最新心脏检查CARDIOVASCUIAREXAMINATIONPPT课件.ppt

心脏检查CARDIOVASCUIAREXAMINATION课堂目标课堂目标learningoblectives说出正常心尖搏动的位置和范围说出正常心尖搏动的位置和范围说出正常心尖搏动的位置和范围说出正常心尖搏动的位置和范围TostatetherangeandsiteofTostatetherangeandsiteofapicalimpulseapicalimpulse 阐述震颤的概念、产生机制及临床意义阐述震颤的概念、产生机制及临床意义阐述震颤的概念、产生机制及临床意义阐述震颤的概念、产生机制及临床意义ToToelaborateelaborate theconcept,mechanismandclinicalstheconcept,mechanismandclinicalsignificanceofthrillignificanceofthrill 描述正常心脏相对浊音界的范围描述正常心脏相对浊音界的范围描述正常心脏相对浊音界的范围描述正常心脏相对浊音界的范围TodescribetheTodescribetheborderofrelativedullnessborderofrelativedullness说出心脏瓣膜听诊区的概念及位置说出心脏瓣膜听诊区的概念及位置说出心脏瓣膜听诊区的概念及位置说出心脏瓣膜听诊区的概念及位置TostatetheconceptandsiteofTostatetheconceptandsiteofauscultatoryauscultatorycardiaccardiacvalveareasvalveareas 比较比较比较比较S S1 1、S S2 2心音的产生机制、特点与临床意义心音的产生机制、特点与临床意义心音的产生机制、特点与临床意义心音的产生机制、特点与临床意义TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterTocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsandclinicalsignificanceignificance陈述杂音的概念与分级陈述杂音的概念与分级陈述杂音的概念与分级陈述杂音的概念与分级TostatetheconceptandgradeofheartmurmursTostatetheconceptandgradeofheartmurmurs(二二)正常心脏相对浊音界正常心脏相对浊音界the normal the normal border of relative dullness RightRightborderborder（cmcm）intercostal intercostal space space LeftLeftborderborder（cmcm）2-3 2-3 2-3 2-3 2-3 2-3 2-3 2-3 3-4 3-4 3-4 3-4 II II II II III III III III IV IV IV IV V V V V 2 3 2 3 2 3 2 3 3.5 4.5 3.5 4.5 3.5 4.5 3.5 4.5 5-6 5-6 5-6 5-6 7-9 7-9 7-9 7-9 听听 诊诊auscultation 用膜型胸件听诊用膜型胸件听诊用膜型胸件听诊用膜型胸件听诊 Auscultate with diaphragm Auscultate with diaphragm Auscultate with diaphragm Auscultate with diaphragm 肺动脉瓣区（胸骨左缘第肺动脉瓣区（胸骨左缘第肺动脉瓣区（胸骨左缘第肺动脉瓣区（胸骨左缘第2 2 2 2肋间隙）肋间隙）肋间隙）肋间隙）主动脉瓣区（胸骨右缘第主动脉瓣区（胸骨右缘第主动脉瓣区（胸骨右缘第主动脉瓣区（胸骨右缘第2 2 2 2肋间隙）肋间隙）肋间隙）肋间隙）主动脉瓣第二听诊区（胸骨左缘第主动脉瓣第二听诊区（胸骨左缘第主动脉瓣第二听诊区（胸骨左缘第主动脉瓣第二听诊区（胸骨左缘第3 3 3 3、4 4 4 4肋间隙）肋间隙）肋间隙）肋间隙）二尖瓣区（心尖部）二尖瓣区（心尖部）二尖瓣区（心尖部）二尖瓣区（心尖部）三尖瓣区（胸骨左缘第三尖瓣区（胸骨左缘第三尖瓣区（胸骨左缘第三尖瓣区（胸骨左缘第4 4 4 4、5 5 5 5肋间隙或胸骨体下端稍偏右）肋间隙或胸骨体下端稍偏右）肋间隙或胸骨体下端稍偏右）肋间隙或胸骨体下端稍偏右）Pulmonary area(second left ICS)Pulmonary area(second left ICS)Aortic area(second right ICS)Aortic area(second right ICS)Second aortic area(third and fourth left ICS)Second aortic area(third and fourth left ICS)Mitral area(Apical area)Mitral area(Apical area)Tricuspid area(fourth,fifth left ICS,LSB and RSB)Tricuspid area(fourth,fifth left ICS,LSB and RSB)听听 诊诊auscultation用钟型胸件听诊用钟型胸件听诊用钟型胸件听诊用钟型胸件听诊 Auscultate with bellAuscultate with bell 肺动脉瓣区肺动脉瓣区肺动脉瓣区肺动脉瓣区 主动脉瓣区主动脉瓣区主动脉瓣区主动脉瓣区 主动脉瓣第二听诊区主动脉瓣第二听诊区主动脉瓣第二听诊区主动脉瓣第二听诊区 二尖瓣区二尖瓣区二尖瓣区二尖瓣区 三尖瓣区三尖瓣区三尖瓣区三尖瓣区Pulmonary areaPulmonary areaAortic areaAortic areaSecond aortic areaSecond aortic areaMitral area(Apical area)Mitral area(Apical area)Tricuspid areaTricuspid area心脏瓣膜听诊区心脏瓣膜听诊区 auscultatorycardiacvalveareas 与各瓣膜的解剖位置并不完全一致。cardiac valves are not exactly located in the auscultatory cardiac valve areas.心脏瓣膜听诊区为四个瓣膜五个区。We have four valves but five auscultatory cardiac valve areas心脏瓣膜听诊区心脏瓣膜听诊区 auscultatorycardiacvalveareas 心心 音音cardiacsounds 心音有四个，第一心音心音有四个，第一心音心音有四个，第一心音心音有四个，第一心音(S1)(S1)，第二心音，第二心音，第二心音，第二心音(S2),(S2),第三心音第三心音第三心音第三心音(S3)(S3)和第四心音和第四心音和第四心音和第四心音(S4)(S4)。Four kinds of Four kinds of cardiac sounds:S1,S2,S3,S4cardiac sounds:S1,S2,S3,S4通常只能听到通常只能听到通常只能听到通常只能听到S1S1和和和和S2S2，在某些健康儿童和青少年也可听到，在某些健康儿童和青少年也可听到，在某些健康儿童和青少年也可听到，在某些健康儿童和青少年也可听到S3S3。S4S4般听不到，如能听到可能为病理性。般听不到，如能听到可能为病理性。般听不到，如能听到可能为病理性。般听不到，如能听到可能为病理性。S1 and S2 can be heard in all people,S3 can be heard in S1 and S2 can be heard in all people,S3 can be heard in some healthy children and teenager,but S4 is often has some healthy children and teenager,but S4 is often has pathological significance.pathological significance.S1 and s2S1S1比比S2S2响亮响亮;S1 is louder than S2;S1 is louder than S2;S1S1与与S2S2的产生机制的产生机制The mechanism of S1 and S2;The mechanism of S1 and S2;心 脏 杂 音cardiac murmurscardiac murmurs产生机制产生机制;mechanismmechanism特点特点CharacterCharacter分级分级:6:6级级Grade:Grade:心包摩擦音心包摩擦音pericardialfrictionsound 产生机制产生机制MechanismMechanism思考题思考题:如何区分心包摩擦音与胸膜摩擦音如何区分心包摩擦音与胸膜摩擦音？Question:how to distinguish the and pericardial friction sound and pleural friction rub 结束语结束语谢谢大家聆听！谢谢大家聆听！19