2022年医学专题-心脏体格检查视诊英文版

PhysicalExaminationofCardiovascularSystemFORMBBSSTUDENTSMaGuotian,M.D.ProfessorofCardiologyDepartmentofDiagnosticsTheFirstAffiliatedHospitalofGuangxiMedicalUniversity1第一页，共三十五页。GeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.2第二页，共三十五页。PhysicalExaminationofCardiovascularsystem

Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.

3第三页，共三十五页。PhysicalExaminationofCardiovascularsystem

Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.4第四页，共三十五页。ReviewtheAnatomy5第五页，共三十五页。RoutineandTechniques

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

6第六页，共三十五页。Partone

Inspection

7第七页，共三十五页。Inspection

Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.

8第八页，共三十五页。ContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium9第九页，共三十五页。MethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface

10第十页，共三十五页。ThoracicCageDeformity

（inspection）

Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood11第十一页，共三十五页。ThoracicCageDeformity

（inspection）suchascongenitalheartdiseaseandrheumaticheartdisease,withskeletalmoldingtoaccommodatecardiacenlargement.12第十二页，共三十五页。ApicalImpulse

（inspection）Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.13第十三页，共三十五页。ApicalImpulse

（inspection）NormalapicalimpulsePosition:

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

indiameter14第十四页，共三十五页。ApicalImpulse

（inspection）ApicalimpulsedisplacementChangesofintensityandareaof

apicalimpulseInwardimpulse15第十五页，共三十五页。ApicalImpulse

（inspection）Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture16第十六页，共三十五页。ApicalImpulseDisplacement

Extra-heartfactors:

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

17第十七页，共三十五页。ApicalImpulseDisplacement

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

18第十八页，共三十五页。ApicalImpulseDisplacement

Extra-heartfactors:

Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.19第十九页，共三十五页。ApicalImpulseDisplacement

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

LVtothesickside20第二十页，共三十五页。NormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside21第二十一页，共三十五页。ApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.22第二十二页，共三十五页。LeftVentricleEnlargementNormalLVenlargement23第二十三页，共三十五页。BothVentriclesEnlargementBothventriclesenlargementNormal24第二十四页，共三十五页。ApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.25第二十五页，共三十五页。ApicalImpulse

（inspection）Changesofintensityandareaofapicalimpulse

(1).Physicalconditions(2).Pathologicalconditions26第二十六页，共三十五页。

PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity

ChangesofIntensityandAreaof

ApicalImpulse27第二十七页，共三十五页。ChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:

leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse

:

dilated

myocardiopathy,hydropericardium,leftpleuraleffusion,pulmonaryemphysema28第二十八页，共三十五页。InwardImpulseInwardimpulse.Theapexdepressesfarfromthechestinsteadofstrikingthechestduringsystole.Broadbent’ssignisofvalueinthediagnosisofadherentpericardium.ItisalsoseeninRVH.29第二十九页，共三十五页。AbnormalPulsationsinPrecordiumRightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess30第三十页，共三十五页。AbnormalPulsationsinPrecordiumInascendingorarchaorticaneurysm,onemaydetectsabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.Pulmonaryhypertens