心脏体格检查视诊英文版.ppt

1 Physical Examination of Cardiovascular System FOR MBBS STUDENTS Department of Diagnostics The First Affiliated Hospital of Guangxi Medical University 2 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.3 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.4 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.5 Review the Anatomy 6 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 7 Part one Inspection 8 Inspection Precordium is the region of the anterior surface of the body covering the heart and lower thorax.9 Contents of Inspection Thoracic cage deformity Apical impulse Abnormal pulsations in precordium 10 Methods of Inspection Inspect the obverse side.Then obverse the patients lateral surface 11 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 12 Thoracic Cage Deformity（inspection）such as congenital heart disease and rheumatic heart disease,with skeletal molding to accommodate cardiac enlargement.13 Apical Impulse （inspection）Apical 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 movement.14 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 15 Apical Impulse （inspection）Apical impulse displacement Changes of intensity and area of apical impulse Inward impulse 16 Apical Impulse （inspection）Apical impulse displacement (1).extra-heart factors (2).cardiac enlargement (3).body posture 17 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.18 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 19 Apical Impulse Displacement Extra-heart factors:Leptosome;severely pulmonary emphysema.Then apical impulse shifts to inward and downward,reaches at the 6th intercostal space.20 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 21 Normal Apical Impulse Displacement heart shifts to the healthy side Pleural effussion in the right to the health side 22 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.23 Left Ventricle Enlargement Normal LV enlargement 24 Both Ventricles Enlargement Both ventricles enlargement Normal 25 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.26 Apical Impulse （inspection）Changes of intensity and area of apical impulse (1).Physical conditions (2).Pathological conditions 27 Physical conditions Thickness of the chest wall Emotion excited Strong physical activity Changes of Intensity and Area of Apical Impulse 28 Changes of intensity and area of apical impulse Pathological conditions Enhanced apical impulse:left ventricular enlargement hyperthyroidism fever,anemia Pathological conditions Weakened apical impulse:dilated myocardiopathy,hydropericardium,left pleural effusion,pulmonary emphysema 29 Inward Impulse Inward impulse.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.30 Abnormal Pulsations in Precordium Right vertricular hypertophy(RVH).The impulse is clearly seen in left third fourth intercostal space.Pulmonary emphysema with RVH,usually the pulsation can be found inferior the xiphoid process 31 Abnormal Pulsations in Precordium In ascending or arch aortic aneurysm,one may detects abnormal pulsations in aortic area,with bul