F心臟檢查A課件

physicalexamination

心臟檢查(1)

CardiacExamination

inspection

視診

palpation

觸診

percussion

叩診

auscultation

聽診InspectionoftheHeart

心臟視診

precordiumshape

心前區(qū)外形

normalapicalimpulse

正常心尖搏動

abnormalapicalimpulse

異常心尖搏動

precordialabnormalimpulse

心前區(qū)異常搏動PrecordiumShape

心前區(qū)外形Precordialbulge心前區(qū)隆起Features:bonybulge特點:骨骼突起Clinicalimportance:Congenitalheartdiseasewithventricularenlargement提示:先天性心臟病右室大Precordialsatiety心前區(qū)飽滿Features:intercostalregionstickingout特點:肋間軟組織外突Clinicalimportance:massofpericardialeffusion提示:大量心包積液AbnormalApicalImpulse

異常心尖搏動(1)Abnormallocation位置改變Physical:posture,pregnancy,etc.

生理因素:體位妊娠Heartdiseases心臟病變L.VandB.Venlargement:inferiorleft

左室或雙室擴大:左下移位R.Venlargement:left

右室擴大:向左移位Chestandabdominaldiseases

肺部或腹部疾病AbnormalApicalImpulse

異常心尖搏動(2)Abnormalrangeorintensity范圍強度異常Increasedintensity:LVhypertrophy,hyperthyroidism,fever,anemia,etc.

搏動增強:左室肥厚甲亢發(fā)熱貧血Decreased:myocardialdiseases,pericardialeffusion,pleuraleffusionofleftthoraxorleft-sidepneumothorax,emphysema.

搏動減弱:心肌病變心包積液肺氣腫左胸腔積液或氣胸Abnormaldirection方向改變Inwardimpulse:adhesivepericarditis.

負性心尖搏動:心包粘連PrecordialAbnormalImpulse

心前區(qū)異常搏動2ndICS,LSB:pulmonaryhypertension,youth胸骨左緣第二肋間:肺動脈高壓青年人2ndICS,RSB:aneurysmofascendingaorta胸骨右緣第二肋間:升主動脈瘤3rd,4thICS,LSB:R.Vhypertrophy胸骨左緣3,4肋間:右心室肥大xiphoidprocess:R.Vhypertrophy,abdominalaneurysm劍突下:右心室肥大腹主動脈瘤Palpation

oftheHeart

心臟觸診

apicalimpulse

心尖搏動

thrill震顫

pericardial

frictionfremitus

心包摩擦感AbnormalofApicalImpulse

心尖搏動異常Increasedcauses:leftventricularpressureoverloadandconsequenthypertrophy

增強原因:左室內(nèi)壓升高和肥厚Clinicalsignificance:leftventricularhypertrophy

臨床意義:左心室肥大Decreasedcauses:decreasedcontractibilityofthemyocardium

減弱原因:心肌收縮力減弱Clinicalsignificance:heartfailure,pericardialeffusion,myocarditis臨床意義:心力衰竭心包積液心肌炎ThrillinSystole

收縮期震顫2ndICS,LSB:pulmonicstenosis

胸骨左緣第二肋間:肺動脈瓣狹窄2ndICS,RSB:aorticstenosis

胸骨右緣第二肋間:主動脈瓣狹窄3rd,4thICS,LSB:interventricularseptaldefect

胸骨左緣3,4肋間:室間隔缺損PericardialFrictionFremitus

心包摩擦感Mechanism:inflammationorirritationofthepericardium機制:心包表面粗糙Typicalsite:4thICS,LSB

部位:胸骨左緣第四肋間Feeling:frictionlikeleatherrubbing感覺:如皮革相互摩擦Features:itisbestpalpatedwiththepersonsittingupandleaningforward,andwiththebreathheldinexpiration特點:坐位前傾呼氣末明顯與心跳一致閉氣時不消失Clinicalsignificance:pericarditis意義:提示心包炎PercussionoftheHeart

心臟叩診

percussionofthe

heartborder

心界叩診

abnormaldullnessheartborder

心界異常PercussionTechnique

叩診方法Force:lightpercussionfortherelativedullnessborder.力量:輕叩叩出相對濁音界Position:supine:parallelthemiddlefingertointercostal;

sitting:plumbthemiddlefinger.體位:仰臥位:板指與肋間平行坐位:板指與肋間垂直Steps:fromlefttoright,lowertoupper,outwardtoinward

順序:先左后右自下而上由外向內(nèi)Leftborder:2~3cmfromtheapicalimpulse

心左界:心尖搏動外

2~3cm開始Rightborder:ICSnexttotheupperborderoftheliver

心右界:肝上界上一肋間開始Measure:thedistancefromdullnessbordertoanteriormidline

測量:濁音界距前正中線的垂直距離NormalRelativeDullnessBorderoftheHeart

正常心濁音界Distancebetweendullnessborderandanteriormidline心臟之相對濁音界距前正中線的距離Right右(cm)ICS肋間Left左(cm)2-3Ⅱ2-32-3Ⅲ3.5-4.53-4Ⅳ5-6Ⅴ7-9(thedistancebetweenleftmidclavicularlineandanteriormidlineis9cm)(左鎖骨中線距前正中線9cm)AbnormalDullnessHeartBorder

心界叩診異常(1)heartvariation心臟改變L.Venlargement:boot-shapedheart

左室擴大:靴形心L.Aenlargement:pear-shapedheart

左房擴大:梨形心B.Venlargement:generalenlargedheart

雙室擴大:普大心R.Venlargement:corpulmonal

右室擴大:先心肺心Pericardialeffusion:flask-shapedheart

心包積液:燒瓶心Boot-shapedHeart

靴形心Mechanism:L.VenlargementFeatures:theleftborderextendstotheinferiorleft,waistoftheheartisdeepened.Causes:aorticinsufficiency,hypertensiveheartdisease機制:左室擴大特點:心左界向左下擴大心腰加深病因:主動脈瓣關(guān)閉不全高血壓心臟病Pear-shapedHeart

梨形心Mechanism:L.AenlargementanddistensionofpulmonaryarteryFeatures:dullnessheartborderinthe2nd,3rdICSontheLSBextendsoutside,waistoftheheartbulgesoutCauses:mitralstenosis機制:左房擴大肺動脈擴大特點:胸骨左緣2,3肋間心濁音界向外擴大心腰飽滿或膨出病因:二尖瓣狹窄Flask-shapedHeart

燒瓶心Mechanism:pericardialeffusionFeatures:Sittingposition:triangulardullnessborderSupine:wideneddullnessborderofthebase機制:心包積液特點:坐位時心濁音界呈三角形仰臥位心底部濁音區(qū)增寬隨體位心界改變AuscultationoftheHeart

心臟聽診

valveauscultationsection

瓣膜聽診區(qū)

contentofauscultation

聽診內(nèi)容AuscultationOrder

聽診順序Mitralvalve

二尖瓣Aorticvalve主動脈瓣P(guān)ulmonicvalve肺動脈瓣The2ndofaorticvalve主動脈瓣第二聽診區(qū)Tricuspidvalve三尖瓣ContentofHeartAuscultation

心臟聽診內(nèi)容Heartrate:60~100/minnormally心率:正常60~100次/分Cardiacrhythm:regularorarrhythmia心律:規(guī)整心律失常Heartsounds:normal,abnormal心音:正常心音異常心音Heartmurmurs

心臟雜音Arrhythmia

心律失常Sinusarrhythmia:quick