F心脏检查A.ppt

* * physical examination心脏检查(1)Cardiac Examination inspection 视诊 palpation 触诊 percussion 叩诊 auscultation 听诊 Inspection of the Heart心脏视诊 precordium shape 心前区外形 normal apical impulse 正常心尖搏动 abnormal apical impulse 异常心尖搏动 precordial abnormal impulse 心前区异常搏动 Precordium Shape心前区外形 Precordial bulge 心前区隆起 Features: bony bulge 特点:骨骼突起 Clinical importance: Congenital heart disease with ventricular enlargement 提示:先天性心脏病右室大 Precordial satiety 心前区饱满 Features: intercostal region sticking out 特点:肋间软组织外突 Clinical importance: mass of pericardial effusion 提示:大量心包积液 Normal Apical Impulse正常心尖搏动 Location: 0.5~1 cm to the left midclavicular line at the 5th ICS outside LSB. Range: 2~2.5cm Direction: outward when ventricular systole begins 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 Abnormal Apical Impulse异常心尖搏动 (1) Abnormal location 位置改变 Physical: posture, pregnancy, etc. 生理因素:体位 妊娠 Heart diseases 心脏病变 L.V and B.V enlargement: inferior left 左室或双室扩大:左下移位 R.V enlargement: left 右室扩大:向左移位 Chest and abdominal diseases 肺部或腹部疾病 Abnormal Apical Impulse异常心尖搏动 (2) Abnormal range or intensity 范围强度异常 Increased intensity: LV hypertrophy, hyperthyroidism, fever, anemia, etc. 搏动增强: 左室肥厚 甲亢 发热 贫血 Decreased: myocardial diseases, pericardial effusion, pleural effusion of left thorax or left-side pneumothorax, emphysema. 搏动减弱: 心肌病变 心包积液 肺气肿 左胸腔积液或气胸 Abnormal direction 方向改变 Inward impulse: adhesive pericarditis. 负性心尖搏动: 心包粘连 Palpation of the Heart心脏触诊 apical impulse 心尖搏动 thrill 震颤 pericardial friction fremitus 心包摩擦感 Apical Impulse心尖搏动 Clinical significance: signifying the start of the systolic phase 临床意义: 指示收缩期的开始 Location and range: same as in inspection 位置和范围: 与心尖搏动视诊相同 Increased (heave): forceful and sustained 增强: 搏动持续有力 lifting apical impulse 抬举性心脏搏动 Decreased: cannot palp. clearly