心脏体格检查视诊英文版ppt课件

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.,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,ifleftlateraldecubitustheapicalimpulseshiftstotheleft23cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright12.5cm.,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.Broadbentssignisofvalueinthediagnosisofadherentpericardium.ItisalsoseeninRVH.,30,.,AbnormalPulsationsinPrecordium,Rightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.,PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess,31,.,AbnormalPulsationsinPrecordium,Inascendingorarchaorticaneurysm,onemaydetectsabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.,Pulmonaryhypertensionwithdilatationthepulsationinsystolemaybedetectedinleftsecondintercostalspacetotheedgeofsternum.,32,.,AbnormalPulsationsinPrecordium,Ma