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ChapterVThoraxD.Heartandbloodvessels

BloodVessel

byDr.Zhuo-renLu1.Inspection(1)Venousbloodpressurel

Whenthevenouspressureiselevated,anengorgedexternaljugularveincanbeseenabovetheloweronethirdofthedistancebetweensuperclavicleandtheangleofthejawwithpatientsittingerect,andabovethelowertwothirdofthedistancebetweensuperclavicleandtheangleofthejawatsupineposition.l

Itoftenindicatestheelevatedpressureintherightatriumandisanimportantsignofcongestiveheartfailure,pericardialconstriction,andpericardialeffusion.(2)ThevisiblepulsationintheneckveinsItindicatesthe

regurgitationoftricuspidvalveandthevisiblepulsationofcarotidarteryoccursinaorticregurgitation.Thelevelofvisiblepulsationintheneckveinsdescendsonnormalinspirationandrisesonexpiration.Thepulsationofjugularveinlooksdiffuse,butthepointofcarotidarterypulseislimited.Itrequiresmuchgreaterpressuretoeliminatethecarotidarterypulsewithadistinctpulsefeeling.

(3)Hepatojugularreflux

Compressionoftherightupperabdominalquadrantfor30to45secondswillresultinmoreprominentdistensionofexternaljugularvein.l

Itusuallyisanimportantsignofrightventricularfailureorpericardialeffusionorconstriction,becausebloodisbeingtransmittedfromthelivertothesuperiorvenacavewithoutreturningbacktorightatriummore.Itisusuallyusedtodistinguishhepotohemia

from

hepatitis,hepotoma,hepatocirrhosis.(4)Capillarypulsation

Checkcapillarypulsation

bypressingonnailsorlipswithaclearglassandlookingatthechangeofcolorfrompinktowhite.Capillarypulsationoccursinaorticregurgitationandotherabnormalitiesassociatedwithwidepulsepressure.2.Palpation(1)Examinerplacefingersovertheradialarteryandcanfeelthestrongarterypulsating.Itisstillaboundingpulsewhenelevatingthepatient’sarmoverhishead.Itiscalledaswater-hammerpulseandoftenoccursinaorticregurgitationandotherabnormalitiesassociatedwithwidepulsepressure.(2)Pulsusparadoxus(paradoxicalpulse)isanimportantsignofcardiactamponadewithtensepericardialeffusionandlessfrequentlywithchronicconstrictivepericarditis.Thetermreferstoweakeningofthepulseduringdeepinspiration.

(3)Pulsusalternansischaracterizedbyaregularlyalternatingpulse,inwhicheveryotherbeatisweakerthantheprecedingbeat.Itisvaluableindicationofleftventricularfailure.(4)Checkthe

symmetryofpulses.Thrombosisorembolisminvolvingonesubclavian,axillary,orbrachialarteryusuallyresultsinanabsentradialpulseo

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