常见心脏病症状和体征.ppt

1、心脏查体复习,视诊 心前区外形 心尖搏动 正常心尖搏动 异常心尖搏动 （移位、弥散、反向） 心前区异常搏动,触诊 心尖搏动 正常 异常（抬举性，移位） 心前区搏动 震颤与临床意义 心包摩擦感,心脏查体复习,叩诊 手法 顺序 正常心浊音界 心浊音界改变 及对应的临床意义,听诊 5个听诊区位置 听诊顺序 6个听诊内容,心脏听诊复习,正常心率范围 心律不齐类型 心音 构成,心动周期划分,强度变化,心音分裂及其临床意义 额外心音及其临床意义 舒张期:奔马律,开瓣音,心包扣击音,肿瘤扑落音 收缩期:A&P喷射音,喀喇音 杂音及其临床意义 5要素概念 5听诊区两期中杂音的临床意义,常见心脏病症状体征,Mi

2、tral stenosis Mitral regurgitation Aortic stenosis Aortic regurgitation Pericardial effusion Heart failure,收缩期心脏瓣膜,舒张期心脏瓣膜,二尖瓣狭窄,History Dyspnea accompany with cough&wheezing Hemoptysis Systemic embolism,PE Mitral facies Apex: Trill of MS Larged RV S1 , P2A2, spilt S2, OS, lowpitched rumbling DM of

3、MS，Graham Steell,二尖瓣关闭不全,History No symptoms for years When LV failure dyspnea weakness，fatigue,PE Apex pulse move to left Apex: Lifting pulse & Trill of MS Left Border : to Left and lower S1 , high-pitched blowing SM, radiation to axilla,主动脉瓣狭窄,History Angina(5y) Syncope(3y) Heart failure(2y) Sudde

4、n death,PE (-) / Apex pulse move to left Apex: Lifting pulse A2 area: Trill of MS Left Border : to Left and lower A2 , P2A2, reverse spilt S2 A1 area: SM,主动脉瓣关闭不全,History Dizziness Palpitation Heart failure,PE carotis A. pulse Apex: left and lower/ lifting pulse Water hammer pulse Left Border: to le

5、ft and lower A2 area: decrescendo DM Austin Flint, Pistol shot sound,心包积液,History 症状取决于积液的速度和量 Cough or dyspnea Dysphagia Pain in chest week and fever,PE Apex pulse: Apex pulse: Double Border: enlarged Ewart sign Little effusion: Pericardial friction sound. Large effusion: HR S1 S2, Pericardial knoc

6、k,左心衰竭,History Exertional dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cough Weak,PE Cyanosis, polypnea, sweat Pulse alternans Double Border: enlarged Pulmonary rales, P2 Gallop rhythm,右心衰竭,History Anorectic, Vomitus Abdominal distension Uropenia,PE Edema Hepatojugular reflux Congestive hepatomegaly RV enlarged Hydrothorax, Ascites