《健康评估》课件-修 心脏视诊

VisualInspection

ofHeart心脏视诊

解剖回顾

心脏体表投影主动脉左肺动脉左心室心尖部肺动脉右心室右心房右肺动脉上腔静脉1

Heartsurface

projectionsuperiorvenacavarightpulmonaryarteryrightatriumrightventricleaorticorificeleftpulmonaryarterycardiacapexleftventricle

Anatomicalreview

pulmonaryartery

解剖回顾

心脏的瓣膜2

Anatomicalreview

valvularheartaortaTricuspidvalveRightAtriumRightVentricleLeftVentriclePulmonaryarteryLeftAtriumcardiacvalvesvalvulabicuspidalisaorticvalvepulmonaryvalve

解剖回顾

valvulabicuspidalispulmonaryvalvepulmonaryvalveaorticvalveTricuspidvalveLeftAtriumpulmonaryvein

Anatomicalreview

解剖回顾

瓣膜狭窄瓣膜关闭不全正常瓣膜打开正常瓣膜关闭

Anatomicalreview

NormalvalveopeningnormalvalveclosureValvularstenosisValvularinsufficiency心前区隆起与凹陷

心前区隆起心脏增大：先天性心脏病、

风湿性心脏病等Enlargedheart:congenitalheartdisease,rheumaticheartdisease,etc.马方综合征Marfansyndrome部分二尖瓣脱垂病人Somepatientswithmitralvalveprolapse

Bulgeanddepressionofprecordialregionprecordialprominence心前区凹陷Precordialdepression心前区隆起与凹陷

心前区隆起鸡胸：佝偻病pectuscapitatum：rickets心包积液pericardialeffusion马方综合征Marfansyndrome部分二尖瓣脱垂病人Somepatientswithmitralvalveprolapse

bulgeanddepressionofprecordialregionprecordialprominence心前区凹陷Precordialdepression心前区隆起心前区凹陷心前区隆起与凹陷

UpliftanddepressionofprecordialregionPrecordialdepressionprecordialprominence心尖搏动

正常心尖搏动正常人坐位时心尖搏动一般位于左侧第5肋间隙锁骨中线内0.5～1.0cm处，Inthenormalsittingposition,theapicalpulsationisgenerallylocatedatthe0.5~1.0cminthemidlineoftheclavicleoftheleftfifthintercostalspace,

apicalbeat

Normalapicalbeat心尖搏动

正常心尖搏动距前正中线7.0～9.0cm,搏动范围为直径2.0～2.5cm。Thenormalapicalbeatis7.0～9.0cmfromtheanteriormedianline,andthebeatingrangeis2.0～2.5cmindiameter.

apicalbeat

Normalapicalbeat心尖搏动的位置变化

生理因素Physiologicalfactors心尖搏动位置变化Apicalpositionchanges体型BodyType超力型心尖搏动向外上移位，无力型者向内下移位Thehyperdynamicapicalpulsationmovesoutwardandupward,whileinthepowerlesstype,theheartofinfantsandchildrenmovesinwardanddownward年龄Age婴儿和儿童心脏常横位，向外上移位theheartsofinfantsandchildrenmoveoutward

Apicalpositionchanges

心尖搏动的位置变化

生理因素Physiologicalfactors心尖搏动位置变化Apicalpositionchanges体位Bodyposition卧位较坐位高；右侧卧位向右移，左侧卧位向左移thesupinepositionishigherthanthesittingposition;therightsupinepositionshiftstotheright,theleftsupinepositionshiftstotheleft呼吸Respiration深呼气时下移，深吸气时上移downwardduringdeepexhalation,theheartmovesupward妊娠Pregnancy心脏常横位，向外上移位theheartmovesupwardduringdeepinhalationApicalpositionchanges

病理因素Pathologicalfactors心尖搏动位置变化Apicalpositionchanges心脏疾病Heartdisease①左心室增大：心尖搏动向左下移位

Leftventricularenlargement:apicaldisplacementtotheleft②右心室增大：心尖搏动向左移位

Rightventricularenlargement:apicaldisplacementtotheleft③全心室增大：心尖搏动向左下移位，心界向两侧扩大

Wholeventricularenlargement:apicaldisplacementtotheleft,cardiacboundarytobothsides④先天性右位心：心尖搏动点在胸骨右侧

Congenitalrightheart:apicalpulsationattherightsideofthesternum心尖搏动的位置变化

Apicalpositionchanges

病理因素Pathologicalfactors心尖搏动位置变化Apicalpositionchanges胸部疾病Chestdisease①一侧胸腔积液或气胸，心尖搏动向健侧移位

onesideofpleuraleffusionorpneumothorax,apicaldisplacementtothehealthyside②一侧肺不张或胸膜粘连，心尖搏动向患侧移位

onesideofatelectasisorpleuraladhesion,apicalmovementtotheaffectedside腹部疾病AbdominalDiseases大量腹腔积液或腹部肿瘤可使心尖搏动上移Abdominaleffusionorabdominaltumorscancausetheapicalpulsationtomoveupward.心尖搏动的位置变化

Apicalpositionchanges

左心室增大右心室增大心尖搏动的位置变化

LeftventricularenlargementrightventricularenlargementApicalpositionchanges

心尖搏动强度变化

增强：生理性：儿童、肋间隙增宽、剧烈运动、情绪激动等病理性：左心室肥厚；甲亢、发热、贫血等Enhancement:

physiology:children,wideningofintercostalspace,strenuousexercise,emotionalagitation

Pathology:leftventricularhypertrophy;hyperthyroidism,fever,anemia

apicalpulsationintensitychanges

心尖搏动强度变化

减弱：生理性：体胖、肋间隙变窄等病理性：急性心肌梗死、扩张型心肌病、心包积液等；

左侧胸腔大量积液、积气，肺气肿等Weakening:

physiology:obesity,narrowingofintercostalspace

Pathology:acutemyocardialinfarction,dilatedcardiomyopathy,pericardialeffusion,etc.Leftpleuraleffusion,gas,emphysema,etc.

apicalpulsationintensitychanges

心尖搏动强度变化

负性心尖搏动：粘连性心包炎、右心室明显肥厚Negativeapicalpulsation:adhesivepericarditis,obviousrightventricularhypertrophy

apicalpulsationintensitychanges

心前区异常搏动

胸骨左缘第3、4肋间：消瘦、右心室持久压力负荷所致右心室肥厚The3rdand4thintercostalsoftheleftmarginofthesternum:emaciation,rightventricularhypertrophycausedbypersistentpressureloadoftherightventricle剑突下：腹主动脉搏动、腹主动脉瘤、右心室肥厚窄Xiphoidprocess:abdominalaorticpulsation,abdominalaorticaneurysm,rightventricularhypertrophy

abnormalprecordialpulsation

心前区异常搏动

胸骨左缘第2肋间：肺动脉高压、肺动脉扩张Thesecondintercostalspaceoftheleftmarginofthesternum:pulmonaryhyperte