physical examination
心脏检查(1)
Cardiac Examination
⏹ inspection 视诊
⏹ palpation 触诊
⏹ percussion 叩诊
⏹ auscultation 听诊
一.The projection of the heart at the anterior chest wall.
二.The auscultatory area of cardial valves and the direction of the blood flow through the various valves
1. The mitral valve area:
The blood flow pass from the posterasuperior to the anterainferior left ---the auculatory area is at apex area.
三、Precordium:
⏹ 1.The superior border is below the left third intercostal space
⏹ 2. The right border is at the midsternum line
⏹ 3.The left border is at the left midclavicular line
⏹ 4.The inferior border is above the diaphragm
The heart examination
Inspection of the Heart
心脏视诊
The focal point of inspection include:
⏹ precordium shape
⏹ 心前区外形
⏹ normal apical impul
⏹ 正常心尖搏动
⏹ abnormal apical impul
⏹ 异常心尖搏动
⏹ rejectingprecordial abnormal impul
⏹ 心前区异常搏动
Precordium Shape
心前区外形
Precordial bulge meritorious心前区隆起
⏹ Features: bony bulge 特点:骨骼突起
⏹ Clinical importance: Congenital heart dia with right ventricular enlargement
ordinary
提示:先天性心脏病右室大
Precordial fullness 心前区饱满
⏹ Features: intercostal region fullness
特点:肋间软组织外突
⏹ Clinical importance: mass of pericardial effusion 提示:大量心包积液
Normal Apical Impul
正常心尖搏动
specification缩写⏹ 一、Inspection
⏹ In most persons ,one can e,synchronous with cardic systolic,an outward moveme
nt of a small portion of the left chest wall caud by the beat of the cardic apex.This is the cardic or apex impul.
⏹ It should be studied with the patient upright and lying in various position since in many instances the impal may be fairly diffu
Normal Apical Impul
正常心尖搏动
⏹ Location: the 5th intercastal space 0.5~1.0 cm inside the left midclavicular line.
⏹ Range: 2~2.5cm
⏹ Direction: outward when ventricular systole begins and it coincide with the left cardic border
⏹ 位置: 第5肋间左锁骨中线
内0.5~1cm
⏹ 范围: 2~2.5cm
⏹ 方向: 收缩时向外搏动
⏹ 意义: 提示心尖位置
代表收缩期
提示心脏大小与心
脏的左缘一致
Abnormal Apical Impul
异常心尖搏动 (1)
Abnormal location 位置改变
⏹ Physical: posture, pregnancy, etc.
生理因素:体位 妊娠
⏹ Heart dias 心脏病变
L.V and B.V enlargement: inferior left
左室或双室扩大:左下移位新目标英语
R.V enlargement: left
右室扩大:向左移位
⏹ Chest and abdominal dias
肺部或腹部疾病
Abnormal Apical Impul
异常心尖搏动 (1)
affiliated⏹ When a large amount of fluid or air is prent in the right plural civity will shift the heart toward the left;
if a large amount of air or fluid in the left plural cavity ,will displace the heart toward the right.
⏹ Retraction of lungs: in vere unilateral plural pulmonary fibrosis or obstraction atlectasis ,the inpul moves toward the affected side.
⏹ Pronounced distention of the abdomin as by gas fluid or large tumor,pushes the impul upward and left.
Abnormal Apical Impul
异常心尖搏动 (2)
Abnormal range or intensity 范围强度异常
⏹ Incread intensity: LV hypertrophy, hyperthyroidism, fever, anemia, etc.
搏动增强: 左室肥厚 甲亢 发热 贫血
⏹ Decread: myocardial dias, pericardial effusion, pleural effusion of left thorax
or left-side pneumothorax, emphyma.
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ahk
⏹ Inward impul: adhesive pericarditis.
负性心尖搏动: 心包粘连
Precordial Abnormal Impul
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
parachute
⏹ 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
Palpation of the Heart
心脏触诊
Palpation of the heart has three purpos
⏹ 1.Confirm the obrvation made during inspection
⏹ 2.To detect the pulsatial movment that are not visible
⏹ 3.To reveal the thrill or friction rubs in the prence of specific cardic dia
Apical Impul
心尖搏动
⏹ Clinical significance:
signifying the start of the systolic pha
临床意义: 指示收缩期的开始
⏹ Location and range: same as in inspection
位置和范围: 与心尖搏动视诊相同
⏹ Incread (heave): forceful and sustained
增强: 搏动持续有力
lifting apical impul 抬举性心脏搏动
ssou⏹ Decread: cannot palp. clearly
减弱: 不能清楚触到
Abnormal of Apical Impul
心尖搏动异常
⏹ Incread caus: left ventricular pressure overload and conquent hypertrophy
增强原因: 左室内压升高和肥厚
⏹ Clinical significance: left ventricular hypertrophy
traffic lights什么意思
临床意义: 左心室肥大
⏹ Decread caus: decread contractibility of the myocardium
