心脏体格检查视诊英文版培训课件

心脏体格检查视诊英文版General Considerationn nDuring lifetime,the heart contracts more than 4 billion times.n nPumping 200 million L blood to systemic circulation.n nCardiac output varies under physiologic conditions from 3 to 30L/min.Heart rate varies from 60 to 150 beats/min.Physical Examination of Cardiovascular Physical Examination of Cardiovascular systemsystemIn the present era of technological advances,particularly in the v a r i o u s i m a g i n g modalities,physical examination of the heart still provides useful i n f o r m a t i o n.Physical Examination of Cardiovascular system n n It is simple,convenient,cheap as premier assessment of the severity and an etiology of the lesions and also serves as an clue to use advanced techniques for the diagnosis of CVD.Review the AnatomyRoutine and Techniques of PE of the HeartPatients exposure and position(sitting or lying down),with enough light and appropriate temperatureFour parts:inspection,palpation,percussion,and auscultation Part oneInspection Inspection Precordium is the region of the anterior surface of the body covering the heart and lower thorax.Contents of Inspectionn nThoracic cage deformityn nApical impulse n nAbnormal pulsations in precordiumMethods of Inspectionn nInspect the obverse side.n nThen obverse the patients lateral surface Thoracic Cage Deformity（inspection）Asymmetry of the thoracic cage due to a convex bulging of the precordium suggests the presence of heart disease since childhoodThoracic Cage Deformity（inspection）such as congenital heart disease and rheumatic heart disease,with skeletal molding to accommodate cardiac enlargement.Apical Impulse（inspection）n nApical impulse mainly results from the left ventricular contraction,when LV contracts,the apical knocks at the correspondent position of anterior chest wall,resulting in intercostal impulse outward movement.Apical Impulse（inspection）Normal apical impulsen nPosition:left border of sternum,fifth intercostal space,inside the midclavicular line 0.51.0cmn nRange:22.5cm in diameterApical Impulse（inspection）n nApical impulse displacementn nChanges of intensity and area of apical impulsen nInward impulseApical Impulse（inspection）Apical impulse displacement(1).extra-heart factors(2).cardiac enlargement(3).body postureApical Impulse Displacement Extra-heart factors:Obesity,pregnancy,etc.cause elevation of diaphragm,apical impulse shifts to outward and upward,at left the 4th intercostal space outside midclavicular line.Apical Impulse Displacement Extra-heart factors:Abdominal disease:abdominal tumor,a large number of ascites,etc.elevation of diaphragm,apical impulse shifts to outward and upward Apical Impulse Displacement Extra-heart factors:Leptosome;severely pulmonary emphysema.Then apical impulse shifts to inward and downward,reaches at the 6th intercostal space.NormalApical Impulse Displacementheart shifts to the healthy sidePleural effussion in the rightto the healthsideApical Impulse DisplacementCardiac enlargementn nRight ventricle enlargement.Apical impulse shifts to the left but not downward.n nLeft ventricle enlargement.Apical impulse shifts to the left and downward at the same time.Left Ventricle EnlargementNormal LV enlargementBoth Ventricles EnlargementBoth ventricles enlargementNormalApical Impulse DisplacementBody posturen nDorsal decubitus.Apical impulse moves a little upward,if left lateral decubitus the apical impulse shifts to the left 23cm.n nRight lateral decubitus.The apical impulse shifts to the right 12.5cm.Apical Impulse（inspection）Changes of intensity and area of apical impulse(1).Physical conditions(2).Pathological conditions Physical conditionsn nThickness of the chest wall n nEmotion excitedn nStrong physical activity Changes of Intensity and Area of Apical ImpulseChanges of intensity and area of apical impulsePathological Pathological conditionsconditionsEnhanced apical impulse:Enhanced apical impulse:n n left ventricular left ventricular enlargementenlargementn n hyperthyroidism hyperthyroidismn n fever,anemia fever,anemiaPathological Pathological conditionsconditionsWeakened apical Weakened apical impulseimpulse :n n dilateddilated myocardiopathy,myocardiopathy,n n hydropericardium hydropericardium,n nleft pleural effusion,left pleural effusion,n n pulmonary emphysema pulmonary emphysemaInward Impulse Inward impulse.The apex depresses far from the chest instead of striking the chest during systole.Broadbents sign is of value in the diagnosis of adherent pericardium.It is also seen in RVH.Abnormal Pulsations in Precordiumn nRight vertricular hypertophy(RVH).The impulse is clearly seen in left third fourth intercostal space.n nPulmonary emphysema with RVH,usually the pulsation can be found inferior the xiphoid processAbnormal Pulsations in Precordiumn nIn ascending or arch aortic aneurysm,one may detects abnormal pulsations in aortic area,with bulging or pulsation in systole.Pulmonary hypertension with dilatation the pulsation in systole may be detected in left second intercostal space to the edge of sternum.Abnormal Pulsations in Precordiumn nMarked pulsation at the base of the heart is seen in aortic insufficiency,in a dilated aorta or a saccular aneurysm.Referencen n诊断学第8版，全国规划教材，陈文彬 主编，人民卫生出版社，2013年n n诊断学医学英文原版改编双语教材，吕卓人 主编，科学出版社，2006年n nHistory and Examination,James Marsh,Chief Editor,科学出版社，2007年