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*,*,单击此处编辑母版标题样式,可编辑ppt,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,二级,三级,四级,五级,可编辑ppt,*,Physical Examination,of Cardiovascular System,FOR MBBS STUDENTS,Ma Guotian,M.D.,Department of Diagnostics,The First Affiliated Hospital,of Guangxi Medical University,1,可编辑ppt,Physical ExaminationFOR MBBS,General Consideration,During lifetime,the heart contracts more than 4 billion times.,Pumping 200 million L blood to systemic circulation.,Cardiac output varies under physiologic conditions from 3 to 30L/min.Heart rate varies from 60 to 150 beats/min.,2,可编辑ppt,General ConsiderationDuring li,Physical Examination of Cardiovascular system,In the present era of technological advances,particularly in the various imaging modalities,physical examination of the heart still provides useful information.,3,可编辑ppt,Physical Examination of Cardi,Physical Examination of Cardiovascular system,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.,4,可编辑ppt,Physical Examination of Cardi,Review the A,natomy,5,可编辑ppt,Review the Anatomy5可,Routine and Techniques of PE of the Heart,Patients exposure and position(sitting or lying down),with enough light and appropriate temperature,Four parts:,inspection,palpation,percussion,and auscultation,6,可编辑ppt,Routine and Techniques of PE,Part one,Inspection,7,可编辑ppt,Part one7可编辑ppt,Inspection,Precordium,is the region of the anterior surface of the body covering the heart and lower thorax.,8,可编辑ppt,Inspection Precordium is the,Contents of Inspection,Thoracic cage,deformity,Apical impulse,Abnormal pulsations in,precordium,9,可编辑ppt,Contents of InspectionThoracic,Methods of Inspection,Inspect the obverse side.,Then obverse the patients lateral surface,10,可编辑ppt,Methods of InspectionInspect t,Thoracic Cage,Deformity,（,inspection）,Asymmetry of the thoracic cage due to a convex bulging of the precordium suggests the presence of heart disease since,childhood,11,可编辑ppt,Thoracic Cage Deformity（insp,Thoracic Cage,Deformity,（,inspection）,such as congenital heart disease and rheumatic heart disease,with skeletal molding to accommodate cardiac enlargement.,12,可编辑ppt,Thoracic Cage Deformity（insp,Apical Impulse,（,inspection）,Apical impulse m,ainly 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.,13,可编辑ppt,Apical Impulse（inspection）,Apical Impulse,（,inspection）,Normal apical impulse,Position,:,left border of sternum,fifth intercostal space,inside the midclavicular line 0.51.0cm,Range,:,22.5cm,in diameter,14,可编辑ppt,Apical Impulse（inspection）,Apical Impulse,（,inspection）,Apical impulse displacement,Changes of intensity and area of apical impulse,Inward impulse,15,可编辑ppt,Apical Impulse（inspection）,Apical Impulse,（,inspection）,Apical impulse displacement,(1).extra-heart factors,(2).cardiac enlargement,(3).body posture,16,可编辑ppt,Apical Impulse（inspection）,Apical 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.,17,可编辑ppt,Apical Impulse Displacement,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,18,可编辑ppt,Apical Impulse Displacement,Apical Impulse Displacement,Extra-heart factors:,Leptosome;severely pulmonary emphysema.Then apical impulse shifts to inward and downward,reaches at the 6th intercostal space.,19,可编辑ppt,Apical Impulse Displacement,Apical Impulse Displacement,Extra-heart factors:,Single side pleural thickening,or adhesion,or atelectasis result in mediastinum and heart shifting to the sick side,and the apical impulse shifts to the sick side,too.,aortic arch,LV,to the,sick side,20,可编辑ppt,Apical Impulse Displacement,Normal,Apical Impulse Displacement,heart shifts to the healthy side,Pleural effussion in the right,to the health,side,21,可编辑ppt,NormalApical Impulse Displacem,Apical Impulse Displacement,Cardiac enlargement,Right ventricle enlargement.Apical impulse shifts to the left but not downward.,Left ventricle enlargement.Apical impulse shifts to the left and downward at the same time.,22,可编辑ppt,Apical Impulse DisplacementCar,Left Ventricle Enlargement,Normal,LV enlargement,23,可编辑ppt,Left Ventricle EnlargementNor,Both Ventricles Enlargement,Both,ventricles enlargement,Normal,24,可编辑ppt,Both Ventricles EnlargementBot,Apical Impulse Displacement,Body posture,Dorsal decubitus.Apical impulse moves a little upward,if left lateral decubitus the apical impulse shifts to the left 23cm.,Right lateral decubitus.The apical impulse shifts to the right 12.5cm.,25,可编辑ppt,Apical Impulse DisplacementBod,Apical Impulse,（,inspection）,Changes of intensity and area of,apical impulse,(1).,Physic
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