward reachesatthe6thintercostalspace 20 ApicalImpulseDisplacement Extra heartfactors Singlesidepleuralthickening oradhesion oratelectasisresultinmediastinumandheartshiftingtothesickside andtheapicalimpulseshiftstothesickside too aorticarch LV tothesickside 21 Normal ApicalImpulseDisplacement heartshiftstothehealthyside Pleuraleffussionintheright tothehealthside 22 ApicalImpulseDisplacement CardiacenlargementRightventricleenlargement Apicalimpulseshiftstotheleftbutnotdownward Leftventricleenlargement Apicalimpulseshiftstotheleftanddownwardatthesametime 23 LeftVentricleEnlargement Normal LVenlargement 24 BothVentriclesEnlargement Bothventriclesenlargement Normal 25 ApicalImpulseDisplacement BodypostureDorsaldecubitus Apicalimpulsemovesalittleupward ifleftlateraldecubitustheapicalimpulseshiftstotheleft2 3cm Rightlateraldecubitus Theapicalimpulseshiftstotheright1 2 5cm 26 ApicalImpulse inspection Changesofintensityandareaofapicalimpulse 1 Physicalconditions 2 Pathologicalconditions 27 PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity ChangesofIntensityandAreaofApicalImpulse 28 Changesofintensityandareaofapicalimpulse PathologicalconditionsEnhancedapicalimpulse leftventricularenlargementhyperthyroidismfever anemia PathologicalconditionsWeakenedapicalimpulse dilatedmyocardiopathy hydropericardium leftpleuraleffusion pulmonaryemphysema 29 InwardImpulse Inwardimpulse Theapexdepressesfarfromthechestinsteadofstrikingthechestduringsystole Broadbent ssignisofvalueinthediagnosisofadherentpericardium ItisalsoseeninRVH 30 AbnormalPulsationsinPrecordium Rightvertricularhypertophy RVH Theimpulseisclearlyseeninleftthirdfourthintercostalspace PulmonaryemphysemawithRVH usuallythepulsationcanbefoundinferiorthexiphoidprocess 31 AbnormalPulsationsinPrecordium Inascendingorarchaorticaneurysm onemaydetectsabnormalpulsationsinaorticarea withbulgingorpulsationinsystole Pulmonaryhypertensionwithdilatationthepulsationinsystolemaybedetectedinleftsecondintercostalspacetotheedgeofsternum 32 AbnormalPulsationsinPrecordium Mark
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