呼吸循环系统体格检查

physicalphysicalphysical examinationexaminationexamination 心脏检查心脏检查心脏检查心脏检查 1 1 1 CardiacCardiacCardiac ExaminationExaminationExamination inspectioninspectioninspection 视诊视诊视诊视诊 palpationpalpationpalpation 触诊触诊触诊触诊 percussionpercussionpercussion 叩诊叩诊叩诊叩诊 auscultationauscultationauscultation 听诊听诊听诊听诊 一 The projection of the heart at the anterior chest wall 二 The auscultatory area of cardial valves and the direction of the blood flow through the various valves 1 The mitral valve area The blood flow pass from the posterasuperior to the anterainferior left the auculatory area is at apex area 三 Precordium 1 The superior border is below the left third intercostal space 2 The right border is at the midsternum line 3 The left border is at the left midclavicular line 4 The inferior border is above the diaphragm The heart examination InspectionInspectionInspection ofofof thethethe HeartHeartHeart 心脏视诊心脏视诊心脏视诊心脏视诊 The focal point of inspection include precordiumprecordiumprecordium shapeshapeshape 心前区外形心前区外形心前区外形心前区外形 normalnormalnormal apicalapicalapical impulseimpulseimpulse 正常心尖搏动正常心尖搏动正常心尖搏动正常心尖搏动 abnormalabnormalabnormal apicalapicalapical impulseimpulseimpulse 异常心尖搏动异常心尖搏动异常心尖搏动异常心尖搏动 precordialprecordialprecordial abnormalabnormalabnormal impulseimpulseimpulse 心前区异常搏动心前区异常搏动心前区异常搏动心前区异常搏动 PrecordiumPrecordiumPrecordium ShapeShapeShape 心前区外形心前区外形心前区外形心前区外形 PrecordialPrecordialPrecordial bulgebulgebulge 心前区隆起心前区隆起心前区隆起心前区隆起 Features Features Features bonybonybony bulgebulgebulge 特点特点特点特点 骨骼突起骨骼突起骨骼突起骨骼突起 ClinicalClinicalClinical importance importance importance CongenitalCongenitalCongenital heartheartheart diseasediseasedisease withwithwith rightrightright ventricularventricularventricular enlargementenlargementenlargement 提示提示提示提示 先天性心脏病右室大先天性心脏病右室大先天性心脏病右室大先天性心脏病右室大 PrecordialPrecordialPrecordial fullnessfullnessfullness 心前区饱满心前区饱满心前区饱满心前区饱满 Features Features Features intercostalintercostalintercostal regionregionregion fullnessfullnessfullness 特点特点特点特点 肋间软组织外突肋间软组织外突肋间软组织外突肋间软组织外突 ClinicalClinicalClinical importance importance importance massmassmass ofofof pericardialpericardialpericardial effusioneffusioneffusion 提示提示提示提示 大量大量大量大量 心包积液心包积液心包积液心包积液 NormalNormalNormal ApicalApicalApical ImpulseImpulseImpulse 正常心尖搏动正常心尖搏动正常心尖搏动正常心尖搏动 一 Inspection In most persons one can see synchronous with cardic systolic an outward movement of a small portion of the left chest wall caused by the beat of the cardic apex This is the cardic or apex impulse It should be studied with the patient upright and lying in various position since in many instances the impalse may be fairly diffuse NormalNormalNormal ApicalApicalApical ImpulseImpulseImpulse 正常心尖搏动正常心尖搏动正常心尖搏动正常心尖搏动 Location Location Location thethethe 5 5 5th thth intercastal intercastalintercastal spacespacespace 0 5 1 00 5 1 00 5 1 0 cmcmcm insideinsideinside thethethe leftleftleft midclavicularmidclavicularmidclavicular line line line Range Range Range 2 2 5cm2 2 5cm2 2 5cm Direction Direction Direction outwardoutwardoutward whenwhenwhen ventricularventricularventricular systolesystolesystole beginsbeginsbegins andandand it it it coincidecoincidecoincide withwithwith thethethe leftleftleft cardiccardiccardic borderborderborder 位置位置位置位置 第第第第5 5 5肋间左锁骨中线肋间左锁骨中线肋间左锁骨中线肋间左锁骨中线 内内内内0 5 1cm 0 5 1cm0 5 1cm 范围范围范围范围 2 2 5cm2 2 5cm2 2 5cm 方向方向方向方向 收缩时向外搏动收缩时向外搏动收缩时向外搏动收缩时向外搏动 意义意义意义意义 提示心尖位置提示心尖位置提示心尖位置提示心尖位置 代表收缩期代表收缩期代表收缩期代表收缩期 提示心脏大小与心提示心脏大小与心提示心脏大小与心提示心脏大小与心 脏的左缘一致脏的左缘一致脏的左缘一致脏的左缘一致 AbnormalAbnormalAbnormal ApicalApicalApical ImpulseImpulseImpulse 异常心尖搏动异常心尖搏动异常心尖搏动异常心尖搏动 1 1 1 AbnormalAbnormalAbnormal locationlocationlocation 位置改变位置改变位置改变位置改变 Physical Physical Physical posture posture posture pregnancy pregnancy pregnancy etc etc etc 生理因素生理因素生理因素生理因素 体位体位体位体位 妊娠妊娠妊娠妊娠 HeartHeartHeart diseasesdiseasesdiseases 心脏病变心脏病变心脏病变心脏病变 L VL VL V andandand B VB VB V enlargement enlargement enlargement inferiorinferiorinferior leftleftleft 左室或双室扩大左室或双室扩大左室或双室扩大左室或双室扩大 左下移位左下移位左下移位左下移位 R VR VR V enlargement enlargement enlargement leftleftleft 右室扩大右室扩大右室扩大右室扩大 向左移位向左移位向左移位向左移位 ChestChestChest andandand abdominalabdominalabdominal diseasesdiseasesdiseases 肺部或腹部疾病肺部或腹部疾病肺部或腹部疾病肺部或腹部疾病 AbnormalAbnormalAbnormal ApicalApicalApical ImpulseImpulseImpulse 异常心尖搏动异常心尖搏动异常心尖搏动异常心尖搏动 1 1 1 When a large amount of fluid or air is present in the right plural civity will shift the heart toward the left if a large amount of air or fluid in the left plural cavity will displace the heart toward the right Retraction of lungs in severe unilateral plural pulmonary fibrosis or obstraction atlectasis the inpulse moves toward the affected side Pronounced distention of the abdomin as by gas fluid or large tumor pushes the impulse upward and left AbnormalAbnormalAbnormal ApicalApicalApical ImpulseImpulseImpulse 异常心尖搏动异常心尖搏动异常心尖搏动异常心尖搏动 2 2 2 AbnormalAbnormalAbnormal rangerangerange ororor intensityintensityintensity 范围强度异常范围强度异常范围强度异常范围强度异常 IncreasedIncreasedIncreased intensity intensity intensity LVLVLV hypertrophy hypertrophy hypertrophy hyperthyroidism hyperthyroidism hyperthyroidism fever fever fever anemia anemia anemia etc etc etc 搏动增强搏动增强搏动增强搏动增强 左室肥厚左室肥厚左室肥厚左室肥厚 甲亢甲亢甲亢甲亢 发热发热发热发热 贫血贫血贫血贫血 Decreased Decreased Decreased myocardialmyocardialmyocardial diseases diseases diseases pericardialpericardialpericardial effusion effusion effusion pleuralpleuralpleural effusioneffusioneffusion ofofof leftleftleft thoraxthoraxthorax ororor left sideleft sideleft side pneumothorax pneumothorax pneumothorax emphysema emphysema emphysema 搏动减弱搏动减弱搏动减弱 搏动减弱 心肌病变心肌病变心肌病变心肌病变 心包积液心包积液心包积液心包积液 肺气肿肺气肿肺气肿肺气肿 左胸腔积液或气左胸腔积液或气左胸腔积液或气左胸腔积液或气 胸胸胸胸 AbnormalAbnormalAbnormal directiondirectiondirection 方向改变方向改变方向改变方向改变 InwardInwardInward impulse impulse impulse adhesiveadhesiveadhesive pericarditis pericarditis pericarditis 负性心尖搏动负性心尖搏动负性心尖搏动负性心尖搏动 心包粘连 心包粘连心包粘连心包粘连 PrecordialPrecordialPrecordial AbnormalAbnormalAbnormal ImpulseImpulseImpulse 心前区异常搏动心前区异常搏动心前区异常搏动心前区异常搏动 2nd2nd2nd ICS ICS ICS LSB LSB LSB pulmonarypulmonarypulmonary hypertension hypertension hypertension youthyouthyouth 胸骨左缘第胸骨左缘第胸骨左缘第 胸骨左缘第二二二肋间肋间肋间肋间 肺动脉高压肺动脉高压肺动脉高压肺动脉高压 青年人青年人青年人青年人 2nd2nd2nd ICS ICS ICS RSB RSB RSB aneurysmaneurysmaneurysm ofofof ascendingascendingascending aortaaortaaorta 胸骨右缘第胸骨右缘第胸骨右缘第 胸骨右缘第二二二肋间肋间肋间肋间 升主动脉瘤升主动脉瘤升主动脉瘤升主动脉瘤 3rd 3rd 3rd 4th4th4th ICS ICS ICS LSB LSB LSB R VR VR V hypertrophyhypertrophyhypertrophy 胸骨左缘胸骨左缘胸骨左缘 胸骨左缘3 3 3 4 4 4肋间肋间肋间肋间 右心室肥大右心室肥大右心室肥大右心室肥大 xiphoidxiphoidxiphoid process process process R VR VR V hypertrophy hypertrophy hypertrophy abdominalabdominalabdominal aneurysmaneurysmaneurysm 剑突下剑突下剑突下 剑突下 右心室肥大右心室肥大右心室肥大右心室肥大 腹主动脉瘤腹主动脉瘤腹主动脉瘤腹主动脉瘤 PalpationPalpationPalpation ofofof thethethe HeartHeartHeart 心脏触诊心脏触诊心脏触诊心脏触诊 Palpation of the heart has three purposes 1 Confirm the observation made during inspection 2 To detect the pulsatial movment that are not visible 3 To reveal the thrill or friction rubs in the presence of specific cardic disease ApicalApicalApical ImpulseImpulseImpulse 心尖搏动心尖搏动心尖搏动心尖搏动 ClinicalClinicalClinical significance significance significance signifyingsignifyingsignifying thethethe startstartstart ofofof thethethe systolicsystolicsystolic phasephasephase 临床意义临床意义临床意义临床意义 指示收缩期的开始指示收缩期的开始指示收缩期的开始指示收缩期的开始 LocationLocationLocation andandand range range range samesamesame asasas in inin inspectioninspectioninspection 位置和范围位置和范围位置和范围位置和范围 与心尖搏动视诊相同与心尖搏动视诊相同与心尖搏动视诊相同与心尖搏动视诊相同 IncreasedIncreasedIncreased heave heave heave forcefulforcefulforceful andandand sustainedsustainedsustained 增强增强增强增强 搏动持续有力搏动持续有力搏动持续有力搏动持续有力 liftingliftinglifting apicalapicalapical impulseimpulseimpulse 抬举性心脏搏动抬举性心脏搏动抬举性心脏搏动抬举性心脏搏动 Decreased Decreased Decreased cannotcannotcannot palp palp palp clearlyclearlyclearly 减弱减弱减弱减弱 不能清楚触到不能清楚触到不能清楚触到不能清楚触到 AbnormalAbnormalAbnormal ofofof ApicalApicalApical ImpulseImpulseImpulse 心尖搏动异常心尖搏动异常心尖搏动异常心尖搏动异常 IncreasedIncreasedIncreased causes causes causes leftleftleft ventricularventricularventricular pressurepressurepressure overloadoverloadoverload andandand consequentconsequentconsequent hypertrophyhypertrophyhypertrophy 增强原因增强原因增强原因增强原因 左室内压升高和肥厚 左室内压升高和肥厚左室内压升高和肥厚左室内压升高和肥厚 ClinicalClinicalClinical significance significance significance leftleftleft ventricularventricularventricular hypertrophyhypertrophyhypertrophy 临床意义临床意义临床意义 临床意义 左心室肥大左心室肥大左心室肥大左心室肥大 DecreasedDecreasedDecreased causes causes causes decreaseddecreaseddecreased contractibilitycontractibilitycontractibility ofofof thethethe myocardiummyocardiummyocardium 减弱原因减弱原因减弱原因减弱原因 心肌收缩力减弱 心肌收缩力减弱心肌收缩力减弱心肌收缩力减弱 ClinicalClinicalClinical significance significance significance heartheartheart failure failure failure pericardialpericardialpericardial effusion effusion effusion myocarditismyocarditismyocarditis 临床意义临床意义临床意义 临床意义 心力衰竭心力衰竭心力衰竭心力衰竭 心包积液心包积液心包积液心包积液 心肌炎心肌炎心肌炎心肌炎 ThrillThrillThrill 震颤震颤震颤震颤 Mechanism Mechanism Mechanism formationformationformation ofofof bloodflowbloodflowbloodflow vorticesvorticesvortices causedcausedcaused bybyby valvevalvevalve stenosisstenosisstenosis ororor abnormalabnormalabnormal pathway pathway pathway 产生机制产生机制产生机制产生机制 血流旋涡引起低频较强震动血流旋涡引起低频较强震动血流旋涡引起低频较强震动血流旋涡引起低频较强震动 由瓣膜狭窄和异常通道引起由瓣膜狭窄和异常通道引起由瓣膜狭窄和异常通道引起由瓣膜狭窄和异常通道引起 Types Types Types systole systole systole diastole diastole diastole continuouscontinuouscontinuous 分型分型分型分型 收缩期震颤收缩期震颤收缩期震颤收缩期震颤 舒张期震颤舒张期震颤舒张期震颤舒张期震颤 持续震颤持续震颤持续震颤持续震颤 ClinicalClinicalClinical significance significance significance reliablereliablereliable signssignssigns ofofof organicorganicorganic heartheartheart diseasesdiseasesdiseases 临床意义临床意义临床意义临床意义 器质性心脏病的征象器质性心脏病的征象器质性心脏病的征象器质性心脏病的征象 ThrillThrillThrill ininin SystoleSystoleSystole 收缩期震颤收缩期震颤收缩期震颤收缩期震颤 2nd2nd2nd ICS ICS ICS LSB LSB LSB pulmonicpulmonicpulmonic stenosisstenosisstenosis 胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间 肺动脉瓣狭窄肺动脉瓣狭窄肺动脉瓣狭窄肺动脉瓣狭窄 2nd2nd2nd ICS ICS ICS RSB RSB RSB aorticaorticaortic stenosisstenosisstenosis 胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间 主动脉瓣狭窄主动脉瓣狭窄主动脉瓣狭窄主动脉瓣狭窄 3rd 3rd 3rd 4th4th4th ICS ICS ICS LSB LSB LSB interventricularinterventricularinterventricular septalseptalseptal defectdefectdefect 胸骨左缘胸骨左缘胸骨左缘胸骨左缘3 3 3 4 4 4肋间肋间肋间肋间 室间隔缺损室间隔缺损室间隔缺损室间隔缺损 ThrillThrillThrill ininin DiastoleDiastoleDiastole andandand ContinuousContinuousContinuous 舒张期和持续性震颤舒张期和持续性震颤舒张期和持续性震颤舒张期和持续性震颤 DiastolicDiastolicDiastolic thrillthrillthrill ononon apex apex apex mitralmitralmitral stenosisstenosisstenosis 心尖部舒张期震颤心尖部舒张期震颤心尖部舒张期震颤心尖部舒张期震颤 二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄 ContinuousContinuousContinuous thrillthrillthrill ononon 2nd2nd2nd ICS ICS ICS LSB LSB LSB PatentPatentPatent ductusductusductus arteriosusarteriosusarteriosus 胸骨左缘第二肋间连续性震颤胸骨左缘第二肋间连续性震颤胸骨左缘第二肋间连续性震颤胸骨左缘第二肋间连续性震颤 动脉导管未闭动脉导管未闭动脉导管未闭动脉导管未闭 PericardialPericardialPericardial FrictionFrictionFriction FremitusFremitusFremitus 心包摩擦感心包摩擦感心包摩擦感心包摩擦感 Mechanism Mechanism Mechanism inflammationinflammationinflammation ororor irritationirritationirritation ofofof thethethe pericardiumpericardiumpericardium 机制机制机制机制 心包表面粗糙心包表面粗糙心包表面粗糙心包表面粗糙 TypicalTypicalTypical site site site 4th4th4th ICS ICS ICS LSBLSBLSB 部位部位部位部位 胸骨左缘第四肋间 胸骨左缘第四肋间胸骨左缘第四肋间胸骨左缘第四肋间 Feeling Feeling Feeling frictionfrictionfriction likelikelike leatherleatherleather rubbingrubbingrubbing 感觉感觉感觉 感觉 如皮革相互摩擦如皮革相互摩擦如皮革相互摩擦如皮革相互摩擦 Features Features Features it it it is is is bestbestbest palpatedpalpatedpalpated withwithwith thethethe personpersonperson sittingsittingsitting upupup andandand leaningleaningleaning forward forward forward andandand withwithwith thethethe breathbreathbreath heldheldheld in inin expirationexpirationexpiration coincidecoincidecoincide withwithwith heartheartheart impulseimpulseimpulse 特点特点特点特点 坐位前倾呼气末明显坐位前倾呼气末明显坐位前倾呼气末明显坐位前倾呼气末明显 与心跳一致与心跳一致与心跳一致与心跳一致 闭气时不消失闭气时不消失闭气时不消失闭气时不消失 ClinicalClinicalClinical significance significance significance pericarditispericarditispericarditis 意义意义意义意义 提示心包炎提示心包炎提示心包炎提示心包炎 PercussionPercussionPercussion ofofof thethethe HeartHeartHeart 心脏叩诊心脏叩诊心脏叩诊心脏叩诊 percussionpercussionpercussion ofofof thethethe heartheartheart borderborderborder 心界叩诊心界叩诊心界叩诊心界叩诊 abnormalabnormalabnormal dullnessdullnessdullness heartheartheart borderborderborder 心界异常心界异常心界异常心界异常 PercussionPercussionPercussion TechniqueTechniqueTechnique 叩诊方法叩诊方法叩诊方法叩诊方法 Force Force Force lightlightlight percussionpercussionpercussion forforfor thethethe relativerelativerelative dullnessdullnessdullness border border border 力量力量力量力量 轻叩叩出相对浊音界轻叩叩出相对浊音界轻叩叩出相对浊音界轻叩叩出相对浊音界 Position Position Position supine supine supine parallelparallelparallel thethethe middlemiddlemiddle fingerfingerfinger tototo intercostal intercostal intercostal sitting sitting sitting plumbplumbplumb thethethe middlemiddlemiddle finger finger finger 体位体位体位体位 仰卧位仰卧位仰卧位仰卧位 板指与肋间平行板指与肋间平行板指与肋间平行板指与肋间平行 坐位坐位坐位坐位 板指与肋间垂直板指与肋间垂直板指与肋间垂直板指与肋间垂直 Steps Steps Steps fromfromfrom leftleftleft tototo right right right lowerlowerlower tototo upper upper upper outwardoutwardoutward tototo inwardinwardinward 顺序顺序顺序 顺序 先左后右先左后右先左后右先左后右 自下而上自下而上自下而上自下而上 由外向内由外向内由外向内由外向内 LeftLeftLeft border border border 2 3cm2 3cm2 3cm fromfromfrom thethethe apicalapicalapical impulseimpulseimpulse 心左界心左界心左界 心左界 心尖搏动外心尖搏动外心尖搏动外心尖搏动外 2 3cm2 3cm2 3cm 开始开始开始开始 RightRightRight border border border ICSICSICS nextnextnext tototo thethethe upperupperupper borderborderborder ofofof thethethe liverliverliver 心右界心右界心右界 心右界 肝上界上一肋间开始肝上界上一肋间开始肝上界上一肋间开始肝上界上一肋间开始 Measure Measure Measure thethethe distancedistancedistance fromfromfrom dullnessdullnessdullness borderborderborder tototo anterioranterioranterior midlinemidlinemidline 测量测量测量 测量 浊音界距前正中线的垂直距离浊音界距前正中线的垂直距离浊音界距前正中线的垂直距离浊音界距前正中线的垂直距离 NormalNormalNormal RelativeRelativeRelative DullnessDullnessDullness BorderBorderBorder ofofof thethethe HeartHeartHeart 正常心浊音界正常心浊音界正常心浊音界正常心浊音界 DistanceDistanceDistance betweenbetweenbetween dullnessdullnessdullness borderborderborder andandand anterioranterioranterior midlinemidlinemidline 心脏之相对浊音界距前正中线的距离心脏之相对浊音界距前正中线的距离心脏之相对浊音界距前正中线的距离心脏之相对浊音界距前正中线的距离 AbnormalAbnormalAbnormal DullnessDullnessDullness HeartHeartHeart BorderBorderBorder 心界叩诊异常心界叩诊异常心界叩诊异常心界叩诊异常 1 1 1 heartheartheart variationvariationvariation 心脏改变心脏改变心脏改变心脏改变 L VL VL V enlargement enlargement enlargement boot shapedboot shapedboot shaped heartheartheart 左室扩大左室扩大左室扩大左室扩大 靴形心靴形心靴形心靴形心 L AL AL A enlargement enlargement enlargement pear shapedpear shapedpear shaped heartheartheart 左房扩大左房扩大左房扩大左房扩大 梨形心梨形心梨形心梨形心 B VB VB V enlargement enlargement enlargement generalgeneralgeneral enlargedenlargedenlarged heartheartheart 双室扩大双室扩大双室扩大双室扩大 普大心普大心普大心普大心 R VR VR V enlargement enlargement enlargement conginetialconginetialconginetial andandand pulmonalpulmonalpulmonal heartheartheart diseasediseasedisease 右室扩大右室扩大右室扩大右室扩大 先心先心先心先心 肺心肺心肺心肺心 PericardialPericardialPericardial effusion effusion effusion flask shapedflask shapedflask shaped heartheartheart 心包积液心包积液心包积液心包积液 烧瓶心烧瓶心烧瓶心烧瓶心 AbnormalAbnormalAbnormal DullnessDullnessDullness HeartHeartHeart BorderBorderBorder 心界叩诊异常心界叩诊异常心界叩诊异常心界叩诊异常 2 2 2 chestchestchest andandand lunglunglung diseasesdiseasesdiseases 胸肺疾病胸肺疾病胸肺疾病胸肺疾病 PleuralPleuralPleural effusioneffusioneffusion ororor lunglunglung consolidation consolidation consolidation dullnessdullnessdullness borderborderborder undetectableundetectableundetectable 胸腔积液或肺实变胸腔积液或肺实变胸腔积液或肺实变胸腔积液或肺实变 叩不出叩不出叩不出叩不出 Emphysema Emphysema Emphysema shrinkedshrinkedshrinked dullnessdullnessdullness borderborderborder 肺气肿肺气肿肺气肿肺气肿 心浊音界缩小心浊音界缩小心浊音界缩小心浊音界缩小 abdominalabdominalabdominal disordersdisordersdisorders 腹部疾病腹部疾病腹部疾病腹部疾病 DiaphragmDiaphragmDiaphragm elevation elevation elevation acrossingacrossingacrossing heartheartheart 膈升高膈升高膈升高膈升高 横位心横位心横位心横位心 Boot shapedBoot shapedBoot shaped HeartHeartHeart 靴形心靴形心靴形心靴形心 Mechanism Mechanism Mechanism L VL VL V enlargementenlargementenlargement Features Features Features thethethe leftleftleft borderborderborder extendsextendsextends tototo thethethe inferiorinferiorinferior left left left waistwaistwaist ofofof thethethe heartheartheart is is is deepened wideneddeepened wideneddeepened widened ofofof thethethe aorta aorta aorta Causes Causes Causes aorticaorticaortic insufficiency insufficiency insufficiency hypertensivehypertensivehypertensive heartheartheart diseasediseasedisease 机制机制机制机制 左室扩大左室扩大左室扩大左室扩大 特点特点特点特点 心左界向左下扩大心左界向左下扩大心左界向左下扩大心左界向左下扩大 心腰加深心腰加深心腰加深心腰加深 主动脉增宽主动脉增宽主动脉增宽主动脉增宽 病因病因病因病因 主动脉瓣关闭不全主动脉瓣关闭不全主动脉瓣关闭不全主动脉瓣关闭不全 高血压心脏病高血压心脏病高血压心脏病高血压心脏病 Pear shapedPear shapedPear shaped HeartHeartHeart 梨形心梨形心梨形心梨形心 Mechanism Mechanism Mechanism L AL AL A enlargementenlargementenlargement andandand distensiondistensiondistension ofofof pulmonarypulmonarypulmonary arteryarteryartery Features Features Features dullnessdullnessdullness heartheartheart borderborderborder in inin thethethe 2nd 2nd 2nd 3rd3rd3rd ICSICSICS ononon thethethe LSBLSBLSB extendsextendsextends outside outside outside waistwaistwaist ofofof thethethe heartheartheart bulgesbulgesbulges outoutout Causes Causes Causes mitralmitralmitral stenosisstenosisstenosis 机制机制机制机制 左房扩大左房扩大左房扩大左房扩大 肺动脉扩大肺动脉扩大肺动脉扩大肺动脉扩大 特点特点特点特点 胸骨左缘胸骨左缘胸骨左缘胸骨左缘2 2 2 3 3 3肋间肋间肋间肋间 心浊音界向外扩大心浊音界向外扩大心浊音界向外扩大心浊音界向外扩大 心腰饱满或膨出心腰饱满或膨出心腰饱满或膨出心腰饱满或膨出 病因病因病因病因 二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄 GeneralGeneralGeneral EnlargedEnlargedEnlarged HeartHeartHeart 普大心普大心普大心普大心 Mechanism Mechanism Mechanism bothbothboth leftleftleft andandand rightrightright ventricleventricleventricle areareare enlargedenlargedenlarged Features Features Features thethethe dullnessdullnessdullness borderborderborder extendsextendsextends tototo bothbothboth sides sides sides thethethe leftleftleft borderborderborder extendsextendsextends tototo inferiorinferiorinferior leftleftleft Causes Causes Causes cardiomyopathy cardiomyopathy cardiomyopathy myocarditis myocarditis myocarditis wholewholewhole heartheartheart failurefailurefailure 机制机制机制机制 左右心室扩大左右心室扩大左右心室扩大左右心室扩大 特点特点特点特点 心浊音界向双侧扩大心浊音界向双侧扩大心浊音界向双侧扩大心浊音界向双侧扩大 左界向下扩大左界向下扩大左界向下扩大左界向下扩大 病因病因病因病因 扩张型心肌病扩张型心肌病扩张型心肌病扩张型心肌病 克山病克山病克山病克山病 重症心肌炎重症心肌炎重症心肌炎重症心肌炎 全心衰竭全心衰竭全心衰竭全心衰竭 Flask shapedFlask shapedFlask shaped HeartHeartHeart 烧瓶心烧瓶心烧瓶心烧瓶心 Mechanism