心脏检查-课件

ExaminationoftheHeart1PPT课件Examination1PPT课件1ExaminationoftheHeart

Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,thereisagrowingconceptionamongpracticingphysiciansincardiovascularmedicinethatbedsidephysicalexaminationisunnecessaryanddoesnotprovideusefulinformation.

2PPT课件ExaminationoftheHeartIn2精品资料精品资料3你怎么称呼老师？如果老师最后没有总结一节课的重点的难点，你是否会认为老师的教学方法需要改进？你所经历的课堂，是讲座式还是讨论式？教师的教鞭“不怕太阳晒，也不怕那风雨狂，只怕先生骂我笨，没有学问无颜见爹娘……”“太阳当空照，花儿对我笑，小鸟说早早早……”心脏检查---ppt课件4

Itshouldbeemphasized,however,thatforproperapplicationandinterpretationofvariousnewandoldteststhatareavailableforcardiovascularevaluationinagivenpatient.

5PPT课件Itshouldbeemphasized,ho5

Bedsideclinicalexaminationshouldbeperformedandpracticedinthesamewayfollowingsimilarsequences.

6PPT课件Bedsideclinicalexamin6PreparingthepatientTheheartexaminationshouldbemadeaseasyaspossibleforthepatient,whousuallyexpectsittobearelativelydistastefulexperience.Ifthephysicianisconsiderateandgentle,thepatientshouldfeelwhenitisallover,thatmostofhisorherfearsonthatscorewereunfounded.

7PPT课件PreparingthepatientTheh7Theidealexaminingroomisprivate,warmenoughtoavoidchilling,andfreefromdistractingnoiseandsourcesofinterruption.Adequate(preferablyfluorescentornatural)lightisessential.

8PPT课件Theidealexaminingroom8

Theexaminingtablemaybeplacedwithitsheadagainstthewall,butbothsides(particularlytheright)andthefootshouldbeaccessibletotheexaminer.Andtheresultsshouldberecordedcarefully.

9PPT课件Theexaminingtablemaybe9ExaminationoftheHeart

Landmarksandtopographicanatomy

Certainbasiclandmarks

midsternallinemidclavicularlines

10PPT课件ExaminationoftheHeartLand10Certainbasiclandmarksanterior,middle,andposterioraxillarylinessuprasternalnotchidentificationofvariousribsandintercostalspace11PPT课件Certainbasiclandmarksanteri11SpecificareasforcardiacPE

sternoclavicularareaaorticareapulmonaryarea

12PPT课件SpecificareasforcardiacPE

12SpecificareasforcardiacPE

anteriorprecordiumapicalareaepigastricareaectopicarea13PPT课件SpecificareasforcardiacPE13InspectionInspectionoftheprecordiumshouldbeginatthefootofthebed.Thesubjectshouldbesupinewiththeleghorizontalandtheheadandtrunkelevatedtoapproximately15-30degrees.14PPT课件InspectionInspection14Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood,suchascongenitalheartdiseaseandrheumaticheartdisease,withskeletalmoldingtoaccommodatecardiacenlargement.

15PPT课件Asymmetryofthethoraci15Intheadult,precordialbulgemaybeproducedfromthemassivepericardialeffusion.16PPT课件16PPT课件16Precordialbulge

congenitalheartdisease(beforepuberty)pericardicaleffusion(adultlife)

17PPT课件Precordialbulge17PPT课件17Pulsationapicalimpulse

Theapicalimpulseisoccurringearlyinsystole.Theapeximpulseisnormallylocatedatormedialtothemidclavicularlineinthefourthorfifthintercostalspacewhenthepatientissupine.18PPT课件Pulsationapicalimpulse18PPT课件18Usuallyitisdetectableinonlyoneintercostalspaceandislessthan2-2.5cmindiameter.Thenormalapeximpulseischaracterizedbyabriefearlysystolicoutwardthrustofmoderateamplitude,whichendswellbeforethesecondheartsound.19PPT课件Usuallyitisdetectablein19Theapeximpulseisnormallyexaggeratedinthin,youngindividualsandwhenthesubjectisintheleftlateraldecubitusposition.20PPT课件Theapeximpulseisno20Diastolicmovementsarenotperceptibleinmostcases,butinchildrenandyoungadultsanearlydiastolicFwaveisoccasionallypresent.21PPT课件Diastolicmovementsare21Normallyapicalimpulse:

It’slocationdurationintensityamplitude22PPT课件Normallyapicalimpulse:22P22DisplacementoftheapicalimpulseHeartdisease

Someheartdiseasescausetheleftventricularhypertrophydilatationorboth,theapicalimpulseisdisplacedlaterallyandinferiorlyandsustained,23PPT课件Displacementoftheapicalimp23

anditmaybeshiftedtotheleftandupwardinrightventricularhypertrophy,dilatationorboth.Itcanbefoundattherightfifthintercostalspaceindextrocardiaandcannotbefoundinmassivepericardialeffusion.

24PPT课件anditmaybeshiftedtoth24Thoracicdisease:

Pneumothoraxandpleuraleffusionwilldisplacetheapicalimpulsetothenormalside.Pleural-adhesionandatelectasiswillresultinadisplacementofimpulsetowardthediseasedside.

25PPT课件Thoracicdisease:25PPT课件25

Abdominaldisease:

Theapicalimpulsealsocanbedisplacedbylargemass,massiveascites.26PPT课件Abdominaldisease:26PPT课件26

Theapicalimpulsemayhaveincreasedamplitudeanddurationinthosepersonswithathinchest,anemia,fever,hyperthyroidismandanxiety.

27PPT课件Theapicalimpulsemay27

Theexaminershouldalwaysobservetheshapeandcontourofpatient’schest.Depressionsofthesternum,Kyphosisofdorsalspine,scoliosisoftenaltertheshapeandpositionoftheapicalimpulse.28PPT课件Theexaminershouldalw28Abnormalpulsationsintheotherareas:

Rightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess.29PPT课件Abnormalpulsationsintheoth29Inascendingorarchaorticaneurysm,onemaydetectabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.Pulmonaryhypertensionwithdilatationthepulsationinsystolemaybedetectedinleftsecondintercostalspacetotheedgeofsternum.30PPT课件Inascendingorarchaortican30DisplacementoftheapicalimpulseHeartdisease

LVH,LVDorboth

displacedto

lateralandinferior31PPT课件Displacementoftheapicalimp31Displacementoftheapicalimpulse

RVH,LVDorboth

displacedto

leftandupward32PPT课件Displacementoftheapicalimp32DisplacementoftheapicalimpulseCongenitaldextrocardiarightCHF,myocarditis,myocardiopathyapicalimpulsedecreaseintensity33PPT课件Displacementoftheapicalimp33DisplacementoftheapicalimpulseMassivepericardialeffusionapicalimpulsedisappear34PPT课件Displacementoftheapicalimp34DisplacementoftheapicalimpulseThoracicdiseasepneumothorax,pleuraleffusionshiftedtohealthyside35PPT课件Displacementoftheapicalimp35DisplacementoftheapicalimpulsePleural-adhesion,atelectasisshiftedtodiseasesideEmphysemawithRVHtoinferiortosubxiphoid36PPT课件Displacementoftheapicalimp36PalpationUsuallyinspectionandpalpationarediscussedtogetherbecausethereisanintimaterelationshipbetweenthesetwoprocessesintheheartexamination.Palpationnotonlyconfirmstheresultsininspection,butalsodiscoversdiagnosticsigns.37PPT课件PalpationUsuallyinspec37Throughcarefulpalpation,theexaminershouldaimtodeterminethelocationandsizeofthecardiacapeximpulse,characterizeitscontour,andidentifyanyabnormalprecordialpulsations.38PPT课件Throughcarefulpalpati38Thepalmofthehand,ventralsurfaceoftheproximalmetacarpals,andfingersshouldallbeusedforpalpationbecauseeachisusefulforoptimalappreciationofcertainmovements.39PPT课件Thepalmofthehand39PalpationPrecordialpulsation

Apicalimpulse:locationdurationamplitudeintensityfrequencyregularity40PPT课件PalpationPrecordialpulsation40Precordialpulsation

LVH:lift,Forcefulsensation,throughsystolewithgreatamplitudemorethan2cmdiameter

41PPT课件Precordialpulsation

LVH:41P41Precordialsustained

orheavy:RVHDecreaseamplitude:myocarditisMassivepericardialeffusion:impulsecannotbepalpable

42PPT课件Precordialsustainedorheavy:42PalpationThrillThrillarepalpablemurmurssomewhatsimilartothesensationonthethroatapurringcat.Thrillsareactuallypalpablefinevibrations,mostcommonlyproducedbybloodfromonechamberofthehearttoanotherthrougharestrictedornarrowedorifice,itmayoccurinsystole,diastole,presystoleandattimesmaybecontinuous.43PPT课件PalpationThrill43PPT课件43PalpationAnythrillshouldbedescribedastoitslocation,itstimeincardiaccycle,anditsmodeofextensionortransmission.Theintensityofthethrillvariesaccordingtothevelocityoftheblood,thedegreeofnarrowingoftheorificeandwhichitisproducedanddifferenceinpressurebetweenthetwochambersoftheheart.44PPT课件PalpationAnythrillsho44PalpationQualityofathrilldependsonthefrequencyofvibrationproducingit,rapidvibrationsresultinfinethrillswhereasslowervibrationsproducecoarserthrill.45PPT课件PalpationQualityofath45PalpationRestrictedornarrowedorificethrill

accordingbloodvelocityIntensitydegreeofnarrowingtogradientbetweentwochambers46PPT课件PalpationRestrictedornarrow46Palpation

dependsqualityfrequencyonfrequency:rapidfinethrillslowercoarser47PPT课件Palpationdepends47PalpationdurationlocationdiseasesystolesecondrightICSAS

secondleftICSPSthirdfourthleftICSVSDdiastoleapicalareaMScontinuous2ndleftICSPDA48PPT课件Palpationduration48PalpationPericardialfrictionrub

Pericardialfrictionrubisato-and-frogratingsensation,whichisusuallypresentduringbothphasesofcardiaccycle,oftenrubsaremorereadilypalpatedwiththepatientsittingerectandleaningforwardduringtheendperiodofdeepinspiration.49PPT课件PalpationPericardialfriction49PalpationTherubiscausedbyafibrinouspericarditis.Inthepresenceofpericardialeffusiontherubwillusuallydisappearbecauseoftheseparationofvisceralandparietallayersbytheaccumulatedfluid.50PPT课件PalpationTherubiscausedb50PalpationShock(palpablesounds)valvecloseasatappingsensation2ndleftICS:PH2ndrightICS:SHapex:MS51PPT课件PalpationShock(palpablesound51PercussionMethodofpercussionforheart

Thechestispercussedtoconfirmthecardiacborders,size,contourandpositioninthethorax,patientshouldliesupineonanexaminingtableorsitonthechair,withthephysicianathisrightside.52PPT课件PercussionMethodofpercussion52PercussionUsuallyweemployindirectpercussionforpercussingheartborders.Itisoutlinedbypercussinginthe5th,4th,3rdand2ndintercostalspaceontheleftsequentially,startingneartheaxillaandmovingmediallyuntilcardiacdullnessisencountered.53PPT课件PercussionUsuallyweemploy53Percussion

Thebeginnershouldmarkwithaskinpencilwherethenotechanges.Thedistancefrommidsternallinetotheleftbordershouldbemeasuredandrecorded,measurementshouldbemadealongastraightlineparalleledtothetransversediameterinthethorax.54PPT课件PercussionThebeginnershou54PercussionHeartbordersRightborderoftheheartformedbysupvean,ascendingaorta,rightatrium55PPT课件PercussionHeartborders55PPT课件55HeartbordersLeftborderoftheheartformedbyaortaarch,pulmonaryarterialtrunkleftatriaappendage,LVInferiorborderoftheheartformedbyRV,lesserextentLV56PPT课件HeartbordersLeftborderofth56Percussion

Normalheartdullness

right(cm)ICS,MSLleft(cm)

2-3Ⅱ2-32-3Ⅲ3.5-4.53-4Ⅳ5-6Ⅴ7-9NormallyfrommidsternallinetoMCLisabout7-9cm57PPT课件PercussionNormalheartdullne57Changingcardiacdullness

Leftventricularenlargement,thecardiacdullnesswillbeextendedtotheleftanddownward,theheartsilhouetteislikeashoe.Itisfrequentlyseeninaorticregurgitationandcalledaorticheart.58PPT课件Changingcar