心脏评估心脏检查视触叩CARDIOVASCUIAR

心脏检查

CARDIOVASCUIAREXAMINATION课堂目的

learningoblectives说出正常心尖搏动的位置和范围Tostatetherangeandsiteofapicalimpulse论述震颤的概念、产活力制及临床意义Toelaboratetheconcept,mechanismandclinicalsignificanceofthrill描画正常心脏相对浊音界的范围Todescribetheborderofrelativedullness说出心脏瓣膜听诊区的概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas比较S1、S2心音的产活力制、特点与临床意义TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陈说杂音的概念与分级Tostatetheconceptandgradeofheartmurmurs概述

introduction运用视、触、叩、听等检查方法初步断定有无心脏疾病，判别心脏病的病因、性质、部位及程度．在临床上具有重要的意义。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.检查的本卷须知

mattersneedingattentionintheexamination普通采取仰卧位或坐位；dorsalpositionorsittingpositionisoftenused;环境应安静；光线充足，最好是来源于左侧，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室温不低于20℃；Temperatureshouldbehigherthan20℃心脏视诊

lnspectionoftheheart(一)心前区隆起与凹陷eminenceorintrocessioninprecordialregion(二)心尖搏动apicalimpulse(三)心前区异常搏动Abnormalprecordialpulsation心脏触诊

Palpationoftheheart检查者常用右手，以全手掌、手掌尺侧(小鱼际)或示指、中指和无名指并拢以指腹触诊。Thewholepalm,antithenareminenceorfingertips

ofRighthandisoftenusedwhenPalpation.检查震颤常用手掌尺侧，检查心尖搏动常用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpationPalpationoftheheart(一)心尖搏动apicalimpulse(二)震颤:概念;产活力制Thrill:concept;mechanism(三)心包摩擦感:概念;产活力制;特点senseofpericardialfriction:concept;mechanism;character心脏叩诊

Percussionoftheheart心脏叩诊用以确定心界，断定心脏大小、外形及在胸腔位置的一种方法。Percussionoftheheartisusedtofindtheborderoftheheart;相对浊音界反映心脏的实践大小,具有重要的临床意义.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.(二)正常心脏相对浊音界

thenormalborderofrelativedullnessRightborder（cm）intercostalspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9听诊

auscultation用膜型胸件听诊Auscultatewithdiaphragm

•肺动脉瓣区〔胸骨左缘第2肋间隙〕

•自动脉瓣区〔胸骨右缘第2肋间隙〕

•自动脉瓣第二听诊区〔胸骨左缘第3、4肋间隙〕

•二尖瓣区〔心尖部〕

•三尖瓣区〔胸骨左缘第4、5肋间隙或胸骨体下端稍偏右〕

•Pulmonaryarea(secondleftICS)

•Aorticarea(secondrightICS)

•Secondaorticarea(thirdandfourthleftICS)

•Mitralarea(Apicalarea)

•Tricuspidarea(fourth,fifthleftICS,LSBandRSB)

听诊

auscultation用钟型胸件听诊Auscultatewithbell

•肺动脉瓣区

•自动脉瓣区

•自动脉瓣第二听诊区

•二尖瓣区

•三尖瓣区

•Pulmonaryarea

•Aorticarea

•Secondaorticarea

•Mitralarea(Apicalarea)

•Tricuspidarea

心脏瓣膜听诊区

auscultatorycardiacvalveareas与各瓣膜的解剖位置并不完全一致。cardiacvalvesarenotexactlylocatedintheauscultatorycardiacvalveareas.心脏瓣膜听诊区为四个瓣膜五个区。Wehavefourvalvesbutfiveauscultatorycardiacvalveareas心脏瓣膜听诊区

auscultatorycardiacvalveareas心音

cardiacsounds心音有四个，第一心音(S1)，第二心音(S2),第三心音(S3)和第四心音(S4)。Fourkindsofcardiacsounds:S1,S2,S3,S4通常只能听到S1和S2，在某些安康儿童和青少年也可听到S3。S4般听不到，如能听到能够为病理性。S1andS2canbeheardinallpeople,S3canbeheardinsomehealthychildrenandteenager,butS4isoftenhaspathologicalsignificance.S1ands2S1比S2响亮;S1islouderthanS2;S1与S2的产活力制ThemechanismofS1andS2;心脏杂音

cardiacmurmurs产活力制;mechanism特点Character分级:6级Gr