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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

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