心脏体格检查视诊英文版课件

PhysicalExaminationofCardiovascularSystemFORMBBSSTUDENTSMaGuotian,M.D.DepartmentofDiagnosticsTheFirstAffiliatedHospitalofGuangxiMedicalUniversity1可编辑pptPhysicalExaminationFORMBBSGeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.2可编辑pptGeneralConsiderationDuringliPhysicalExaminationofCardiovascularsystem

Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.

3可编辑pptPhysicalExaminationofCardiPhysicalExaminationofCardiovascularsystem

Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.4可编辑pptPhysicalExaminationofCardiReviewtheAnatomy5可编辑pptReviewtheAnatomy5可RoutineandTechniques

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

6可编辑pptRoutineandTechniques

ofPEPartone

Inspection

7可编辑pptPartone7可编辑pptInspection

Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.

8可编辑pptInspectionPrecordiumistheContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium9可编辑pptContentsofInspectionThoracicMethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface

10可编辑pptMethodsofInspectionInspecttThoracicCageDeformity

（inspection）

Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood11可编辑pptThoracicCageDeformity

（inspThoracicCageDeformity

（inspection）suchascongenitalheartdiseaseandrheumaticheartdisease,withskeletalmoldingtoaccommodatecardiacenlargement.12可编辑pptThoracicCageDeformity

（inspApicalImpulse

（inspection）Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.13可编辑pptApicalImpulse

（inspection）ApicalImpulse

（inspection）NormalapicalimpulsePosition:

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

indiameter14可编辑pptApicalImpulse

（inspection）ApicalImpulse

（inspection）ApicalimpulsedisplacementChangesofintensityandareaof

apicalimpulseInwardimpulse15可编辑pptApicalImpulse

（inspection）ApicalImpulse

（inspection）Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture16可编辑pptApicalImpulse

（inspection）ApicalImpulseDisplacement

Extra-heartfactors:

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

17可编辑pptApicalImpulseDisplacementApicalImpulseDisplacement

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

18可编辑pptApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:

Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.19可编辑pptApicalImpulseDisplacementApicalImpulseDisplacement

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

LVtothesickside20可编辑pptApicalImpulseDisplacementNormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside21可编辑pptNormalApicalImpulseDisplacemApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.22可编辑pptApicalImpulseDisplacementCarLeftVentricleEnlargementNormalLVenlargement23可编辑pptLeftVentricleEnlargementNorBothVentriclesEnlargementBothventriclesenlargementNormal24可编辑pptBothVentriclesEnlargementBotApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.25可编辑pptApicalImpulseDisplacementBodApicalImpulse

（inspection）Changesofintensityandareaofapicalimpulse

(1).Physicalconditions(2).Pathologicalconditions26可编辑pptApicalImpulse

（inspection）

PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity

ChangesofIntensityandAreaof

ApicalImpulse27可编辑pptPhysicalconditionsChangesChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:

leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse

:

dilated

myocardiopathy,hydropericardium,leftpleuraleffusion,pulmonaryemphysema28可编辑pptChangesofintensityandareInwardImpulseInwardimpulse.Theapexdepressesfarfromthechestinsteadofstrikingthechestduringsystole.Broadbent’ssignisofvalueinthediagnosisofadherentpericardium.ItisalsoseeninRVH.29可编辑pptInwardImpulseInwardimpulsAbnormalPulsationsinPrecordiumRightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess30可编辑pptAbnormalPulsationsinPrecordAbnormalPulsationsinPrecordiumInascendingorarchaorticaneurysm,onemaydetectsabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.Pulmonaryhypertensionwithdilatationthepulsationinsystolemaybedetectedinleftsecondintercostalspacetotheedgeofsternum.31可编辑pptAbnormalPulsationsinPrecordAbnormalPulsationsinPrecordiumMarkedpulsationatthebaseoftheheartisseeninaorticinsufficiency,inadilatedaortaorasaccularaneurysm.32可编辑pptAbnormalPulsationsinPrecordReference《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33可编辑pptReference《诊断学》第8版，全国规划教材，陈文彬Thankyou！34可编辑pptThankyou！34可编辑ppt此课件下载可自行编辑修改，此课件供参考！部分内容来源于网络，如有侵权请与我联系删除！感谢你的观看！此课件下载可自行编辑修改，此课件供参考！PhysicalExaminationofCardiovascularSystemFORMBBSSTUDENTSMaGuotian,M.D.DepartmentofDiagnosticsTheFirstAffiliatedHospitalofGuangxiMedicalUniversity36可编辑pptPhysicalExaminationFORMBBSGeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.37可编辑pptGeneralConsiderationDuringliPhysicalExaminationofCardiovascularsystem

Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.

38可编辑pptPhysicalExaminationofCardiPhysicalExaminationofCardiovascularsystem

Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.39可编辑pptPhysicalExaminationofCardiReviewtheAnatomy40可编辑pptReviewtheAnatomy5可RoutineandTechniques

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

41可编辑pptRoutineandTechniques

ofPEPartone

Inspection

42可编辑pptPartone7可编辑pptInspection

Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.

43可编辑pptInspectionPrecordiumistheContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium44可编辑pptContentsofInspectionThoracicMethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface

45可编辑pptMethodsofInspectionInspecttThoracicCageDeformity

（inspection）

Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood46可编辑pptThoracicCageDeformity

（inspThoracicCageDeformity

（inspection）suchascongenitalheartdiseaseandrheumaticheartdisease,withskeletalmoldingtoaccommodatecardiacenlargement.47可编辑pptThoracicCageDeformity

（inspApicalImpulse

（inspection）Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.48可编辑pptApicalImpulse

（inspection）ApicalImpulse

（inspection）NormalapicalimpulsePosition:

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

indiameter49可编辑pptApicalImpulse

（inspection）ApicalImpulse

（inspection）ApicalimpulsedisplacementChangesofintensityandareaof

apicalimpulseInwardimpulse50可编辑pptApicalImpulse

（inspection）ApicalImpulse

（inspection）Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture51可编辑pptApicalImpulse

（inspection）ApicalImpulseDisplacement

Extra-heartfactors:

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

52可编辑pptApicalImpulseDisplacementApicalImpulseDisplacement

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

53可编辑pptApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:

Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.54可编辑pptApicalImpulseDisplacementApicalImpulseDisplacement

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

LVtothesickside55可编辑pptApicalImpulseDisplacementNormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside56可编辑pptNormalApicalImpulseDisplacemApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.57可编辑pptApicalImpulseDisplacementCarLeftVentricleEnlargementNormalLVenlargement58可编辑pptLeftVentricleEnlargementNorBothVentriclesEnlargementBothventriclesenlargementNormal59可编辑pptBothVentriclesEnlargementBotApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.60可编辑pptApicalImpulseDisplacementBodApicalImpulse

（inspection）Changesofintensityandareaofapicalimpulse

(1).Physicalconditions(2).Pathologicalconditions61可编辑pptApicalImpulse

（inspection）

PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity

ChangesofIntensityandAreaof

ApicalImpulse62可编辑pptPhysicalconditionsChangesChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:

leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse

:

dilated

myocardiopathy,hydropericardium,left