心臟體格檢查視診英文版講義課件

心臟體格檢查視診英文版心臟體格檢查視診英文版GeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.2GeneralConsiderationDuringliPhysicalExaminationofCardiovascularsystem

Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.

3PhysicalExaminationofCardiPhysicalExaminationofCardiovascularsystem

Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.4PhysicalExaminationofCardiReviewtheAnatomy5ReviewtheAnatomy5RoutineandTechniques

ofPEoftheHeartPatient’sexposureandposition(sittingorlyingdown),withenoughlightandappropriatetemperatureFourparts:inspection,palpation,percussion,andauscultation

6RoutineandTechniques

ofPEPartone

Inspection

7Partone7Inspection

Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.

8InspectionPrecordiumistheContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium9ContentsofInspectionThoracicMethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface

10MethodsofInspectionInspecttThoracicCageDeformity

（inspection）

Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood11ThoracicCageDeformity

（insp心臟體格檢查視診英文版講義課件ApicalImpulse

（inspection）Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.13ApicalImpulse

（inspection）ApicalImpulse

（inspection）NormalapicalimpulsePosition:

leftborderofsternum,fifthintercostalspace,insidethemidclavicularline0.5~1.0cmRange: 2~2.5cm

indiameter14ApicalImpulse

（inspection）ApicalImpulse

（inspection）ApicalimpulsedisplacementChangesofintensityandareaof

apicalimpulseInwardimpulse15ApicalImpulse

（inspection）ApicalImpulse

（inspection）Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture16ApicalImpulse

（inspection）ApicalImpulseDisplacement

Extra-heartfactors:

Obesity,pregnancy,etc.causeelevationofdiaphragm,apicalimpulseshiftstooutwardandupward,atleftthe4thintercostalspaceoutsidemidclavicularline.

17ApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:Abdominaldisease:abdominaltumor,alargenumberofascites,etc.elevationofdiaphragm,apicalimpulseshiftstooutwardandupward

18ApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:

Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.19ApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:Singlesidepleuralthickening,oradhesion,oratelectasisresultinmediastinumandheartshiftingtothesickside,andtheapicalimpulseshiftstothesickside,too.aorticarch

LVtothesickside20ApicalImpulseDisplacementNormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside21NormalApicalImpulseDisplacemApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.22ApicalImpulseDisplacementCarLeftVentricleEnlargementNormalLVenlargement23LeftVentricleEnlargementNorBothVentriclesEnlargementBothventriclesenlargementNormal24BothVentriclesEnlargementBotApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.25ApicalImpulseDisplacementBodApicalImpulse

（inspection）Changesofintensityandareaofapicalimpulse

(1).Physicalconditions(2).Pathologicalconditions26ApicalImpulse

（inspection）

PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity

ChangesofIntensityandAreaof

ApicalImpulse27PhysicalconditionsChangesChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:

leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse

:

dilated

myocardiopathy,hydropericardium,leftpleuraleffusion,pulmonaryemphysema28ChangesofintensityandareInwardImpulseInwardimpulse.Theapexdepressesfarfromthechestinsteadofstrikingthechestduringsystole.Broadbent’ssignisofvalueinthediagnosisofadherentpericardium.ItisalsoseeninRVH.29InwardImpulseInwardimpulsAbnormalPulsationsinPrecordiumRightvertricularhypertophy(RVH).Theimpulseisclearlyseeninleftthirdfourthintercostalspace.PulmonaryemphysemawithRVH,usuallythepulsationcanbefoundinferiorthexiphoidprocess30AbnormalPulsationsinPrecordAbnormalPulsationsinPrecordiumInascendingorarchaorticaneurysm,onemaydetectsabnormalpulsationsinaorticarea,withbulgingorpulsationinsystole.Pulmonaryhypertensionwithdilatationthepulsationinsystolemaybedetectedinleftsecondintercostalspacetotheedgeofsternum.31AbnormalPulsationsinPrecordAbnormalPulsationsinPrecordiumMarkedpulsationatthebaseoftheheartisseeninaorticinsufficiency,inadilatedaortaorasaccularaneurysm.32AbnormalPulsationsinPrecordReference《診斷學(xué)》第8版，全國規(guī)劃教材，陳文彬主編，人民衛(wèi)生出版社，2013年《診斷學(xué)》醫(yī)學(xué)英文原版改編雙語教材，呂卓人主編，科學(xué)出版社，2006年《HistoryandExamination》,JamesMarsh,ChiefEditor,科學(xué)出版社，2007年33Reference《診斷學(xué)》第8版，全國規(guī)劃教材，陳文彬Thankyou！34Thankyou！34心臟體格檢查視診英文版心臟體格檢查視診英文版GeneralConsiderationDuringlifetime,theheartcontractsmorethan4billiontimes.Pumping200millionLbloodtosystemiccirculation.Cardiacoutputvariesunderphysiologicconditionsfrom3to30L/min.Heartratevariesfrom60to150beats/min.36GeneralConsiderationDuringliPhysicalExaminationofCardiovascularsystem

Inthepresenteraoftechnologicaladvances,particularlyinthevariousimagingmodalities,physicalexaminationoftheheartstillprovidesusefulinformation.

37PhysicalExaminationofCardiPhysicalExaminationofCardiovascularsystem

Itissimple,convenient,cheapaspremierassessmentoftheseverityandanetiologyofthelesionsandalsoservesasancluetouseadvancedtechniquesforthediagnosisofCVD.38PhysicalExaminationofCardiReviewtheAnatomy39ReviewtheAnatomy5RoutineandTechniques

ofPEoftheHeartPatient’sexposureandposition(sittingorlyingdown),withenoughlightandappropriatetemperatureFourparts:inspection,palpation,percussion,andauscultation

40RoutineandTechniques

ofPEPartone

Inspection

41Partone7Inspection

Precordiumistheregionoftheanteriorsurfaceofthebodycoveringtheheartandlowerthorax.

42InspectionPrecordiumistheContentsofInspectionThoraciccagedeformityApicalimpulseAbnormalpulsationsinprecordium43ContentsofInspectionThoracicMethodsofInspectionInspecttheobverseside.Thenobversethepatient’slateralsurface

44MethodsofInspectionInspecttThoracicCageDeformity

（inspection）

Asymmetryofthethoraciccageduetoaconvexbulgingoftheprecordiumsuggeststhepresenceofheartdiseasesincechildhood45ThoracicCageDeformity

（insp心臟體格檢查視診英文版講義課件ApicalImpulse

（inspection）Apicalimpulsemainlyresultsfromtheleftventricularcontraction,whenLVcontracts,theapicalknocksatthecorrespondentpositionofanteriorchestwall,resultinginintercostalimpulseoutwardmovement.47ApicalImpulse

（inspection）ApicalImpulse

（inspection）NormalapicalimpulsePosition:

leftborderofsternum,fifthintercostalspace,insidethemidclavicularline0.5~1.0cmRange: 2~2.5cm

indiameter48ApicalImpulse

（inspection）ApicalImpulse

（inspection）ApicalimpulsedisplacementChangesofintensityandareaof

apicalimpulseInwardimpulse49ApicalImpulse

（inspection）ApicalImpulse

（inspection）Apicalimpulsedisplacement(1).extra-heartfactors(2).cardiacenlargement(3).bodyposture50ApicalImpulse

（inspection）ApicalImpulseDisplacement

Extra-heartfactors:

Obesity,pregnancy,etc.causeelevationofdiaphragm,apicalimpulseshiftstooutwardandupward,atleftthe4thintercostalspaceoutsidemidclavicularline.

51ApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:Abdominaldisease:abdominaltumor,alargenumberofascites,etc.elevationofdiaphragm,apicalimpulseshiftstooutwardandupward

52ApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:

Leptosome;severelypulmonaryemphysema.Thenapicalimpulseshiftstoinwardanddownward,reachesatthe6thintercostalspace.53ApicalImpulseDisplacementApicalImpulseDisplacement

Extra-heartfactors:Singlesidepleuralthickening,oradhesion,oratelectasisresultinmediastinumandheartshiftingtothesickside,andtheapicalimpulseshiftstothesickside,too.aorticarch

LVtothesickside54ApicalImpulseDisplacementNormalApicalImpulseDisplacementheartshiftstothehealthysidePleuraleffussionintherighttothehealthside55NormalApicalImpulseDisplacemApicalImpulseDisplacementCardiacenlargementRightventricleenlargement.Apicalimpulseshiftstotheleftbutnotdownward.Leftventricleenlargement.Apicalimpulseshiftstotheleftanddownwardatthesametime.56ApicalImpulseDisplacementCarLeftVentricleEnlargementNormalLVenlargement57LeftVentricleEnlargementNorBothVentriclesEnlargementBothventriclesenlargementNormal58BothVentriclesEnlargementBotApicalImpulseDisplacementBodypostureDorsaldecubitus.Apicalimpulsemovesalittleupward,ifleftlateraldecubitustheapicalimpulseshiftstotheleft2~3cm.Rightlateraldecubitus.Theapicalimpulseshiftstotheright1~2.5cm.59ApicalImpulseDisplacementBodApicalImpulse

（inspection）Changesofintensityandareaofapicalimpulse

(1).Physicalconditions(2).Pathologicalconditions60ApicalImpulse

（inspection）

PhysicalconditionsThicknessofthechestwallEmotionexcitedStrongphysicalactivity

ChangesofIntensityandAreaof

ApicalImpulse61PhysicalconditionsChangesChangesofintensityandareaofapicalimpulsePathologicalconditionsEnhancedapicalimpulse:

leftventricularenlargementhyperthyroidismfever,anemiaPathologicalconditionsWeakenedapicalimpulse

:

dilated

myocardiopathy,hydropericardium,leftpleurale