06心脏基本检查(7)

郑州大学第一附属医院CardiacBasicExamination心脏基本检查inspection视诊palpation触诊percussion叩诊auscultation听诊郑州大学第一附属医院InspectionoftheHeart心脏视诊precordiumshape心前区外形normalapicalimpulse正常心尖搏动abnormalapicalimpulse异常心尖搏动precordialabnormalimpulse心前区异常搏动郑州大学第一附属医院PrecordiumShape心前区外形Precordialbulge心前区隆起Features:bonybulge特点:骨骼突起Clinicalimportance:Congenitalheartdiseasewithventricularenlargement提示:先天性心脏病右室大Precordialsatiety心前区饱满Features:intercostalregionstickingout特点:肋间软组织外突Clinicalimportance:massofpericardialeffusion提示:大量心包积液郑州大学第一附属医院NormalApicalImpulse正常心尖搏动Location:0.5~1cmtotheleftmidclavicularlineatthe5thICSoutsideLSB.Range:2~2.5cmDirection:outwardwhenventricularsystolebegins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郑州大学第一附属医院AbnormalLocationofApicalImpulse心尖搏动位置改变Physical:posture,pregnancy,etc.生理因素:体位妊娠Heartdiseases心脏病变L.VandB.Venlargement:inferiorleft左室或双室扩大:左下移位R.Venlargement:left右室扩大:向左移位Chestandabdominaldiseases肺部或腹部疾病郑州大学第一附属医院AbnormalApicalImpulse异常心尖搏动Abnormalrangeorintensity范围强度异常Increasedintensity:LVhypertrophy,hyperthyroidism,fever,anemia,etc.搏动增强:左室肥厚甲亢发热贫血Decreased:myocardialdiseases,pericardialeffusion,pleuraleffusionofleftthoraxorleft-sidepneumothorax,emphysema.搏动减弱:心肌病变心包积液肺气肿左胸腔积液或气胸Abnormaldirection方向改变Inwardimpulse:adhesivepericarditis.负性心尖搏动:心包粘连郑州大学第一附属医院PrecordialAbnormalImpulse心前区异常搏动2ndICS,LSB:pulmonaryhypertension,youth胸骨左缘第二肋间:肺动脉高压青年人2ndICS,RSB:aneurysmofascendingaorta胸骨右缘第二肋间:升主动脉瘤3rd,4thICS,LSB:R.Vhypertrophy胸骨左缘3,4肋间:右心室肥大xiphoidprocess:R.Vhypertrophy,abdominalaneurysm剑突下:右心室肥大腹主动脉瘤郑州大学第一附属医院PalpationoftheHeart心脏触诊apicalimpulse心尖搏动thrill震颤pericardialfrictionfremitus心包摩擦感郑州大学第一附属医院ApicalImpulse心尖搏动Clinicalsignificance:signifyingthestartofthesystolicphase临床意义:指示收缩期的开始Locationandrange:sameasininspection位置和范围:与视诊相同Increased(heave):forcefulandsustained增强:搏动持续有力liftingapicalimpulse抬举性心脏搏动Decreased:cannotpalp.clearly减弱:不能清楚触到郑州大学第一附属医院AbnormalofApicalImpulse心尖搏动异常Increasedcauses:leftventricularpressureoverloadandconsequenthypertrophy增强原因:左室内压升高和肥厚Clinicalsignificance:leftventricularhypertrophy临床意义:左心室肥大Decreasedcauses:decreasedcontractibilityofthemyocardium减弱原因:心肌收缩力减弱Clinicalsignificance:heartfailure,pericardialeffusion,myocarditis临床意义:心力衰竭心包积液心肌炎郑州大学第一附属医院Thrill震颤Mechanism:formationofbloodflowvorticescausedbyvalvestenosisorabnormalpathway.产生机制:血流旋涡引起低频较强震动由瓣膜狭窄和异常通道引起Types:systole,diastole,continuous分型:收缩期震颤舒张期震颤持续震颤Clinicalsignificance:reliablesignsoforganicheartdiseases临床意义:器质性心脏病的征象郑州大学第一附属医院ThrillinSystole收缩期震颤2ndICS,LSB:pulmonicstenosis胸骨左缘第二肋间:肺动脉瓣狭窄2ndICS,RSB:aorticstenosis胸骨右缘第二肋间:主动脉瓣狭窄3rd,4thICS,LSB:interventricularseptaldefect胸骨左缘34肋间:室间隔缺损郑州大学第一附属医院ThrillinDiastoleandContinuous舒张期和持续性震颤Diastolicthrillonapex:mitralstenosis心尖部舒张期震颤:二尖瓣狭窄Continuousthrillon2ndICS,LSB:Patentductusarteriosus胸骨左缘第二肋间连续性震颤:动脉导管未闭郑州大学第一附属医院PericardialFrictionFremitus心包摩擦感Mechanism:inflammationorirritationofthepericardium机制:心包表面粗糙Typicalsite:4thICS,LSB部位:胸骨左缘第四肋间Feeling:frictionlikeleatherrubbing感觉:如皮革相互摩擦Features:itisbestpalpatedwiththepersonsittingupandleaningforward,andwiththebreathheldinexpiration特点:坐位前倾呼气末明显与心跳一致闭气时不消失Clinicalsignificance:pericarditis意义:提示心包炎郑州大学第一附属医院PercussionoftheHeart心脏叩诊percussionoftheheartborder心界叩诊abnormaldullnessheartborder心界异常郑州大学第一附属医院PercussionTechnique叩诊方法Force:lightpercussionfortherelativedullnessborder.力量:轻叩叩出相对浊音界Position:supine:parallelthemiddlefingertointercostal;sitting:plumbthemiddlefinger.体位:仰卧位:板指与肋间平行坐位:板指与肋间垂直Steps:fromlefttoright,lowertoupper,outwardtoinward顺序:先左后右自下而上由外向内Leftborder:2~3cmfromtheapicalimpulse心左界:心尖搏动外2~3cm开始Rightborder:ICSnexttotheupperborderoftheliver心右界:肝上界上一肋间开始Measure:thedistancefromdullnessbordertoanteriormidline测量:浊音界距前正中线的垂直距离郑州大学第一附属医院NormalRelativeDullnessBorderoftheHeart正常心浊音界Distancebetweendullnessborderandanteriormidline心脏之相对浊音界距前正中线的距离Right右(cm)ICS肋间Left左(cm)2-3Ⅱ2-32-3Ⅲ3.5-4.53-4Ⅳ5-6Ⅴ7-9(thedistancebetweenleftmidclavicularlineandanteriormidlineis9cm)(左锁骨中线距前正中线9cm)郑州大学第一附属医院AbnormalBorderbyHeartVariation心脏改变引起心界异常L.Venlargement:boot-shapedheart左室扩大:靴形心L.Aenlargement:pear-shapedheart左房扩大:梨形心B.Venlargement:generalenlargedheart双室扩大:普大心R.Venlargement:corpulmonal右室扩大:先心肺心Pericardialeffusion:flask-shapedheart心包积液:烧瓶心郑州大学第一附属医院AbnormalDullnessHeartBorder心界叩诊异常chestandlungdiseases胸肺疾病Pleuraleffusionorlungconsolidation:dullnessborderundetectable胸腔积液或肺实变:叩不出Emphysema:“shrinked”dullnessborder肺气肿:心浊音界缩小abdominaldisorders腹部疾病Diaphragmelevation:acrossingheart膈升高:横位心郑州大学第一附属医院Boot-shapedHeart靴形心Mechanism:L.VenlargementFeatures:theleftborderextendstotheinferiorleft,waistoftheheartisdeepened.Causes:aorticinsufficiency,hypertensiveheartdisease机制左室扩大特点心左界向左下扩大心腰加深病因主动脉瓣关闭不全高血压心脏病郑州大学第一附属医院Pear-shapedHeart梨形心Mechanism:L.AenlargementanddistensionofpulmonaryarteryFeatures:dullnessheartborderinthe2nd,3rdICSontheLSBextendsoutside,waistoftheheartbulgesoutCauses:mitralstenosis机制左房扩大肺动脉扩大特点胸骨左缘23肋间心浊音界向外扩大心腰饱满或膨出病因二尖瓣狭窄郑州大学第一附属医院GeneralEnlargedHeart普大心Mechanism:bothleftan