心脏体格检查视诊英文版课件

PhysicalExaminationofCardiovascularSystemFORMBBSSTUDENTSMaGuotian,M.D.ProfessorofCardiologyDepartmentofDiagnosticsTheFirstAffiliatedHospitalofGuangxiMedicalUniversity第一页，共三十五页。1心脏体格检查视诊英文版GeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.第二页，共三十五页。2心脏体格检查视诊英文版PhysicalExaminationofCardiovascularsystem

Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.

第三页，共三十五页。3心脏体格检查视诊英文版PhysicalExaminationofCardiovascularsystem

Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.第四页，共三十五页。4心脏体格检查视诊英文版ReviewtheAnatomy第五页，共三十五页。5心脏体格检查视诊英文版RoutineandTechniques

ofPEoftheHeartPatient’sexposureandposition(sittingorlyingdown),withenoughlightandappropriatetemperatureFourparts:inspection,palpation,percussion,andauscultation

第六页，共三十五页。6心脏体格检查视诊英文版Partone

Inspection

第七页，共三十五页。7心脏体格检查视诊英文版Inspection

Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.

第八页，共三十五页。8心脏体格检查视诊英文版ContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium第九页，共三十五页。9心脏体格检查视诊英文版MethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface

第十页，共三十五页。10心脏体格检查视诊英文版ThoracicCageDeformity

（inspection）

Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood第十一页，共三十五页。11心脏体格检查视诊英文版ThoracicCageDeformity

（inspection）suchascongenitalheartdiseaseandrheumaticheartdisease,withskeletalmoldingtoaccommodatecardiacenlargement.第十二页，共三十五页。12心脏体格检查视诊英文版ApicalImpulse

（inspection）Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.第十三页，共三十五页。13心脏体格检查视诊英文版ApicalImpulse

（inspection）NormalapicalimpulsePosition:

leftborderofsternum,fifthintercostalspace,insidethemidclavicularline0.5~1.0cmRange: 2~2.5cm

indiameter第十四页，共三十五页。14心脏体格检查视诊英文版ApicalImpulse

（inspection）ApicalimpulsedisplacementChangesofintensityandareaof

apicalimpulseInwardimpulse第十五页，共三十五页。15心脏体格检查视诊英文版ApicalImpulse

（inspection）Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture第十六页，共三十五页。16心脏体格检查视诊英文版ApicalImpulseDisplacement

Extra-heartfactors:

Obesity,pregnancy,etc.causeelevationofdiaphragm,apicalimpulseshiftstooutwardandupward,atleftthe4thintercostalspaceoutsidemidclavicularline.

第十七页，共三十五页。17心脏体格检查视诊英文版ApicalImpulseDisplacement

Extra-heartfactors:Abdominaldisease:abdominaltumor,alargenumberofascites,etc.elevationofdiaphragm,apicalimpulseshiftstooutwardandupward

第十八页，共三十五页。18心脏体格检查视诊英文版ApicalImpulseDisplacement

Extra-heartfactors:

Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.第十九页，共三十五页。19心脏体格检查视诊英文版ApicalImpulseDisplacement

Extra-heartfactors:Singlesidepleuralthickening,oradhesion,oratelectasisresultinmediastinumandheartshiftingtothesickside,andtheapicalimpulseshiftstothesickside,too.aorticarch

LVtothesickside第二十页，共三十五页。20心脏体格检查视诊英文版NormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside第二十一页，共三十五页。21心脏体格检查视诊英文版ApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.第二十二页，共三十五页。22心脏体格检查视诊英文版LeftVentricleEnlargementNormalLVenlargement第二十三页，共三十五页。23心脏体格检查视诊英文版BothVentriclesEnlargementBothventriclesenlargementNormal第二十四页，共三十五页。24心脏体格检查视诊英文版ApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.第二十五页，共三十五页。25心脏体格检查视诊英文版ApicalImpulse

（inspection）Changesofintensityandareaofapicalimpulse

(1).Physicalconditions(2).Pathologicalconditions第二十六页，共三十五页。26心脏体格检查视诊英文版

PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity

ChangesofIntensityandAreaof

ApicalImpulse第二十七页，共三十五页。27心脏体格检查视诊英文版ChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:

leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse

:

dilated

myocardiopathy,hydropericardium,leftpleuraleffusion,pulmonaryemphysema第二十八页，共三十五页。28心脏体格检查视诊英文版InwardImpulseInwardimpulse.Theapexdepressesfarfromthechestinsteadofstrikingthechestduringsystole.Broadbent’ssignisofvalueinthediagnosisofadherentpericardium.ItisalsoseeninRVH.第二十九页，共三十五页。29心脏体格检查视诊英文版AbnormalPulsationsinPrecordiumRightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess第三十页，共三十五页。30心脏体格检查视诊英文版AbnormalPulsationsinPrecordiumInascendingorarchaorticaneurysm,onemaydetectsabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.Pulmonaryhypertensionwithdilatatio