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心脏体格检查视诊英文版心脏体格检查视诊英文版GeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.2GeneralConsiderationDuringliPhysicalExaminationofCardiovascularsystem
Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.
3PhysicalExaminationofCardiPhysicalExaminationofCardiovascularsystem
Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.4PhysicalExaminationofCardiReviewtheAnatomy5ReviewtheAnatomy5RoutineandTechniques
ofPEoftheHeartPatient’sexposureandposition(sittingorlyingdown),withenoughlightandappropriatetemperatureFourparts:inspection,palpation,percussion,andauscultation
6RoutineandTechniques
ofPEPartone
Inspection
7Partone7Inspection
Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.
8InspectionPrecordiumistheContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium9ContentsofInspectionThoracicMethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface
10MethodsofInspectionInspecttThoracicCageDeformity
(inspection)
Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood11ThoracicCageDeformity
(insp心脏体格检查视诊英文版讲义课件ApicalImpulse
(inspection)Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.13ApicalImpulse
(inspection)ApicalImpulse
(inspection)NormalapicalimpulsePosition:
leftborderofsternum,fifthintercostalspace,insidethemidclavicularline0.5~1.0cmRange: 2~2.5cm
indiameter14ApicalImpulse
(inspection)ApicalImpulse
(inspection)ApicalimpulsedisplacementChangesofintensityandareaof
apicalimpulseInwardimpulse15ApicalImpulse
(inspection)ApicalImpulse
(inspection)Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture16ApicalImpulse
(inspection)ApicalImpulseDisplacement
Extra-heartfactors:
Obesity,pregnancy,etc.causeelevationofdiaphragm,apicalimpulseshiftstooutwardandupward,atleftthe4thintercostalspaceoutsidemidclavicularline.
17ApicalImpulseDisplacementApicalImpulseDisplacement
Extra-heartfactors:Abdominaldisease:abdominaltumor,alargenumberofascites,etc.elevationofdiaphragm,apicalimpulseshiftstooutwardandupward
18ApicalImpulseDisplacementApicalImpulseDisplacement
Extra-heartfactors:
Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.19ApicalImpulseDisplacementApicalImpulseDisplacement
Extra-heartfactors:Singlesidepleuralthickening,oradhesion,oratelectasisresultinmediastinumandheartshiftingtothesickside,andtheapicalimpulseshiftstothesickside,too.aorticarch
LVtothesickside20ApicalImpulseDisplacementNormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside21NormalApicalImpulseDisplacemApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.22ApicalImpulseDisplacementCarLeftVentricleEnlargementNormalLVenlargement23LeftVentricleEnlargementNorBothVentriclesEnlargementBothventriclesenlargementNormal24BothVentriclesEnlargementBotApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.25ApicalImpulseDisplacementBodApicalImpulse
(inspection)Changesofintensityandareaofapicalimpulse
(1).Physicalconditions(2).Pathologicalconditions26ApicalImpulse
(inspection)
PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity
ChangesofIntensityandAreaof
ApicalImpulse27PhysicalconditionsChangesChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:
leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse
:
dilated
myocardiopathy,hydropericardium,leftpleuraleffusion,pulmonaryemphysema28ChangesofintensityandareInwardImpulseInwardimpulse.Theapexdepressesfarfromthechestinsteadofstrikingthechestduringsystole.Broadbent’ssignisofvalueinthediagnosisofadherentpericardium.ItisalsoseeninRVH.29InwardImpulseInwardimpulsAbnormalPulsationsinPrecordiumRightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess30AbnormalPulsationsinPrecordAbnormalPulsationsinPrecordiumInascendingorarchaorticaneurysm,onemaydetectsabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.Pulmonaryhypertensionwithdilatationthepulsationinsystolemaybedetectedinleftsecondintercostalspacetotheedgeofsternum.31AbnormalPulsationsinPrecordAbnormalPulsationsinPrecordiumMarkedpulsationatthebaseoftheheartisseeninaorticinsufficiency,inadilatedaortaorasaccularaneurysm.32AbnormalPulsationsinPrecordReference《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33Reference《诊断学》第8版,全国规划教材,陈文彬Thankyou!34Thankyou!34心脏体格检查视诊英文版心脏体格检查视诊英文版GeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.36GeneralConsiderationDuringliPhysicalExaminationofCardiovascularsystem
Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.
37PhysicalExaminationofCardiPhysicalExaminationofCardiovascularsystem
Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.38PhysicalExaminationofCardiReviewtheAnatomy39ReviewtheAnatomy5RoutineandTechniques
ofPEoftheHeartPatient’sexposureandposition(sittingorlyingdown),withenoughlightandappropriatetemperatureFourparts:inspection,palpation,percussion,andauscultation
40RoutineandTechniques
ofPEPartone
Inspection
41Partone7Inspection
Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.
42InspectionPrecordiumistheContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium43ContentsofInspectionThoracicMethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface
44MethodsofInspectionInspecttThoracicCageDeformity
(inspection)
Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood45ThoracicCageDeformity
(insp心脏体格检查视诊英文版讲义课件ApicalImpulse
(inspection)Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.47ApicalImpulse
(inspection)ApicalImpulse
(inspection)NormalapicalimpulsePosition:
leftborderofsternum,fifthintercostalspace,insidethemidclavicularline0.5~1.0cmRange: 2~2.5cm
indiameter48ApicalImpulse
(inspection)ApicalImpulse
(inspection)ApicalimpulsedisplacementChangesofintensityandareaof
apicalimpulseInwardimpulse49ApicalImpulse
(inspection)ApicalImpulse
(inspection)Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture50ApicalImpulse
(inspection)ApicalImpulseDisplacement
Extra-heartfactors:
Obesity,pregnancy,etc.causeelevationofdiaphragm,apicalimpulseshiftstooutwardandupward,atleftthe4thintercostalspaceoutsidemidclavicularline.
51ApicalImpulseDisplacementApicalImpulseDisplacement
Extra-heartfactors:Abdominaldisease:abdominaltumor,alargenumberofascites,etc.elevationofdiaphragm,apicalimpulseshiftstooutwardandupward
52ApicalImpulseDisplacementApicalImpulseDisplacement
Extra-heartfactors:
Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.53ApicalImpulseDisplacementApicalImpulseDisplacement
Extra-heartfactors:Singlesidepleuralthickening,oradhesion,oratelectasisresultinmediastinumandheartshiftingtothesickside,andtheapicalimpulseshiftstothesickside,too.aorticarch
LVtothesickside54ApicalImpulseDisplacementNormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside55NormalApicalImpulseDisplacemApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.56ApicalImpulseDisplacementCarLeftVentricleEnlargementNormalLVenlargement57LeftVentricleEnlargementNorBothVentriclesEnlargementBothventriclesenlargementNormal58BothVentriclesEnlargementBotApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.59ApicalImpulseDisplacementBodApicalImpulse
(inspection)Changesofintensityandareaofapicalimpulse
(1).Physicalconditions(2).Pathologicalconditions60ApicalImpulse
(inspection)
PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity
ChangesofIntensityandAreaof
ApicalImpulse61PhysicalconditionsChangesChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:
leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse
:
dilated
myocardiopathy,hydropericardium,leftpleurale
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