心脏检查医学知识讲座专家讲座

,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,心脏检验,郑州大学第一从属医院,呼吸内科 姚孟英,心脏检查医学知识讲座,第1页,心脏视诊,心前区外形,正常心尖搏动,异常心尖搏动,心前区异常搏动,心脏检查医学知识讲座,第2页,Precordium Shape,心前区外形,心脏检查医学知识讲座,第3页,Precordial bulge,心前区隆起,Features:bony bulge,特点,:,骨骼突起,Clinical importance:Congenital heart disease with ventricular enlargement,提醒,:,先天性心脏病右室大,Precordial satiety,心前区饱满,Features:intercostal region sticking out,特点,:,肋间软组织外突,Clinical importance:mass of pericardial effusion,提醒,:,大量心包积液,心脏检查医学知识讲座,第4页,Normal Apical Impulse,正常心尖搏动,Location:0.51 cm to the left midclavicular line at the 5th ICS outside LSB.,Range:22.5cm,Direction:outward when ventricular systole begins,位置,:,第,5,肋间,左锁骨中线内,0.51cm,范围,:,22.5cm,方向,:,收缩时向外搏动,意义,:,提醒心尖位置,代表收缩期,提醒心脏大小,心脏检查医学知识讲座,第5页,Abnormal Location of Apical Impulse,心尖搏动位置改变,Physical:posture,pregnancy,etc.,生理原因,:,体位 妊娠,Heart diseases,心脏病变,L.V and B.V enlargement:inferior left,左室或双室扩大,:,左下移位,R.V enlargement:left,右室扩大,:,向左移位,Chest and abdominal diseases,肺部或腹部疾病,心脏检查医学知识讲座,第6页,Abnormal Apical Impulse,异常心尖搏动,Abnormal range or intensity,范围强度异常,Increased intensity:LV hypertrophy,hyperthyroidism,fever,anemia,etc.,搏动增强,:,左室肥厚 甲亢 发烧 贫血,Decreased:myocardial diseases,pericardial effusion,pleural effusion of left thorax or left-side pneumothorax,emphysema.,搏动减弱,:,心肌病变 心包积液 肺气肿,左胸腔积液或气胸,Abnormal direction,方向改变,Inward impulse:adhesive pericarditis.,负性心尖搏动,:,心包粘连,心脏检查医学知识讲座,第7页,Precordial Abnormal Impulse,心前区异常搏动,2nd ICS,LSB:pulmonary hypertension,youth,胸骨左缘第二肋间,:,肺动脉高压 青年人,2nd ICS,RSB:aneurysm of ascending aorta,胸骨右缘第二肋间,:,升主动脉瘤,3rd,4th ICS,LSB:R.V hypertrophy,胸骨左缘,3,4,肋间,:,右心室肥大,xiphoid process:R.V hypertrophy,abdominal aneurysm,剑突下,:,右心室肥大 腹主动脉瘤,心脏检查医学知识讲座,第8页,Palpation of the Heart,心脏触诊,apical impulse,心尖搏动,thrill,震颤,pericardial friction fremitus,心包摩擦感,心脏检查医学知识讲座,第9页,Apical Impulse,心尖搏动,Clinical significance:,signifying the start of the systolic phase,临床意义,:,指示收缩期开始,Location and range:same as in inspection,位置和范围,:,与视诊相同,Increased(heave):forceful and sustained,增强,:,搏动连续有力,lifting apical impulse,抬举性心脏搏动,Decreased:cannot palp.clearly,减弱,:,不能清楚触到,心脏检查医学知识讲座,第10页,Abnormal of Apical Impulse,心尖搏动异常,Increased causes:left ventricular pressure overload and consequent hypertrophy,增强原因,:,左室内压升高和肥厚,Clinical significance:left ventricular hypertrophy,临床意义,:,左心室肥大,Decreased causes:decreased contractibility of the myocardium,减弱原因,:,心肌收缩力减弱,Clinical significance:heart failure,pericardial effusion,myocarditis,临床意义,:,心力衰竭 心包积液 心肌炎,心脏检查医学知识讲座,第11页,Thrill,震颤,Mechanism:formation of bloodflow vortices caused by valve stenosis or abnormal pathway.,产生机制,:,血流旋涡引发低频较强震动,由瓣膜狭窄和异常通道引发,Types:systole,diastole,continuous,分型,:,收缩期震颤 舒张期震颤 连续震颤,Clinical significance:reliable signs of organic heart diseases,临床意义,:,器质性心脏病征象,心脏检查医学知识讲座,第12页,Thrill in Systole,收缩期震颤,2nd ICS,LSB:pulmonic stenosis,胸骨左缘第二肋间,:,肺动脉瓣狭窄,2nd ICS,RSB:aortic stenosis,胸骨右缘第二肋间,:,主动脉瓣狭窄,3rd,4th ICS,LSB:interventricular septal defect,胸骨左缘,3,4,肋间,:,室间隔缺损,心脏检查医学知识讲座,第13页,Thrill in Diastole and,Continuous,舒张期和连续性震颤,Diastolic thrill on apex:,mitral stenosis,心尖部舒张期震颤,:,二尖瓣狭窄,Continuous thrill on 2nd ICS,LSB:,Patent ductus arteriosus,胸骨左缘第二肋间连续性震颤,:,动脉导管未闭,心脏检查医学知识讲座,第14页,Pericardial Friction Fremitus,心包摩擦感,Mechanism:inflammation or irritation of the pericardium,机制,:,心包表面粗糙,Typical site:4th ICS,LSB,部位,:,胸骨左缘第四肋间,Feeling:friction like leather rubbing,感觉,:,如皮革相互摩擦,Features:it is best palpated with the person sitting up and leaning forward,and with the breath held in expiration,特点,:,坐位前倾呼气末显著 与心跳一致 闭气时不消失,Clinical significance:pericarditis,意义,:,提醒心包炎,心脏检查医学知识讲座,第15页,Percussion of the Heart,心脏叩诊,percussion of the,heart border,心界叩诊,abnormal dullness heart border,心界异常,心脏检查医学知识讲座,第16页,Percussion Technique,叩诊方法,Force:light percussion for the relative dullness border.,力量,:,轻叩叩出相对浊音界,Position:supine:parallel the,middle finger to intercostal;,sitting:plumb the middle finger.,体位,:,仰卧位,:,板指与肋间平行 坐位,:,板指与肋间垂直,Steps:from left to right,lower to upper,outward to inward,次序,:,先左后右 自下而上 由外向内,Left border:23cm from the apical impulse,心左界,:,心尖搏动外,23cm,开始,Right border:ICS next to the upper border of the liver,心右界,:,肝上界上一肋间开始,Measure:the distance from dullness border to anterior midline,测量,:,浊音界距前正中线垂直距离,心脏检查医学知识讲座,第17页,Normal Relative Dullness Border of the Heart,正常心浊音界,Distance between dullness border and anterior midline,心脏之相对浊音界距前正中线距离,Right,右,(cm),ICS,肋间,Left,左,(cm),2-3,2-3,2-3,3.5-4.5,3-4,5-6,7-9,(the distance between left midclavicular line and anterior midline is 9 cm),(,左锁骨中线距前正中线,9 cm,),心脏检查医学知识讲座,第18页,Abnormal Border by Heart Variation,心脏改变引发心界异常,L.V enlargement:boot-shaped heart,左室扩大,:,靴形心,L.A enlargement:pear-shaped heart,左房扩大,:,梨形心,B.V enlargement:general enlarged heart,双室扩大,:,普大心,R.V enlargement:cor pulmonal,右室扩大,:,先心 肺心,Pericardial effusion:flask-shaped heart,心包积液,:,烧瓶心,心脏检查医学知识讲座,第19页,Abnormal Dullness Heart Border,心界叩诊异常,chest and lung diseases,胸肺疾病,Pleural effusion or lung consolidation:dullness border undetectable,胸腔积液或肺实变,:,叩不出,Emphysema:“shrinked”dullness border,肺气肿,