2018年《心脏体检》PPT课件-文档资料.ppt
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1、1,Equipment(器材):Stethoscope(听诊器); Position(体位):Supine (卧位)or seated(坐位)a patient;standing to the right side of the patient (an examiner); Environment(环境):Quiet (安静); Exposure(暴露):Strip to waist(腰部); Lightening(光线):Good;left side; tangent(切线); Knowledge of anatomy(解剖知识):thorough(全面) Considerate and g
2、entle。,Physical examination of heart (心脏检查) Preparation,2,Midsternal line(胸骨中线) or Anterior midline (前正中线) Midclavicular lines(锁骨中线) Anterior, middle,and posterior axillary lines (腋前、中、后线) Sternal angle (胸骨角)- connected with 2th costal cartilage (与第二肋软骨相连) Intercostal space (肋间隙),Physical examinatio
3、n of heart (心脏检查)landmarks of topographic anatomy(解剖标志),3,Inspection (望诊),Palpation (触诊),Percussion (叩诊),Auscultation (听诊),心 脏 检 查,Physical examination of heart (心脏检查),4,Tangent lightening(切线方向光线); Same height as thorax (与胸廓同高)。,Inspection(望诊)-gist(要点),5,Precordial prominence(心前区隆起): Right ventricul
4、ar hypertrophy at puberty(儿童发育完成前右心室肥大) Congenital heart disease (先天性心脏病) Rheumatic heart disease (风湿性心脏病) Massive pericardial effusion in the adult (成人大量心包积液)。,Inspection(望诊)- Deformity of thoraxes(胸廓畸形),6,Inspection(望诊)- Apical impulse(心尖搏动),Definition(定义):Heart contracts(心脏收缩) impacts correspondi
5、ng site of front chest(心尖向前冲击前胸壁相应位置) apical impulse (心尖搏动)。,7,Inspection(望诊),Normal apical impulse(正常心尖搏动): Location-The 5th intercostal space(第五肋间), 0.5 1.0 cm medial to left midclavicular line (左锁骨中线内侧 0.5 1.0 cm ); Diameter- 2.0 2.5 cm。,Inspection(望诊)- Apical impulse(心尖搏动),8,Physiological factor
6、s(生理性因素): Left lateral position (左侧卧位)- extend to the left(向左移)for 2.0 3.0 cm. Right lateral position(右侧卧位)- extend to the right(向右移)for 1.0 2.5 cm.,Inspection(望诊)- Displacement of apical impulse(心尖搏动移位),9,Pathological factors(病理性因素): Heart itself(心脏本身) Enlargement of left ventricle(左 心室增大)-extend t
7、o left and downwards(左下移位);,Inspection(望诊)- Displacement of apical impulse(心尖搏动移位),10,Pathological factors(病理性因素): Heart itself(心脏本身) Enlargement of right ventricle(右 心室增大)-extend to left but not downwards(向左不向下移位); Enlargement of both ventricles(左 右室均增大)-extend to both left and right.,Inspection(望诊
8、)- Displacement of apical impulse(心尖搏动移位),11,Pathological factors(病理性因素): Displacement of mediastinum(纵隔移 位) Pleural adhesion (胸膜粘连), pulmonary atelectasis of one side (肺 不张- displacement of apical impulse toward the diseased side(移向 患侧); Pleural effusion(胸腔积液), pneumothorax of one side(气胸)- displac
9、ement of apical impulse toward the opposite side(移向健侧).,Inspection(望诊)- Displacement of apical impulse(心尖搏动移位),12,Pathological factors(病理性因素): Displacement of diaphragm(横隔移位) Massive ascites (大量腹水),huge tumor of abdominal cavity (腹腔巨大 肿瘤)-displacement of apical impulse to left (移向左侧); Severe emphyse
10、ma(肺气肿)- displacement of apical impulse inward and downward(移向内下)。,Inspection(望诊)- Displacement of apical impulse(心尖搏动移位),13,Physiological factors(生理性因素): Thick chest wall(胸壁肥厚)- weak and narrow(减弱、缩小); Thin chest wall(胸壁薄)- strong and wide(增强、较大)。,Inspection(望诊)-Changes of intensity and range in ap
11、ical impulse(心尖搏动强度与范围的改变),14,Pathological factors(病理性因素): Increase in intensity of apical impulse(心尖搏动增强)- fever(发热),anemia (贫血), hyperthyroidism(甲状腺机能亢进); Decrease in intensity of apical impulse(心尖搏动减弱)-dilated cardiomyopathy(扩张型心肌病) ,acute myocardial infarction(急性心肌梗死),pericardial effusion(心包积液),
12、 emphysema(肺气肿)。,Inspection(望诊)-Changes of intensity and range in apical impulse(心尖搏动强度与范围的改变),15,Inspection(望诊)- Inward impulse (负性心尖搏动),Definition(定义):invagination(内陷) of apical impulse when contracting。 Significance(意义):adhesive pericarditis(粘连性心包积液)。,16,Inspection(望诊)- precordial impulse(心前区搏动),
13、Impulse at 3th 4th left intercostal space just lateral to sternum (胸骨左 缘3 4肋间) : right ventricular hypertrophy(右室肥 大); Impulse at xiphoid process(剑突下搏 动): right ventricular hypertrophy; beating of abdominal aorta(腹主动脉搏 动).,17,Impulse at base of heart(心底部搏动): 2nd left intercostal space just lateral t
14、o sternum (胸骨左缘2肋间): dilation of pulmonary artery; pulmonary hypertension. 2nd right intercostal space just lateral to sternum (胸骨右缘2肋间): dilation of ascending aorta(升主动 脉扩张)。,Inspection(望诊)- precordial impulse(心前区搏动),18,Inspection(望诊)-contents (内容),Deformity of thoraxes (胸廓畸形) Apical impulse (心尖搏动)
15、 Precordial impulse (心前区搏动),19,Palpation(触诊) Importance of palpation(触诊意义),To confirm the observations made during inspection (进一步证实望诊所见); To detect invisible pulsatile movements (发现望诊看不见的搏动); To reveal thrill and pericardial friction rubs(发现震颤和心包摩擦感)。,20,Palpation(触诊)-method (方法),Right palm first (
16、先用右手手掌)- detecting thrills(检查震颤); Fingertips then(后用指尖)- detecting pulsations(检查搏动)。,21,Definition(定义):Slow and forceful beat in apex(心尖区徐缓、有力的搏动),lift finger tip (可使手指尖端抬起)。 Significance(意义):Sign of left ventri- cular hypertrophy(左室肥大的体征)。,Palpation(触诊)- heaving apex impulse (抬举样心尖搏动),22,Palpation(
17、触诊)-thrills (震颤),Definition(定义): Tiny vibrations felt by palm(手掌感觉到的一种细小震动感),somewhat similar to the sensations on the throat of a purring cat,therefore also called purring (与在猫喉部摸到的呼吸震颤类似,故亦称猫喘)。 Mechanism:The same as cardiac murmurs(同杂音)。,23,Significance(意义): Signs of organic heart diseases(器质性心脏病
18、的体征); always Thrill - cardiac murmur, not always Cardiac murmur - thrill; Usually - congenital heart disease(先天性心脏病)、valvular stenosis(瓣 膜狭窄),seldom valvular regurgi- tation(关闭不全)。,Palpation(触诊)-thrills (震颤),24,Palpation(触诊)-thrills (震颤),Clinical importance of thrills at apex (心前区震颤的临床意义) Location(部
19、位) Phase(时相) Disease 2nd right intercostal systole(收缩期) aortic space just lateral to stenosis sternum (胸骨右缘2肋间) (主动脉瓣狭窄) 2nd left intercostal systole(收缩期) pulmonary space just lateral to stenosis sternum (胸骨左缘2肋间) (肺动脉瓣狭窄) 3th-4th left intercostal systole(收缩期) ventricular space just lateral to septa
20、l defect sternum (胸骨左缘3-4肋间) (室间隔缺损) 2nd left intercostal continuous(连续性) patent ductus space just lateral to arteriosus sternum (胸骨左缘2肋间) (动脉导管未闭) Apex(心尖区) diastole(舒张期) mitral stenosis (二尖瓣狭窄),25,Palpation(触诊)-pericardial friction rubs(心包摩擦感),Definition(定义) Acute pericarditis(急性心包炎) Fibrin effuse
21、s from pericardium(心包膜纤维素渗出) Roughness of peri- cardium(心包粗糙) Visceral and parietal pericardial surfaces rub against each other when heart beats (心脏搏动时脏层与壁层心包摩擦) Pericardial friction rubs(心包摩擦感)。,26,Palpation(触诊)-pericardial friction rubs(心包摩擦感),Features to and fro grating sensation; both in systole
22、 and diastole; best sensed at apex or 3th 4th left intercostal space just lateral to sternum; clearer if patients lean against forward; disappear: pericardial effusion.,27,Palpation(触诊)-contents(内容),Apical impulse and heaving apex impulse (心尖搏动和抬举样心尖搏动) Thrills (震颤) Pericardial friction rubs (心包摩擦感)
23、,28,Percussion(叩诊),Aim(目的): To detect size of heart and its contour(确定心界大小及形态)。,29,Percussion(叩诊),Relative and absolute dullness of the heart,30,Percussion- method of percussion (叩诊方法),Use mediate percussion(间接叩诊); In recumbent position(仰卧体位); Place pleximeter parallel with intercostal space when pa
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