心内复习汇总VIP

心内复习汇总2024/1/42IntroductionPalpationofthepulseMeasurmentofarterialbloodpressureAuscultationofbloodvessels2024/1/43PalpationofThePulseRadialarteryisusuallyselectedPatient’shandplacedwiththepalmupwardPhysician’sfirstthreefingersontheradialarteryIndexfingernearesttheheart2024/1/44CharacteristicsofThePulse

RateIntensityTypeofwaveRhythmTension2024/1/45RATE

-Pulsefrequency(rapidorslow)Varieswithage,sex,physicalactivity,emotionalstatusNormalrange:60-100bpminadults;90-120bpminchildren2024/1/46Rateincrease(tachycardia心动过速):severeanemia,highfever,massivehemorrhage(大出血),varioustypesofcardiacarrhythmias,hyperthyroidism,andattimesincongestiveheartfailure.2024/1/47Ratedecrease(bradycardia心动过缓):increasedintracranialpressure(颅高压),SSS,aboveⅡAVB,hypothyroid(甲减),Digoxin(地高辛),etc2024/1/48RhythmThemorecommondisturbancesofrhythmcanandshouldbedetectedbypalpatingthepulse.Auscultationoftheheartisamoreaccuratemethodfordeterminingtherhythm.SomeofthemorecomplexarrhythmiascanbediagnosedonlybyEKG.2024/1/49Commonirregularpulse:Sinusarrhythmia(窦不齐)Prematurebeat(早搏)Atrialfibrillation(房颤)Bigeminalpulse(二联律)Trigeminalpulse(三联律)Paroxysmalatrial,ventriculartachycardiaHeartblock(传导阻滞)2024/1/410TensionThetensionofpulsedependsonthelevelofthearterialsystolicpressure.2024/1/411IntensityTheintensitydependsonthecardiacoutput,pulsepressureandtheresistanceofperipheralvessels.2024/1/412Pulsusmagnus(boundingpulse洪脉):increasedcardiacoutput,highpulsepressure,lowresistance.aorticinsufficiency,highfever,hyperthyroid2024/1/413Smallpulse(threadypulse细脉):decreasedcardiacoutput,lowpulsepressure,highresistance.aorticstenosis,heartfailure,shock.2024/1/414WaveformThearterialpulsestartsattheinstantaorticvalveopens,resultsinanabruptsharpriseinaorticpressure.Duringsystolealargepartofbloodistemporarilystoredintheproximalaorta.Oncetheaorticpressurereachesapeakitbeginstofall,andbloodcontinuesitsflowintheperipheralarteriesinlatersystoleanddiastole.2024/1/415Normalpulsewave:AscendinglimbPeakDescendinglimbsmallnotch(onthedescendinglimb)Smallnotch(ontheascendinglimb)2024/1/4162024/1/417Theupstrokeispromptandsmooth,buttheanacroticnotchisnotpalpableinmostnormalpersons.Thepeakisroundedandsmooth.Thedescendinglimbismoregradualandlesssteep.Thedicroticnotchinmostnormalpersonscannotbepalpatedbutcanbesensedasachangeintheslopeofthedownstroke.2024/1/418TypeofWaveAbnormalpulsewaveWaterhammerpulse(水冲脉)Pulsustardus(迟脉)Dicroticpulse(重搏脉)Pulsusalternans(交替脉)Paradoxicalpulse(奇脉)Asphygmia(无脉)2024/1/419Waterhammerpulse（水冲脉）Astrongboundingpulsewithatallrapidascendinglimbandanequallyrapiddescendinglimb.Itisalsocalledcollapsingpulse.Duetoincreasingpulsepressure,itisCommonlyfoundinAI,PDA,hyperthyroidandsevereanemia.2024/1/4202024/1/421PulsusTardus（迟脉）AsmallweakpulsewithadelayedsystolicpeakItoccursinthepresenceofnarrowpulsepressure,increasedperipheralvascularresistance,lowSVCommoninaorticstenosis,mitralstenosis,LVheartfailureafterAMI.2024/1/4222024/1/423DicroticPulse（重搏脉）Therearetwoimpulsesthatarepalpableduringsystoleanddiastolerespectively.Itusuallyoccursinthepresenceofhighfeverandtyphoid(伤寒).2024/1/4242024/1/425PulsusAlternans（交替脉）Itischaracterizedbyaregularlyalternatingpulse,inwhicheverybeatisweakerthantheprecedingbeat.Itiseasytobedetectedwhenthepatientissittingorstanding.Itisavaluableindicationofleftventricularfailure.Severearterialhypertension.2024/1/4262024/1/427Paradoxicalpulse （奇脉）Adecreaseintheamplitudeoranactualimperceptibilityofthepulseduringinspiration.Commonlyfoundinmassivepericardialeffusion,constrictivepericarditis,andseverepulmonaryemphysema.2024/1/428Asphygmia（无脉）SevereshockPrimaryarteritisoftheaortaanditsmainbranches(pulseless)2024/1/429ConsistencyofArterialWallNormallythewallofradialarteryissoftandpliableInarteriosclerosis(动脉硬化),moreresistancetocompressionbythepalpatingfinger,andthevesselmayberolledeasilybetweentheexamingdigits.2024/1/430MeasurementofArterial

BloodPressureMethodsformeasuringthebloodpressure:DirectmethodIndirectmethod2024/1/431DefinitionsandClassificationofBloodPressureLevelsCategorysystolic(mmHg)diastolic(mmHg)Normal＜120＜80High-normal120-13980-89Hypertension≥140≥90Isolatedsystolic≥140＜90hypertension2024/1/432AbnormalBloodPressureHypertensionHypotensionSignificantdifferenceintwoupperextremitiesSignificantdifferenceinupperandlowerextremitiesAbnormalityinpulsepressure2024/1/433HypertensionEssentialhypertensionSymptomatichypertensionRenalcauses,endocrinecauses,etc2024/1/434LowBloodPressure

Systolicpressure＜90mmHgdiastolicpressure＜60mmHgDecreaseincardiacoutput:acutemyocardialinfarction,pericarditiswitheffusion,heartfailure,followinghemorrhageDecreaseinperipheralresistance:septicemia(败血症),Addison’sdisease,drugintoxications2024/1/435SignificantDifferenceintheUpperExtremitiesLittleornosignificantdifferenceDifferenceofpressureabove10mmHgPrimaryarteritis(动脉炎)oftheaortaanditsmainbranches,obstructionoftheinnominateartery(无名动脉),aorticaneurysm2024/1/436SignificantDifferenceintheUpperandLowerExtremitiesOrdinarilythesystolicpressureisslightlyhigherinthelowerextremitiesthanintheupper(20~40mmHg)Mostcommonincoarctationoftheaorta(congenitalnarrowing)2024/1/437AbnormalityinPulsePressureThepulsepressureisthedifferencebetweenthesystolicanddiastolicpressuresandnormallyamountsto30or40mmHg.Pulsepressureincreased:＞40mmHgatherosclerosisoftheaorta(大动脉硬化),hyperthyroidism,aorticregurgitation(返流),arteriovenousfistula(动静脉瘘),severeanemia,PDA2024/1/438Pulsepressuredecreased:＜30mmHgAorticstenosis,hypotension,heartfailureandmassivepericardialeffusion2024/1/439Auscultationofvein

Venoushumoverthejugularvein(颈静脉):asoftlow-pitchedcontinuousmurmur,decreaseordisappearinsupineposition,especiallyincasesofmarkedanemiaLoudmurmurheardoverdilatedveininlivercirrhosis(肝硬化)2024/1/440AuscultationofArteriesNormalarterysoundPistol–shotsoundDurozier’ssoundPathologicalsound:includingsystolicandcontinuousmurmer2024/1/441Pistol-shotSoundInaorticinsufficiency,aloudfirstsound(pistol-shotsound)maybeheardoverthefemoralarteries(股动脉)withoutexertingpressure2024/1/442Durozier’sSignOnpressingt