2023年心脏体检上课用（教学课件）.ppt

1 Department of Diagnostics 1st Affiliated Hospital Chen Ming 2 Equipment器材器材：Stethoscope听诊器听诊器；Position体位体位：Supine 卧位卧位or seated坐位坐位a patient；standing to the right side of the patient an examiner；Environment环境环境：Quiet 安静安静；Exposure暴露暴露：Strip to waist腰部腰部；Lightening光线光线：Good；left side；tangent切线切线；Knowledge of anatomy解剖知识解剖知识：thorough全面全面 Considerate and gentle。Physical examination of heart(心脏检查心脏检查)Preparation 3 Midsternal line胸骨中线胸骨中线 or Anterior midline 前正中线前正中线 Midclavicular lines锁骨中线锁骨中线 Anterior,middle,and posterior axillary lines 腋前、中、后线腋前、中、后线 Sternal angle 胸骨角胸骨角-connected with 2th costal cartilage 与第二肋软骨相连与第二肋软骨相连 Intercostal space 肋间隙肋间隙 Physical examination of heart(心脏检查心脏检查)landmarks of topographic anatomy解剖标解剖标志志 4 Inspection(望诊望诊)Palpation(触诊触诊)Percussion(叩诊叩诊)Auscultation(听诊听诊)心心 脏脏 检检 查查 Physical examination of heart(心脏检查心脏检查)5 Tangent lightening切线方向光线切线方向光线；Same height as thorax(与胸廓同高与胸廓同高。InspectionInspection望诊望诊-gistgist要点要点 6 Precordial prominencePrecordial prominence心前区隆起心前区隆起：Right ventricular hypertrophy at Right ventricular hypertrophy at pubertypuberty儿童发育完成前右心室肥大儿童发育完成前右心室肥大 Congenital heart disease(Congenital heart disease(先天性心脏先天性心脏病病)Rheumatic heart disease(Rheumatic heart disease(风湿性心脏病风湿性心脏病)Massive pericardial effusion in the Massive pericardial effusion in the adult adult 成人大量心包积液成人大量心包积液。Inspection望诊望诊-Deformity of thoraxes胸廓畸形胸廓畸形 7 InspectionInspection望诊望诊-ApicalApical impulseimpulse心尖搏动心尖搏动 DefinitionDefinition定义定义：Heart contractsHeart contracts心脏收缩心脏收缩 impacts impacts corresponding site of front chestcorresponding site of front chest心尖向心尖向前冲击前胸壁相应位置前冲击前胸壁相应位置)apical)apical impulse(impulse(心尖搏动心尖搏动)。8 InspectionInspection望诊望诊 Normal apical impulseNormal apical impulse正常心尖搏动正常心尖搏动：LocationLocation-The 5th intercostal The 5th intercostal spacespace第五肋间第五肋间,0.5,0.5 1.0 cm 1.0 cm medial to left midclavicular linemedial to left midclavicular line 左锁骨中线内侧左锁骨中线内侧 0.5 0.5 1.0 cm 1.0 cm；DiameterDiameter-2.0 2.0 2.5 cm2.5 cm。InspectionInspection望诊望诊-ApicalApical impulseimpulse心尖搏动心尖搏动 9 Physiological factorsPhysiological factors生理性因生理性因素素：Left lateral position Left lateral position 左侧卧位左侧卧位-extend to the leftextend to the left向左移向左移for for 2.0 2.0 3.0 cm.3.0 cm.Right lateral positionRight lateral position右侧卧位右侧卧位-extend to the rightextend to the right向右移向右移for for 1.0 1.0 2.5 cm.2.5 cm.InspectionInspection望诊望诊-Displacement of Displacement of apical apical impulseimpulse心尖搏动移位心尖搏动移位 10 Pathological factorsPathological factors病理性因素病理性因素：Heart itselfHeart itself心脏本身心脏本身 Enlargement of left ventricleEnlargement of left ventricle左左 心室增大心室增大-extend to left and extend to left and downwardsdownwards左下移位左下移位；InspectionInspection望诊望诊-Displacement of Displacement of apical apical impulseimpulse心尖搏动移位心尖搏动移位 11 Pathological factors病理性因素病理性因素：Heart itself心脏本身心脏本身 Enlargement of right ventricle右右 心室增大心室增大-extend to left but not downwards向左不向下移位向左不向下移位；Enlargement of both ventricles左左 右室均增大右室均增大-extend to both left and right.InspectionInspection望诊望诊-Displacement of Displacement of apical apical impulseimpulse心尖搏动移位心尖搏动移位 12 Pathological factorsPathological factors病理性因素病理性因素：Displacement of mediastinumDisplacement of mediastinum纵隔移纵隔移 位位 Pleural adhesion Pleural adhesion 胸膜粘连胸膜粘连，pulmonary atelectasis of one side pulmonary atelectasis of one side 肺肺 不张不张-displacement of apical displacement of apical impulse toward the diseased sideimpulse toward the diseased side移向移向 患侧患侧；Pleural effusionPleural effusion胸腔积液胸腔积液，pneumothorax of one sidepneumothorax of one side气胸气胸-displacement of apical impulse toward displacement of apical impulse toward the opposite sidethe opposite side移向健侧移向健侧.InspectionInspection望诊望诊-Displacement of Displacement of apical apical impulseimpulse心尖搏动移位心尖搏动移位 13 Pathological factorsPathological factors病理性因素病理性因素：Displacement of diaphragmDisplacement of diaphragm横隔移位横隔移位 Massive ascites Massive ascites 大量腹水大量腹水，huge huge tumor of abdominal cavity tumor of abdominal cavity 腹腔巨大腹腔巨大 肿瘤肿瘤-displacement of apical displacement of apical impulse to left impulse to left 移向左侧移向左侧；Severe emphysemaSevere emphysema肺气肿肺气肿-displacement of apical impulsedisplacement of apical impulse inward and downwardinward and downward移向内下移向内下。InspectionInspection望诊望诊-Displacement of Displacement of apical apical impulseimpulse心尖搏动移位心尖搏动移位 14 Physiological factorsPhysiological factors生理性因素生理性因素：Thick chest wallThick chest wall胸壁肥厚胸壁肥厚-weak weak and narrowand narrow减弱、缩小减弱、缩小；Thin chest wallThin chest wall胸壁薄胸壁薄-strong strong and wideand wide增强、较大增强、较大。InspectionInspection望诊望诊-Changes of Changes of intensity and range in apical intensity and range in apical impulse(impulse(心尖搏动强度与范围的改变心尖搏动强度与范围的改变 15 Pathological factorsPathological factors病理性因素病理性因素：Increase in intensity of apical Increase in intensity of apical impulseimpulse心尖搏动增强心尖搏动增强-feverfever发热发热，anemia anemia 贫血贫血，hyperthyroidismhyperthyroidism甲状腺机甲状腺机能亢进能亢进；Decrease in intensity of apical Decrease in intensity of apical impulseimpulse心尖搏动减弱心尖搏动减弱-dil