医学专题一心脏体格检查视诊英文版.ppt

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1、Physical Examinationof Cardiovascular SystemFOR MBBS STUDENTSDepartment of DiagnosticsThe First Affiliated Hospital of Guangxi Medical University1第一页，共三十五页。General Considerationn nDuring lifetime,the heart contracts more than 4 billion times.n nPumping 200 million L blood to systemic circulation.n n

2、Cardiac output varies under physiologic conditions from 3 to 30L/min.Heart rate varies from 60 to 150 beats/min.2第二页，共三十五页。Physical Examination of Cardiovascular systemPhysical Examination of Cardiovascular system In the present era of technological advances,particularly in the various imaging modal

3、ities,physical examination of the heart still provides useful information.3第三页，共三十五页。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 diag

4、nosis of CVD.4第四页，共三十五页。Review the Anatomy5第五页，共三十五页。Routine 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 6第六页，共三十五页。Part oneInspection 7第七页，共三十五页。Inspec

5、tion Precordium is the region of the anterior surface of the body covering the heart and lower thorax.8第八页，共三十五页。Contents of Inspectionn nThoracic cage deformityn nApical impulse n nAbnormal pulsations in precordium9第九页，共三十五页。Methods of Inspectionn nInspect the obverse side.n nThen obverse the patie

6、nts lateral surface 10第十页，共三十五页。Thoracic Cage Deformity（inspection）Asymmetry of the thoracic cage due to a convex bulging of the precordium suggests the presence of heart disease since childhood11第十一页，共三十五页。Thoracic Cage Deformity（inspection）such as congenital heart disease and rheumatic heart disea

7、se,with skeletal molding to accommodate cardiac enlargement.12第十二页，共三十五页。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

8、movement.13第十三页，共三十五页。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 diameter14第十四页，共三十五页。Apical Impulse（inspection）n nApical impulse displacementn nChanges of intensity and area of ap

9、ical impulsen nInward impulse15第十五页，共三十五页。Apical Impulse（inspection）Apical impulse displacement(1).extra-heart factors(2).cardiac enlargement(3).body posture16第十六页，共三十五页。Apical Impulse Displacement Extra-heart factors:Obesity,pregnancy,etc.cause elevation of diaphragm,apical impulse shifts to outwar

10、d and upward,at left the 4th intercostal space outside midclavicular line.17第十七页，共三十五页。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第十八页，共三十五页。Apical Impulse Displa

11、cement Extra-heart factors:Leptosome;severely pulmonary emphysema.Then apical impulse shifts to inward and downward,reaches at the 6th intercostal space.19第十九页，共三十五页。Apical Impulse Displacement Extra-heart factors:Single side pleural thickening,or adhesion,or atelectasis result in mediastinum and he

12、art shifting to the sick side,and the apical impulse shifts to the sick side,too.aortic arch LV to the sick side20第二十页，共三十五页。NormalApical Impulse Displacementheart shifts to the healthy sidePleural effussion in the rightto the healthside21第二十一页，共三十五页。Apical Impulse DisplacementCardiac enlargementn n

13、Right 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.22第二十二页，共三十五页。Left Ventricle EnlargementNormal LV enlargement23第二十三页，共三十五页。Both Ventricles EnlargementBoth ventricles enlargeme

14、ntNormal24第二十四页，共三十五页。Apical 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.25第二十五页，共三十五页。Apical Impulse（inspection）

15、Changes of intensity and area of apical impulse(1).Physical conditions(2).Pathological conditions26第二十六页，共三十五页。Physical conditionsn nThickness of the chest wall n nEmotion excitedn nStrong physical activity Changes of Intensity and Area of Apical Impulse27第二十七页，共三十五页。Changes of intensity and area of

16、 apical impulsePathological conditionsEnhanced apical impulse:n left ventricular enlargementn hyperthyroidismn fever,anemiaPathological conditionsWeakened apical impulse:n dilated myocardiopathy,n hydropericardium,nleft pleural effusion,n pulmonary emphysema28第二十八页，共三十五页。Inward Impulse Inward impuls

17、e.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.29第二十九页，共三十五页。Abnormal Pulsations in Precordiumn nRight vertricular hypertophy(RVH).The impulse is clearly seen in left thi

18、rd fourth intercostal space.n nPulmonary emphysema with RVH,usually the pulsation can be found inferior the xiphoid process30第三十页，共三十五页。Abnormal Pulsations in Precordiumn nIn ascending or arch aortic aneurysm,one may detects abnormal pulsations in aortic area,with bulging or pulsation in systole.Pul

19、monary hypertension with dilatation the pulsation in systole may be detected in left second intercostal space to the edge of sternum.31第三十一页，共三十五页。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.3

20、2第三十二页，共三十五页。Referencen n诊断学第8版，全国规划(guhu)(guhu)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33第三十三页，共三十五页。34第三十四页，共三十五页。内容(nirng)总结Physical Examination。Ma Guotian,M.D.。(1).extra-heart factors。to the health。(2).Pathological conditions。34第三十五页，共三十五页。