心脏检查专题知识讲座

课堂目标

learningoblectives说出正常心尖搏动位置和范围Tostatetherangeandsiteofapicalimpulse阐述震颤概念、产生机制及临床意义Toelaboratetheconcept,mechanismandclinicalsignificanceofthrill描述正常心脏相对浊音界范围Todescribetheborderofrelativedullness说出心脏瓣膜听诊区概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas比较S1.S2心音产生机制、特点与临床意义TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陈说杂音概念与分级Tostatetheconceptandgradeofheartmurmurs心脏检查专题知识讲座第1页概述

introduction

利用视、触、叩、听等检验方法初步判定有没有心脏疾病，判断心脏病病因、性质、部位及程度.在临床上含有主要意义。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.心脏检查专题知识讲座第2页检验注意事项

mattersneedingattentionintheexamination

普通采取仰卧位或坐位;dorsalpositionorsittingpositionisoftenused;环境应平静;光线充分，最好是起源于左侧，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室温不低于20℃;Temperatureshouldbehigherthan20℃心脏检查专题知识讲座第3页心脏视诊

lnspectionoftheheart

(一)心前区隆起与凹陷eminenceorintrocessioninprecordialregion

(二)心尖搏动apicalimpulse(三)心前区异常搏动Abnormalprecordialpulsation

心脏检查专题知识讲座第4页心脏触诊

Palpationoftheheart检验者惯用右手,以全手掌、手掌尺侧(小鱼际)或示指、中指和无名指并拢以指腹触诊。Thewholepalm,antithenareminenceorfingertips

ofRighthandisoftenusedwhenPalpation.检验震颤惯用手掌尺侧,检验心尖搏动惯用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpation心脏检查专题知识讲座第5页Palpationoftheheart(一)心尖搏动apicalimpulse(二)震颤:概念;产生机制Thrill:concept;mechanism(三)心包摩擦感:概念;产生机制;特点senseofpericardialfriction:concept;mechanism;character心脏检查专题知识讲座第6页心脏叩诊

Percussionoftheheart

心脏叩诊用以确定心界,判定心脏大小、形状及在胸腔位置一个方法。Percussionoftheheartisusedtofindtheborderoftheheart;相对浊音界反应心脏实际大小,含有主要临床意义.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.心脏检查专题知识讲座第7页(二)正常心脏相对浊音界

thenormalborderofrelativedullness

Rightborder（cm)Rightborder（cm)Rightborder（cm)Rightborder（cm)Rightborder（cm)Rightborder（cm)心脏检查专题知识讲座第8页听诊

auscultation

用膜型胸件听诊Auscultatewithdiaphragm

•肺动脉瓣区（胸骨左缘第2肋间隙）

•主动脉瓣区（胸骨右缘第2肋间隙）

•主动脉瓣第二听诊区（胸骨左缘第3、4肋间隙）

•二尖瓣区（心尖部）

•三尖瓣区（胸骨左缘第4.5肋间隙或胸骨体下端稍偏右）

•Pulmonaryarea(secondleftICS)

•Aorticarea(secondrightICS)

•Secondaorticarea(thirdandfourthleftICS)

•Mitralarea(Apicalarea)

•Tricuspidarea(fourth,fifthleftICS,LSBandRSB)

心脏检查专题知识讲座第9页听诊

auscultation用钟型胸件听诊Auscultatewithbell

•肺动脉瓣区

•主动脉瓣区

•主动脉瓣第二听诊区

•二尖瓣区

•三尖瓣区

•Pulmonaryarea

•Aorticarea

•Secondaorticarea

•Mitralarea(Apicalarea)

•Tricuspidarea

心脏检查专题知识讲座第10页心脏瓣膜听诊区

auscultatorycardiacvalveareas

与各瓣膜解剖位置并不完全一致。cardiacvalvesarenotexactlylocatedintheauscultatorycardiacvalveareas.心脏瓣膜听诊区为四个瓣膜五个区。Wehavefourvalvesbutfiveauscultatorycardiacvalveareas

心脏检查专题知识讲座第11页心脏瓣膜听诊区

auscultatorycardiacvalveareas

心脏检查专题知识讲座第12页心音

cardiacsounds

心音有四个,第一心音(S1),第二心音(S2),第三心音(S3)和第四心音(S4)。Fourkindsofcardiacsounds:S1,S2,S3,S4通常只能听到S1和S2,在一些健康儿童和青少年也可听到S3。S4般听不到,如能听到可能为病理性。S1andS2canbeheardinallpeople,S3canbeheardinsomehealthychildrenandteenager,butS4isoftenhaspathologicalsignificance.心脏检查专题知识讲座第13页S1ands2S1比S2响亮;S1islouderthanS2;S1与S2产生机制ThemechanismofS1andS2;心脏检查专题知识讲座第14页心脏杂音

cardiacmurmurs产生机制;mechanism特点Character分级:6级Grade:Ⅰ~Ⅵ心脏