心臟檢查

CARDIOVASCUIAREXAMINATION

心臟檢查

CARDIOVASCUIAREXAMINATIO1課堂目標

learningoblectives說出正常心尖搏動的位置和范圍Tostatetherangeandsiteofapicalimpulse

闡述震顫的概念、產(chǎn)生機制及臨床意義Toelaborate

theconcept,mechanismandclinicalsignificanceofthrill

描述正常心臟相對濁音界的范圍Todescribetheborderofrelativedullness說出心臟瓣膜聽診區(qū)的概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas

比較S1、S2心音的產(chǎn)生機制、特點與臨床意義TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陳述雜音的概念與分級Tostatetheconceptandgradeofheartmurmurs課堂目標

learningoblectives說出正常心尖2概述

introduction

運用視、觸、叩、聽等檢查方法初步判定有無心臟疾病，判斷心臟病的病因、性質(zhì)、部位及程度．在臨床上具有重要的意義。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.概述

introduction運用視、觸、叩、聽等3檢查的注意事項

mattersneedingattentionintheexamination

一般采取仰臥位或坐位；dorsalpositionorsittingpositionisoftenused;環(huán)境應(yīng)安靜；光線充足，最好是來源于左側(cè)，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室溫不低于20℃；Temperatureshouldbehigherthan20℃檢查的注意事項

mattersneedingattent4心臟視診

lnspectionoftheheart

(一)心前區(qū)隆起與凹陷eminenceorintrocessioninprecordialregion

(二)心尖搏動apicalimpulse(三)心前區(qū)異常搏動Abnormalprecordialpulsation

心臟視診

lnspectionoftheheart(5心臟觸診

Palpationoftheheart檢查者常用右手，以全手掌、手掌尺側(cè)(小魚際)或示指、中指和無名指并攏以指腹觸診。Thewholepalm,antithenareminenceorfingertips

ofRighthandisoftenusedwhenPalpation.檢查震顫常用手掌尺側(cè)，檢查心尖搏動常用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpation心臟觸診

Palpationoftheheart檢查者6Palpationoftheheart(一)心尖搏動apicalimpulse(二)震顫:概念;產(chǎn)生機制Thrill:concept;mechanism(三)心包摩擦感:概念;產(chǎn)生機制;特點senseofpericardialfriction:concept;mechanism;characterPalpationoftheheart(一)心尖搏動7心臟叩診

Percussionoftheheart

心臟叩診用以確定心界，判定心臟大小、形狀及在胸腔位置的一種方法。Percussionoftheheartisusedtofindtheborderoftheheart;相對濁音界反映心臟的實際大小,具有重要的臨床意義.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.心臟叩診

Percussionoftheheart心8(二)正常心臟相對濁音界

thenormalborderofrelativedullness

Rightborder（cm）intercostalspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9(二)正常心臟相對濁音界

thenormalborder9聽診

auscultation

用膜型胸件聽診Auscultatewithdiaphragm

?肺動脈瓣區(qū)（胸骨左緣第2肋間隙）

?主動脈瓣區(qū)（胸骨右緣第2肋間隙）

?主動脈瓣第二聽診區(qū)（胸骨左緣第3、4肋間隙）

?二尖瓣區(qū)（心尖部）

?三尖瓣區(qū)（胸骨左緣第4、5肋間隙或胸骨體下端稍偏右）

?Pulmonaryarea(secondleftICS)

?Aorticarea(secondrightICS)

?Secondaorticarea(thirdandfourthleftICS)

?Mitralarea(Apicalarea)

?Tricuspidarea(fourth,fifthleftICS,LSBandRSB)

聽診

auscultation用膜型胸件聽診Au10聽診

auscultation用鐘型胸件聽診Auscultatewithbell

?肺動脈瓣區(qū)

?主動脈瓣區(qū)

?主動脈瓣第二聽診區(qū)

?二尖瓣區(qū)

?三尖瓣區(qū)

?Pulmonaryarea

?Aorticarea

?Secondaorticarea

?Mitralarea(Apicalarea)

?Tricuspidarea

聽診

auscultation用鐘型胸件聽診Aus11心臟瓣膜聽診區(qū)

auscultatorycardiacvalveareas

與各瓣膜的解剖位置并不完全一致。cardiacvalvesarenotexactlylocatedintheauscultatorycardiacvalveareas.心臟瓣膜聽診區(qū)為四個瓣膜五個區(qū)。Wehavefourvalvesbutfiveauscultatorycardiacvalveareas

心臟瓣膜聽診區(qū)

auscultatorycardiac12心臟瓣膜聽診區(qū)

auscultatorycardiacvalveareas

心臟瓣膜聽診區(qū)

auscultatorycardiac13心音

cardiacsounds

心音有四個，第一心音(S1)，第二心音(S2),第三心音(S3)和第四心音(S4)。Fourkindsofcardiacsounds:S1,S2,S3,S4通常只能聽到S1和S2，在某些健康兒童和青少年也可聽到S3。S4般聽不到，如能聽到可能為病理性。S1andS2canbeheardinallpeople,S3canbeheardinsomehealthychildrenandteenager,butS4isoftenhaspathologicalsignificance.心音

cardiacsounds心音有四個，第一心音14S1ands2S1比S2響亮;S1islouderthanS2;S1與S2的產(chǎn)生機制ThemechanismofS1andS2;S1ands2S1比S2響亮;15心臟雜音

cardiacmurmurs產(chǎn)生機制;mechanism特點Character分級:6級Grade:Ⅰ~Ⅵ心臟雜音

cardiacmurmurs產(chǎn)生機制16心包摩擦音

pericardialfrictionsound

產(chǎn)生機制Mechanism思考題:如何區(qū)分心包摩擦音與胸膜摩擦音？Question:howtodistinguishtheandpericardialfrictionsoundandpleuralfrictionrub

心包摩擦音

pericardialfrictionsou17QUESTIONS？QUESTIONS？18心臟檢查

CARDIOVASCUIAREXAMINATION

心臟檢查

CARDIOVASCUIAREXAMINATIO19課堂目標

learningoblectives說出正常心尖搏動的位置和范圍Tostatetherangeandsiteofapicalimpulse

闡述震顫的概念、產(chǎn)生機制及臨床意義Toelaborate

theconcept,mechanismandclinicalsignificanceofthrill

描述正常心臟相對濁音界的范圍Todescribetheborderofrelativedullness說出心臟瓣膜聽診區(qū)的概念及位置Tostatetheconceptandsiteofauscultatorycardiacvalveareas

比較S1、S2心音的產(chǎn)生機制、特點與臨床意義TocomparethedifferencebetweenS1andS2abouttheirmechanism,characterandclinicalsignificance陳述雜音的概念與分級Tostatetheconceptandgradeofheartmurmurs課堂目標

learningoblectives說出正常心尖20概述

introduction

運用視、觸、叩、聽等檢查方法初步判定有無心臟疾病，判斷心臟病的病因、性質(zhì)、部位及程度．在臨床上具有重要的意義。Touseinspection,palpation,percussionandauscultationtodeterminewhetherheartdiseasesexistandwhatthecausesmaybe,thesiteandthecharactersifheartdiseasesexist.SoCARDIOVASCUIAREXAMINATIONhasgreatsignificance.概述

introduction運用視、觸、叩、聽等21檢查的注意事項

mattersneedingattentionintheexamination

一般采取仰臥位或坐位；dorsalpositionorsittingpositionisoftenused;環(huán)境應(yīng)安靜；光線充足，最好是來源于左側(cè)，Theenvironmentshouldbequietandbright;itwillbebetteriflightsourcecomesfromleftside;室溫不低于20℃；Temperatureshouldbehigherthan20℃檢查的注意事項

mattersneedingattent22心臟視診

lnspectionoftheheart

(一)心前區(qū)隆起與凹陷eminenceorintrocessioninprecordialregion

(二)心尖搏動apicalimpulse(三)心前區(qū)異常搏動Abnormalprecordialpulsation

心臟視診

lnspectionoftheheart(23心臟觸診

Palpationoftheheart檢查者常用右手，以全手掌、手掌尺側(cè)(小魚際)或示指、中指和無名指并攏以指腹觸診。Thewholepalm,antithenareminenceorfingertips

ofRighthandisoftenusedwhenPalpation.檢查震顫常用手掌尺側(cè)，檢查心尖搏動常用2-4指指腹。antithenareminenceisoftenusedforthrillPalpation,whilefingertipsareoftenusedforapicalimpulsePalpation心臟觸診

Palpationoftheheart檢查者24Palpationoftheheart(一)心尖搏動apicalimpulse(二)震顫:概念;產(chǎn)生機制Thrill:concept;mechanism(三)心包摩擦感:概念;產(chǎn)生機制;特點senseofpericardialfriction:concept;mechanism;characterPalpationoftheheart(一)心尖搏動25心臟叩診

Percussionoftheheart

心臟叩診用以確定心界，判定心臟大小、形狀及在胸腔位置的一種方法。Percussionoftheheartisusedtofindtheborderoftheheart;相對濁音界反映心臟的實際大小,具有重要的臨床意義.borderofrelativedullnesspresentthetruesizeoftheheart,soithasmoreclinicalsignificance.心臟叩診

Percussionoftheheart心26(二)正常心臟相對濁音界

thenormalborderofrelativedullness

Rightborder（cm）intercostalspaceLeftborder（cm）2-32-33-4IIIIIIVV2–33.5–4.55-67-9(二)正常心臟相對濁音界

thenormalborder27聽診

auscultation

用膜型胸件聽診Auscultatewithdiaphragm

?肺動脈瓣區(qū)（胸骨左緣第2肋間隙）

?主動脈瓣區(qū)（胸骨右緣第2肋間隙）

?主動脈瓣第二聽診區(qū)（胸骨左緣第3、4肋間隙）

?二尖瓣區(qū)（心尖部）

?三尖瓣區(qū)（胸骨左緣第4、5肋間隙或胸骨體下端稍偏右）

?Pulmonaryarea(secondleftICS)

?Aorticarea(secondrightICS)

?Secondaorticarea(thirdandfourthleftICS)

?Mitralarea(Apicalarea)

?Tricuspidarea(fourth,fifthleftICS,LSBandRSB)

聽診

auscultation用膜型胸件聽診Au28聽診

auscultation用鐘型胸件聽診Auscultatewithbell

?肺動脈瓣區(qū)

?主動脈瓣區(qū)

?主動脈瓣第二聽診區(qū)

?二尖瓣區(qū)

?三尖瓣區(qū)

?Pulmonaryarea

?Aorticarea

?Secondaorticarea

?Mitralarea(Apicalarea)

?Tricuspidarea

聽診

auscultation用鐘型胸件聽診Aus29心臟瓣膜聽診區(qū)

auscultatorycardiacvalveareas

與各瓣膜的解剖位置并不完全一致。cardiacvalvesarenotexactlylocatedintheauscultatorycardiacvalveareas.心臟瓣膜聽診區(qū)為四個瓣膜五個區(qū)。Wehavefourvalvesbutfiveauscultatorycardiacvalveareas

心臟瓣膜聽診區(qū)

auscultatorycardia