心脏体格检查视诊英文版.ppt

心脏体格检查视诊英文版.ppt

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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,Markedpulsationatthebaseoftheheartisseeninaorticinsufficiency,inadilatedaortaorasaccularaneurysm.,33,Reference,诊断学第8版，全国规划教材，陈文彬主编，人民卫生出版社，2013年诊断学医学英文原版改编双语教材，吕卓人主编，科学出版社，2006年HistoryandExamination,JamesMarsh,ChiefEditor,科学出版社，2007年,34,Thankyou！