上海交通大学医学院仁济临床医学院

1、上海交通大学医学院仁济临床医学院理论课教案第2次课 教学方式Lecture 学时3 专业diagnostics 班级 04级英文班2007年4月30日题目Examination of the heart本课目的要求1.Master the basic maneuver of inspection, palpation and percussion of heart.2.Master the normal manifestation of heart examination.3.Master the clinic significance of abnormal changes of heart

2、 examination.本课的重点、难点1.Location and range of normal apical impulse.2.Mechanism and clinic significance of thrills as well as the difference between thrills and murmus.3.Accurate maneuver and sequence of percussion, normal dullness of the heart and the clinic significance of abnormal changes.本课使用教材及参

3、考书“Diagnostics” (英文版) 上海第二医科大学诊断学教研室“诊断学” 第四版 人民卫生出版社本次课应用教具及电化器材多媒体教学程序、时间分配及主要内容备注Total time for course: 2hoursInspection1. Observe precordium2. Apical impulseIn adults the apical impulse normally is located in the left fifth intercostal space, either at or medial to the mvl and about 2-2.5 cm dia

4、meter, it serves the examiner as a marker for the onset of cardiac contraction.Displacement of the apical impulse:a) Heart disease:b) Abdominal disease: c) Thoracic disease:d) The apical impulse may have increased amplitued and duration in those persons with a thin chest, anemia, fever, hyperthyroid

5、ism and anxiety.Abnormal pulsations in the other areas.a) Right vertricular hypertophy (RBH).b) Pulmonary emphysema with RVH: inferior the xiphoid process.c) Asending or arch aortic aneurysm: in aortic area, with bulging or pulsation in systole.d) Pulmonary hypertension: in left second intercostal s

6、pace to the edge of sternum.palpation1) Usage of the palpation confirms the precordial pulsations location.2) Thrills are actually palpable fine vibrations, most commonly produced by blood from one chamber of the heart to another through a restricted or narrowed orifice.3) Pericardial friction rub i

7、s a to-and-fro grating sensation.Percussion 1) Main point: Usually we employ indirect percussion. It is outlined by percussing in the 5th, 4th, 3rd and 2nd interspace on the left sequentially, starting near the axilla and moving medially until cardiac dullness is encountered.2) The heart borders(1).

8、 The base of the heart:(2). The right border of the heart:(3). The left border of heart:(4). The inferior border:3) Normal relative dullness of the heartRightIntercostal spaceLeft (cm)2-3II2-33-4IV5-6 (cm)V7-9In normal person the distance from the 5th to the midsternal line is about 7-9 cm.4) Changi

9、ng cardiac dullnessHeart diseaseLeft ventricular enlargement, the cardiac dullness will be extended to the left and downward.Right ventrucular enlargement, the cardiac dullness will extended to left and upward.Both the left artrium and pulmonary artery enlarged. It is frequentlyseen in mitral valve

10、stenosis.The base border of heart enlargement: Aortic dilation, aneurysm of aorta, pericardial effusionHeart silhouette extending both to right and left: Congestive heart failure, myocarditis, myocardiopathy and pericardial effusion.小结要点及复习思考题InspectionObserve precordiumApical impulse1.Normal locati

11、on and range: in the left fifth intercostal space, either at or medial to the mvl and about 2-2.5 cm diameter.2.Displacement of the apical impulse3.Abnormal pulsations in the other areasPalpation1.Usage: confirms the precordial pulsations location 2.Thrills; palpable fine vibrations produced by bloo

12、d from one chamber of the heart to another through a restricted or narrowed orifice.3.Pericardial friction rub Percussion1.Main point: It is outlined by percussing in the 5th, 4th, 3rd and 2nd interspace on the left sequentially, starting near the axilla and moving medially until cardiac dullness is encountered. 2.The heart borders: base, right border, left border and inferior