医学诊断学：心脏检查A.ppt

心脏检查心脏检查心脏视诊心脏视诊n n心前区外形心前区外形n n正常心尖搏动正常心尖搏动n n异常心尖搏动异常心尖搏动n n心前区异常搏动心前区异常搏动Precordium ShapePrecordium ShapePrecordium ShapePrecordium Shape心前区外形心前区外形Precordial bulge Precordial bulge Precordial bulge Precordial bulge 心前区隆起心前区隆起心前区隆起心前区隆起n nFeatures: bony bulge Features: bony bulge Features: bony bulge Features: bony bulge 特点特点特点特点: : : : 骨骼突起骨骼突起骨骼突起骨骼突起 n nClinical importance: Congenital heart disease with Clinical importance: Congenital heart disease with Clinical importance: Congenital heart disease with Clinical importance: Congenital heart disease with ventricular enlargementventricular enlargementventricular enlargementventricular enlargement 提示提示提示提示: : : : 先天性心脏病右室大先天性心脏病右室大先天性心脏病右室大先天性心脏病右室大Precordial satiety Precordial satiety Precordial satiety Precordial satiety 心前区饱满心前区饱满心前区饱满心前区饱满n nFeatures: intercostal region sticking outFeatures: intercostal region sticking outFeatures: intercostal region sticking outFeatures: intercostal region sticking out 特点特点特点特点: : : : 肋间软组织外突肋间软组织外突肋间软组织外突肋间软组织外突n nClinical importance: mass of pericardial effusionClinical importance: mass of pericardial effusionClinical importance: mass of pericardial effusionClinical importance: mass of pericardial effusion 提示提示提示提示: : : : 大量心包积液大量心包积液大量心包积液大量心包积液Normal Apical ImpulseNormal Apical ImpulseNormal Apical ImpulseNormal Apical Impulse正常心尖搏动正常心尖搏动n nLocation: 0.5~1 cm to Location: 0.5~1 cm to Location: 0.5~1 cm to Location: 0.5~1 cm to the left midclavicular the left midclavicular the left midclavicular the left midclavicular line at the 5th ICS line at the 5th ICS line at the 5th ICS line at the 5th ICS outside LSB. outside LSB. outside LSB. outside LSB. n nRange: 2~2.5cmRange: 2~2.5cmRange: 2~2.5cmRange: 2~2.5cmn nDirection: outward Direction: outward Direction: outward Direction: outward when ventricular when ventricular when ventricular when ventricular systole beginssystole beginssystole beginssystole beginsn n位置位置位置位置: : : : 第第第第5 5肋间肋间肋间肋间 左锁骨中线内左锁骨中线内左锁骨中线内左锁骨中线内 0.5~1cm0.5~1cm0.5~1cm0.5~1cmn n范围范围范围范围: : : : 2~2.5cm2~2.5cm2~2.5cm2~2.5cmn n方向方向方向方向: : : : 收缩时向外搏动收缩时向外搏动收缩时向外搏动收缩时向外搏动n n意义意义意义意义: : : : 提示心尖位置提示心尖位置提示心尖位置提示心尖位置 代表收缩期代表收缩期代表收缩期代表收缩期 提示心脏大小提示心脏大小提示心脏大小提示心脏大小Abnormal Location of Apical ImpulseAbnormal Location of Apical ImpulseAbnormal Location of Apical ImpulseAbnormal Location of Apical Impulse心尖搏动位置改变心尖搏动位置改变n nPhysical: posture, pregnancy, etc.Physical: posture, pregnancy, etc.Physical: posture, pregnancy, etc.Physical: posture, pregnancy, etc. 生理因素生理因素生理因素生理因素: : : : 体位体位体位体位 妊娠妊娠妊娠妊娠n nHeart diseases Heart diseases Heart diseases Heart diseases 心脏病变心脏病变心脏病变心脏病变 L.V and B.V enlargement: inferior leftL.V and B.V enlargement: inferior leftL.V and B.V enlargement: inferior leftL.V and B.V enlargement: inferior left 左室或双室扩大左室或双室扩大左室或双室扩大左室或双室扩大: : : : 左下移位左下移位左下移位左下移位 R.V enlargement: leftR.V enlargement: leftR.V enlargement: leftR.V enlargement: left 右室扩大右室扩大右室扩大右室扩大: : : : 向左移位向左移位向左移位向左移位n nChest and abdominal diseasesChest and abdominal diseasesChest and abdominal diseasesChest and abdominal diseases 肺部或腹部疾病肺部或腹部疾病肺部或腹部疾病肺部或腹部疾病Abnormal Apical ImpulseAbnormal Apical ImpulseAbnormal Apical ImpulseAbnormal Apical Impulse异常心尖搏动异常心尖搏动Abnormal range or intensity Abnormal range or intensity Abnormal range or intensity Abnormal range or intensity 范围强度异常范围强度异常范围强度异常范围强度异常n nIncreased intensity: LV hypertrophy, Increased intensity: LV hypertrophy, Increased intensity: LV hypertrophy, Increased intensity: LV hypertrophy, hyperthyroidism, fever, anemia, etc.hyperthyroidism, fever, anemia, etc.hyperthyroidism, fever, anemia, etc.hyperthyroidism, fever, anemia, etc. 搏动增强搏动增强搏动增强搏动增强: : : : 左室肥厚左室肥厚左室肥厚左室肥厚 甲亢甲亢甲亢甲亢 发热发热发热发热 贫血贫血贫血贫血n nDecreased: myocardial diseases, pericardial Decreased: myocardial diseases, pericardial Decreased: myocardial diseases, pericardial Decreased: myocardial diseases, pericardial effusion, pleural effusion of left thorax or effusion, pleural effusion of left thorax or effusion, pleural effusion of left thorax or effusion, pleural effusion of left thorax or left-side pneumothorax, emphysema.left-side pneumothorax, emphysema.left-side pneumothorax, emphysema.left-side pneumothorax, emphysema. 搏动减弱搏动减弱搏动减弱搏动减弱: : : : 心肌病变心肌病变心肌病变心肌病变 心包积液心包积液心包积液心包积液 肺气肿肺气肿肺气肿肺气肿 左胸腔积液或气胸左胸腔积液或气胸左胸腔积液或气胸左胸腔积液或气胸Abnormal direction Abnormal direction Abnormal direction Abnormal direction 方向改变方向改变方向改变方向改变n nInward impulse: adhesive pericarditis.Inward impulse: adhesive pericarditis.Inward impulse: adhesive pericarditis.Inward impulse: adhesive pericarditis. 负性心尖搏动负性心尖搏动负性心尖搏动负性心尖搏动: : : : 心包粘连心包粘连心包粘连心包粘连Precordial Abnormal ImpulsePrecordial Abnormal ImpulsePrecordial Abnormal ImpulsePrecordial Abnormal Impulse心前区异常搏动心前区异常搏动n n2nd ICS, LSB: pulmonary hypertension, youth2nd ICS, LSB: pulmonary hypertension, youth2nd ICS, LSB: pulmonary hypertension, youth2nd ICS, LSB: pulmonary hypertension, youth 胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间: : : : 肺动脉高压肺动脉高压肺动脉高压肺动脉高压 青年人青年人青年人青年人n n2nd ICS, RSB: aneurysm of ascending aorta 2nd ICS, RSB: aneurysm of ascending aorta 2nd ICS, RSB: aneurysm of ascending aorta 2nd ICS, RSB: aneurysm of ascending aorta 胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间: : : : 升主动脉瘤升主动脉瘤升主动脉瘤升主动脉瘤n n3rd, 4th ICS, LSB: R.V hypertrophy3rd, 4th ICS, LSB: R.V hypertrophy3rd, 4th ICS, LSB: R.V hypertrophy3rd, 4th ICS, LSB: R.V hypertrophy 胸骨左缘胸骨左缘胸骨左缘胸骨左缘3,43,43,43,4肋间肋间肋间肋间: : : : 右心室肥大右心室肥大右心室肥大右心室肥大n nxiphoid process: R.V hypertrophy, abdominal xiphoid process: R.V hypertrophy, abdominal xiphoid process: R.V hypertrophy, abdominal xiphoid process: R.V hypertrophy, abdominal aneurysmaneurysmaneurysmaneurysm 剑突下剑突下剑突下剑突下: : : : 右心室肥大右心室肥大右心室肥大右心室肥大 腹主动脉瘤腹主动脉瘤腹主动脉瘤腹主动脉瘤Palpation of the HeartPalpation of the Heart心脏触诊心脏触诊n n apical impulse apical impulse apical impulse apical impulse 心尖搏动心尖搏动心尖搏动心尖搏动n n thrill thrill thrill thrill 震颤震颤震颤震颤n n pericardial friction pericardial friction pericardial friction pericardial friction fremitusfremitusfremitusfremitus 心包摩擦感心包摩擦感心包摩擦感心包摩擦感Apical ImpulseApical ImpulseApical ImpulseApical Impulse心尖搏动心尖搏动n nClinical significance: Clinical significance: Clinical significance: Clinical significance: signifying the start of the systolic phase signifying the start of the systolic phase signifying the start of the systolic phase signifying the start of the systolic phase 临床意义临床意义临床意义临床意义: : : : 指示收缩期的开始指示收缩期的开始指示收缩期的开始指示收缩期的开始n nLocation and range: same as in Location and range: same as in Location and range: same as in Location and range: same as in inspectioninspectioninspectioninspection 位置和范围位置和范围位置和范围位置和范围: : : : 与视诊相同与视诊相同与视诊相同与视诊相同n nIncreased (heave): forceful and sustainedIncreased (heave): forceful and sustainedIncreased (heave): forceful and sustainedIncreased (heave): forceful and sustained 增强增强增强增强: : : : 搏动持续有力搏动持续有力搏动持续有力搏动持续有力 lifting apical impulse lifting apical impulse lifting apical impulse lifting apical impulse 抬举性心脏搏动抬举性心脏搏动抬举性心脏搏动抬举性心脏搏动n nDecreased: cannot palp. clearlyDecreased: cannot palp. clearlyDecreased: cannot palp. clearlyDecreased: cannot palp. clearly 减弱减弱减弱减弱: : : : 不能清楚触到不能清楚触到不能清楚触到不能清楚触到Abnormal of Apical ImpulseAbnormal of Apical ImpulseAbnormal of Apical ImpulseAbnormal of Apical Impulse心尖搏动异常心尖搏动异常n nIncreased causes: left ventricular pressure Increased causes: left ventricular pressure Increased causes: left ventricular pressure Increased causes: left ventricular pressure overload and consequent hypertrophyoverload and consequent hypertrophyoverload and consequent hypertrophyoverload and consequent hypertrophy 增强原因增强原因增强原因增强原因: : : : 左室内压升高和肥厚左室内压升高和肥厚左室内压升高和肥厚左室内压升高和肥厚n nClinical significance: left ventricular hypertrophyClinical significance: left ventricular hypertrophyClinical significance: left ventricular hypertrophyClinical significance: left ventricular hypertrophy 临床意义临床意义临床意义临床意义: : : : 左心室肥大左心室肥大左心室肥大左心室肥大n nDecreased causes: decreased contractibility of Decreased causes: decreased contractibility of Decreased causes: decreased contractibility of Decreased causes: decreased contractibility of the myocardiumthe myocardiumthe myocardiumthe myocardium 减弱原因减弱原因减弱原因减弱原因: : : : 心肌收缩力减弱心肌收缩力减弱心肌收缩力减弱心肌收缩力减弱n nClinical significance: heart failure, pericardial Clinical significance: heart failure, pericardial Clinical significance: heart failure, pericardial Clinical significance: heart failure, pericardial effusion, myocarditiseffusion, myocarditiseffusion, myocarditiseffusion, myocarditis 临床意义临床意义临床意义临床意义: : : : 心力衰竭心力衰竭心力衰竭心力衰竭 心包积液心包积液心包积液心包积液 心肌炎心肌炎心肌炎心肌炎ThrillThrillThrillThrill震颤震颤n nMechanism: formation of bloodflow vortices Mechanism: formation of bloodflow vortices Mechanism: formation of bloodflow vortices Mechanism: formation of bloodflow vortices caused by valve stenosis or abnormal caused by valve stenosis or abnormal caused by valve stenosis or abnormal caused by valve stenosis or abnormal pathway. pathway. pathway. pathway. 产生机制产生机制产生机制产生机制: : : : 血流旋涡引起低频较强震动血流旋涡引起低频较强震动血流旋涡引起低频较强震动血流旋涡引起低频较强震动 由瓣膜狭窄和异常通道引起由瓣膜狭窄和异常通道引起由瓣膜狭窄和异常通道引起由瓣膜狭窄和异常通道引起n nTypes: systole, diastole, continuousTypes: systole, diastole, continuousTypes: systole, diastole, continuousTypes: systole, diastole, continuous 分型分型分型分型: : : : 收缩期震颤收缩期震颤收缩期震颤收缩期震颤 舒张期震颤舒张期震颤舒张期震颤舒张期震颤 持续震颤持续震颤持续震颤持续震颤n nClinical significance: reliable signs of organic Clinical significance: reliable signs of organic Clinical significance: reliable signs of organic Clinical significance: reliable signs of organic heart diseasesheart diseasesheart diseasesheart diseases 临床意义临床意义临床意义临床意义: : : : 器质性心脏病的征象器质性心脏病的征象器质性心脏病的征象器质性心脏病的征象Thrill in SystoleThrill in SystoleThrill in SystoleThrill in Systole收缩期震颤收缩期震颤n n2nd ICS, LSB: pulmonic stenosis2nd ICS, LSB: pulmonic stenosis2nd ICS, LSB: pulmonic stenosis2nd ICS, LSB: pulmonic stenosis 胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间: : : : 肺动脉瓣狭窄肺动脉瓣狭窄肺动脉瓣狭窄肺动脉瓣狭窄n n2nd ICS, RSB: aortic stenosis2nd ICS, RSB: aortic stenosis2nd ICS, RSB: aortic stenosis2nd ICS, RSB: aortic stenosis 胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间: : : : 主动脉瓣狭窄主动脉瓣狭窄主动脉瓣狭窄主动脉瓣狭窄n n3rd, 4th ICS, LSB: interventricular 3rd, 4th ICS, LSB: interventricular 3rd, 4th ICS, LSB: interventricular 3rd, 4th ICS, LSB: interventricular septal defectseptal defectseptal defectseptal defect 胸骨左缘胸骨左缘胸骨左缘胸骨左缘3, 43, 43, 43, 4肋间肋间肋间肋间: : : : 室间隔缺损室间隔缺损室间隔缺损室间隔缺损Thrill in Diastole and Thrill in Diastole and Thrill in Diastole and Thrill in Diastole and ContinuousContinuousContinuousContinuous舒张期和持续性震颤舒张期和持续性震颤n nDiastolic thrill on apex:Diastolic thrill on apex:Diastolic thrill on apex:Diastolic thrill on apex: mitral stenosis mitral stenosis mitral stenosis mitral stenosis 心尖部舒张期震颤心尖部舒张期震颤心尖部舒张期震颤心尖部舒张期震颤: : : : 二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄n nContinuous thrill on 2nd ICS, Continuous thrill on 2nd ICS, Continuous thrill on 2nd ICS, Continuous thrill on 2nd ICS, LSB:LSB:LSB:LSB: Patent ductus arteriosus Patent ductus arteriosus Patent ductus arteriosus Patent ductus arteriosus 胸骨左缘第二肋间连续性震颤胸骨左缘第二肋间连续性震颤胸骨左缘第二肋间连续性震颤胸骨左缘第二肋间连续性震颤: : : : 动脉导管未闭动脉导管未闭动脉导管未闭动脉导管未闭Pericardial Friction FremitusPericardial Friction FremitusPericardial Friction FremitusPericardial Friction Fremitus心包摩擦感心包摩擦感n nMechanism: inflammation or irritation of the Mechanism: inflammation or irritation of the Mechanism: inflammation or irritation of the Mechanism: inflammation or irritation of the pericardiumpericardiumpericardiumpericardium 机制机制机制机制: : : : 心包表面粗糙心包表面粗糙心包表面粗糙心包表面粗糙n nTypical site: 4th ICS, LSBTypical site: 4th ICS, LSBTypical site: 4th ICS, LSBTypical site: 4th ICS, LSB 部位部位部位部位: : : : 胸骨左缘第四肋间胸骨左缘第四肋间胸骨左缘第四肋间胸骨左缘第四肋间n nFeeling: friction like leather rubbingFeeling: friction like leather rubbingFeeling: friction like leather rubbingFeeling: friction like leather rubbing 感觉感觉感觉感觉: : : : 如皮革相互摩擦如皮革相互摩擦如皮革相互摩擦如皮革相互摩擦n nFeatures: it is best palpated with the person sitting up Features: it is best palpated with the person sitting up Features: it is best palpated with the person sitting up Features: it is best palpated with the person sitting up and leaning forward, and with the breath held in and leaning forward, and with the breath held in and leaning forward, and with the breath held in and leaning forward, and with the breath held in expirationexpirationexpirationexpiration 特点特点特点特点: : : : 坐位前倾呼气末明显坐位前倾呼气末明显坐位前倾呼气末明显坐位前倾呼气末明显 与心跳一致与心跳一致与心跳一致与心跳一致 闭气时不消失闭气时不消失闭气时不消失闭气时不消失n nClinical significance: pericarditisClinical significance: pericarditisClinical significance: pericarditisClinical significance: pericarditis 意义意义意义意义: : : : 提示心包炎提示心包炎提示心包炎提示心包炎Percussion of the HeartPercussion of the Heart心脏叩诊心脏叩诊n n percussion of the percussion of the percussion of the percussion of the heart borderheart borderheart borderheart border 心界叩诊心界叩诊心界叩诊心界叩诊n n abnormal dullness heart abnormal dullness heart abnormal dullness heart abnormal dullness heart borderborderborderborder 心界异常心界异常心界异常心界异常Percussion TechniquePercussion TechniquePercussion TechniquePercussion Technique叩诊方法叩诊方法n nForce: light percussion for the relative dullness border.Force: light percussion for the relative dullness border.Force: light percussion for the relative dullness border.Force: light percussion for the relative dullness border. 力量力量力量力量: : : : 轻叩叩出相对浊音界轻叩叩出相对浊音界轻叩叩出相对浊音界轻叩叩出相对浊音界n nPosition: supine: parallel the Position: supine: parallel the Position: supine: parallel the Position: supine: parallel the middle finger to intercostal; middle finger to intercostal; middle finger to intercostal; middle finger to intercostal; sitting: plumb the middle finger.sitting: plumb the middle finger.sitting: plumb the middle finger.sitting: plumb the middle finger. 体位体位体位体位: : : : 仰卧位仰卧位仰卧位仰卧位: : : : 板指与肋间平行板指与肋间平行板指与肋间平行板指与肋间平行 坐位坐位坐位坐位: : : : 板指与肋间垂直板指与肋间垂直板指与肋间垂直板指与肋间垂直n nSteps: from left to right, lower to upper, outward to inward Steps: from left to right, lower to upper, outward to inward Steps: from left to right, lower to upper, outward to inward Steps: from left to right, lower to upper, outward to inward 顺序顺序顺序顺序: : : : 先左后右先左后右先左后右先左后右 自下而上自下而上自下而上自下而上 由外向内由外向内由外向内由外向内n nLeft border: 2~3cm from the apical impulseLeft border: 2~3cm from the apical impulseLeft border: 2~3cm from the apical impulseLeft border: 2~3cm from the apical impulse 心左界心左界心左界心左界: : : : 心尖搏动外心尖搏动外心尖搏动外心尖搏动外 2~3cm 2~3cm 2~3cm 2~3cm 开始开始开始开始n nRight border: ICS next to the upper border of the liverRight border: ICS next to the upper border of the liverRight border: ICS next to the upper border of the liverRight border: ICS next to the upper border of the liver 心右界心右界心右界心右界: : : : 肝上界上一肋间开始肝上界上一肋间开始肝上界上一肋间开始肝上界上一肋间开始n nMeasure: the distance from dullness border to anterior Measure: the distance from dullness border to anterior Measure: the distance from dullness border to anterior Measure: the distance from dullness border to anterior midlinemidlinemidlinemidline 测量测量测量测量: : : : 浊音界距前正中线的垂直距离浊音界距前正中线的垂直距离浊音界距前正中线的垂直距离浊音界距前正中线的垂直距离Normal Relative Dullness Border of the HeartNormal Relative Dullness Border of the HeartNormal Relative Dullness Border of the HeartNormal Relative Dullness Border of the Heart正常心浊音界正常心浊音界Distance between dullness border and anterior midlineDistance between dullness border and anterior midlineDistance between dullness border and anterior midlineDistance between dullness border and anterior midline心脏之相对浊音界距前正中线的距离心脏之相对浊音界距前正中线的距离心脏之相对浊音界距前正中线的距离心脏之相对浊音界距前正中线的距离Right Right Right Right 右右右右 (cm)(cm)(cm)(cm)ICS ICS ICS ICS 肋间肋间肋间肋间Left Left Left Left 左左左左 (cm)(cm)(cm)(cm)2-32-32-32-3ⅡⅡⅡⅡ2-32-32-32-32-32-32-32-3ⅢⅢⅢⅢ3.5-4.53.5-4.53.5-4.53.5-4.53-43-43-43-4ⅣⅣⅣⅣ5-65-65-65-6ⅤⅤⅤⅤ7-97-97-97-9(the distance between left midclavicular line and anterior midline is 9 cm)(the distance between left midclavicular line and anterior midline is 9 cm)(the distance between left midclavicular line and anterior midline is 9 cm)(the distance between left midclavicular line and anterior midline is 9 cm)( ( ( (左锁骨中线距前正中线左锁骨中线距前正中线左锁骨中线距前正中线左锁骨中线距前正中线 9 cm9 cm9 cm9 cm) ) ) )Abnormal Border by Heart VariationAbnormal Border by Heart VariationAbnormal Border by Heart VariationAbnormal Border by Heart Variation心脏改变引起心界异常心脏改变引起心界异常n nL.V enlargement: boot-shaped heartL.V enlargement: boot-shaped heartL.V enlargement: boot-shaped heartL.V enlargement: boot-shaped heart 左室扩大左室扩大左室扩大左室扩大: : : : 靴形心靴形心靴形心靴形心n nL.A enlargement: pear-shaped heartL.A enlargement: pear-shaped heartL.A enlargement: pear-shaped heartL.A enlargement: pear-shaped heart 左房扩大左房扩大左房扩大左房扩大: : : : 梨形心梨形心梨形心梨形心n nB.V enlargement: general enlarged heartB.V enlargement: general enlarged heartB.V enlargement: general enlarged heartB.V enlargement: general enlarged heart 双室扩大双室扩大双室扩大双室扩大: : : : 普大心普大心普大心普大心n nR.V enlargement: cor pulmonalR.V enlargement: cor pulmonalR.V enlargement: cor pulmonalR.V enlargement: cor pulmonal 右室扩大右室扩大右室扩大右室扩大: : : : 先心先心先心先心 肺心肺心肺心肺心n nPericardial effusion: flask-shaped heartPericardial effusion: flask-shaped heartPericardial effusion: flask-shaped heartPericardial effusion: flask-shaped heart 心包积液心包积液心包积液心包积液: : : : 烧瓶心烧瓶心烧瓶心烧瓶心Abnormal Dullness Heart BorderAbnormal Dullness Heart BorderAbnormal Dullness Heart BorderAbnormal Dullness Heart Border心界叩诊异常心界叩诊异常chest and lung diseases chest and lung diseases chest and lung diseases chest and lung diseases 胸肺疾病胸肺疾病胸肺疾病胸肺疾病n nPleural effusion or lung consolidation: Pleural effusion or lung consolidation: Pleural effusion or lung consolidation: Pleural effusion or lung consolidation: dullness border undetectabledullness border undetectabledullness border undetectabledullness border undetectable 胸腔积液或肺实变胸腔积液或肺实变胸腔积液或肺实变胸腔积液或肺实变: : : : 叩不出叩不出叩不出叩不出n nEmphysema: Emphysema: Emphysema: Emphysema: “ “ “ “shrinkedshrinkedshrinkedshrinked” ” ” ” dullness dullness dullness dullness borderborderborderborder 肺气肿肺气肿肺气肿肺气肿: : : : 心浊音界缩小心浊音界缩小心浊音界缩小心浊音界缩小abdominal disorders abdominal disorders abdominal disorders abdominal disorders 腹部疾病腹部疾病腹部疾病腹部疾病n nDiaphragm elevation: acrossing heartDiaphragm elevation: acrossing heartDiaphragm elevation: acrossing heartDiaphragm elevation: acrossing heart 膈升高膈升高膈升高膈升高: : : : 横位心横位心横位心横位心Boot-shaped HeartBoot-shaped HeartBoot-shaped HeartBoot-shaped Heart靴形心靴形心n nMechanism: L.V Mechanism: L.V Mechanism: L.V Mechanism: L.V enlargementenlargementenlargementenlargementn nFeatures: the left border Features: the left border Features: the left border Features: the left border extends to the inferior left, extends to the inferior left, extends to the inferior left, extends to the inferior left, waist of the heart is waist of the heart is waist of the heart is waist of the heart is deepened.deepened.deepened.deepened.n nCauses: aortic Causes: aortic Causes: aortic Causes: aortic insufficiency, hypertensive insufficiency, hypertensive insufficiency, hypertensive insufficiency, hypertensive heart diseaseheart diseaseheart diseaseheart diseasen n机制机制机制机制: : : : 左室扩大左室扩大左室扩大左室扩大n n特点特点特点特点: : : : 心左界向左下扩大心左界向左下扩大心左界向左下扩大心左界向左下扩大 心腰加深心腰加深心腰加深心腰加深n n病因病因病因病因: : : : 主动脉瓣关闭不全主动脉瓣关闭不全主动脉瓣关闭不全主动脉瓣关闭不全 高血压心脏病高血压心脏病高血压心脏病高血压心脏病Pear-shaped HeartPear-shaped HeartPear-shaped HeartPear-shaped Heart梨形心梨形心n nMechanism: L.A Mechanism: L.A Mechanism: L.A Mechanism: L.A enlargement and enlargement and enlargement and enlargement and distension of distension of distension of distension of pulmonary arterypulmonary arterypulmonary arterypulmonary arteryn nFeatures: dullness Features: dullness Features: dullness Features: dullness heart border in the heart border in the heart border in the heart border in the 2nd, 3rd ICS on the 2nd, 3rd ICS on the 2nd, 3rd ICS on the 2nd, 3rd ICS on the LSB extends outside, LSB extends outside, LSB extends outside, LSB extends outside, waist of the heart waist of the heart waist of the heart waist of the heart bulges outbulges outbulges outbulges outn nCauses: mitral stenosisCauses: mitral stenosisCauses: mitral stenosisCauses: mitral stenosisn n机制机制机制机制: : : : 左房扩大左房扩大左房扩大左房扩大 肺动脉扩大肺动脉扩大肺动脉扩大肺动脉扩大n n特点特点特点特点: : : : 胸骨左缘胸骨左缘胸骨左缘胸骨左缘2, 32, 3肋间肋间肋间肋间 心浊音界向外扩大心浊音界向外扩大心浊音界向外扩大心浊音界向外扩大 心腰饱满或膨出心腰饱满或膨出心腰饱满或膨出心腰饱满或膨出n n病因病因病因病因: : : : 二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄二尖瓣狭窄General Enlarged HeartGeneral Enlarged HeartGeneral Enlarged HeartGeneral Enlarged Heart普大心普大心n nMechanism: both left Mechanism: both left Mechanism: both left Mechanism: both left and right ventricle are and right ventricle are and right ventricle are and right ventricle are enlargedenlargedenlargedenlargedn nFeatures: the dullness Features: the dullness Features: the dullness Features: the dullness border extends to both border extends to both border extends to both border extends to both sides, the left border sides, the left border sides, the left border sides, the left border extends to inferior leftextends to inferior leftextends to inferior leftextends to inferior leftn nCauses: Causes: Causes: Causes: cardiomyopathy, cardiomyopathy, cardiomyopathy, cardiomyopathy, myocarditis, whole myocarditis, whole myocarditis, whole myocarditis, whole heart failureheart failureheart failureheart failuren n机制机制机制机制: : : : 左右心室扩大左右心室扩大左右心室扩大左右心室扩大n n特点特点特点特点: : : : 心浊音界向双侧扩大心浊音界向双侧扩大心浊音界向双侧扩大心浊音界向双侧扩大 左界向下扩大左界向下扩大左界向下扩大左界向下扩大n n病因病因病因病因 扩张型心肌病扩张型心肌病扩张型心肌病扩张型心肌病 克山病克山病克山病克山病 重症心肌炎重症心肌炎重症心肌炎重症心肌炎 全心衰竭全心衰竭全心衰竭全心衰竭Flask-shaped HeartFlask-shaped HeartFlask-shaped HeartFlask-shaped Heart烧瓶心烧瓶心n nMechanism: Mechanism: Mechanism: Mechanism: pericardial effusionpericardial effusionpericardial effusionpericardial effusionn nFeatures: Features: Features: Features: n nSitting position: Sitting position: Sitting position: Sitting position: triangular dullness triangular dullness triangular dullness triangular dullness borderborderborderbordern nSupine: widened Supine: widened Supine: widened Supine: widened dullness border of dullness border of dullness border of dullness border of the basethe basethe basethe base机制机制机制机制: : : : 心包积液心包积液心包积液心包积液特点特点特点特点: : : :n n坐位时坐位时坐位时坐位时 心浊音界呈三角形心浊音界呈三角形心浊音界呈三角形心浊音界呈三角形n n仰卧位仰卧位仰卧位仰卧位 心底部浊音区增宽心底部浊音区增宽心底部浊音区增宽心底部浊音区增宽n n随体位心界改变随体位心界改变随体位心界改变随体位心界改变Auscultation of the HeartAuscultation of the Heart心脏听诊心脏听诊n n valve auscultation valve auscultation valve auscultation valve auscultation sectionsectionsectionsection 瓣膜听诊区瓣膜听诊区瓣膜听诊区瓣膜听诊区n n content of auscultationcontent of auscultationcontent of auscultationcontent of auscultation 听诊内容听诊内容听诊内容听诊内容Valve Auscultation SectionValve Auscultation SectionValve Auscultation SectionValve Auscultation Section瓣膜听诊区瓣膜听诊区n nMitral valve: in the apex areaMitral valve: in the apex areaMitral valve: in the apex areaMitral valve: in the apex area 二尖瓣听诊区二尖瓣听诊区二尖瓣听诊区二尖瓣听诊区: : : : 心尖搏动最强点心尖搏动最强点心尖搏动最强点心尖搏动最强点n nPulmonic valve: in the 2Pulmonic valve: in the 2Pulmonic valve: in the 2Pulmonic valve: in the 2ndndndnd ICS, LSB ICS, LSB ICS, LSB ICS, LSB 肺动脉瓣听诊区肺动脉瓣听诊区肺动脉瓣听诊区肺动脉瓣听诊区: : : : 胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间胸骨左缘第二肋间n nAortic valve: in the 2Aortic valve: in the 2Aortic valve: in the 2Aortic valve: in the 2ndndndnd ICS, RSB ICS, RSB ICS, RSB ICS, RSB 主动脉瓣听诊区主动脉瓣听诊区主动脉瓣听诊区主动脉瓣听诊区: : : : 胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间胸骨右缘第二肋间n nThe 2nd of aortic valve: in the 3The 2nd of aortic valve: in the 3The 2nd of aortic valve: in the 3The 2nd of aortic valve: in the 3rdrdrdrd ICS, LSB ICS, LSB ICS, LSB ICS, LSB 第二听诊区第二听诊区第二听诊区第二听诊区: : : : 胸骨左缘第三肋间胸骨左缘第三肋间胸骨左缘第三肋间胸骨左缘第三肋间n nTricuspid valve: in the inferior sternumTricuspid valve: in the inferior sternumTricuspid valve: in the inferior sternumTricuspid valve: in the inferior sternum 三尖瓣听诊区三尖瓣听诊区三尖瓣听诊区三尖瓣听诊区: : : : 胸骨左缘胸骨左缘胸骨左缘胸骨左缘4, 54, 54, 54, 5肋间肋间肋间肋间Auscultation OrderAuscultation OrderAuscultation OrderAuscultation Order听诊顺序听诊顺序n nMitral valveMitral valveMitral valveMitral valve 二尖瓣二尖瓣二尖瓣二尖瓣n nAortic valveAortic valveAortic valveAortic valve 主动脉瓣主动脉瓣主动脉瓣主动脉瓣n nPulmonic valvePulmonic valvePulmonic valvePulmonic valve 肺动脉瓣肺动脉瓣肺动脉瓣肺动脉瓣n nThe 2nd of aortic The 2nd of aortic The 2nd of aortic The 2nd of aortic valvevalvevalvevalve 主动脉瓣第二听诊区主动脉瓣第二听诊区主动脉瓣第二听诊区主动脉瓣第二听诊区n nTricuspid valveTricuspid valveTricuspid valveTricuspid valve 三尖瓣三尖瓣三尖瓣三尖瓣Content of Heart AuscultationContent of Heart AuscultationContent of Heart AuscultationContent of Heart Auscultation心脏听诊内容心脏听诊内容n nHeart rate: 60~100/min normallyHeart rate: 60~100/min normallyHeart rate: 60~100/min normallyHeart rate: 60~100/min normally 心率心率心率心率: : : : 正常正常正常正常60~10060~10060~10060~100次次次次/ / / /分分分分n nCardiac rhythm: regular or arrhythmiaCardiac rhythm: regular or arrhythmiaCardiac rhythm: regular or arrhythmiaCardiac rhythm: regular or arrhythmia 心律心律心律心律: : : : 规整规整规整规整 心律失常心律失常心律失常心律失常n nHeart sounds: normal, abnormalHeart sounds: normal, abnormalHeart sounds: normal, abnormalHeart sounds: normal, abnormal 心音心音心音心音: : : : 正常心音正常心音正常心音正常心音 异常心音异常心音异常心音异常心音n nHeart murmursHeart murmursHeart murmursHeart murmurs 心脏杂音心脏杂音心脏杂音心脏杂音ArrhythmiaArrhythmiaArrhythmiaArrhythmia心律失常心律失常n nSinus arrhythmia: quick in inspiration and Sinus arrhythmia: quick in inspiration and Sinus arrhythmia: quick in inspiration and Sinus arrhythmia: quick in inspiration and slow in expirationslow in expirationslow in expirationslow in expiration 窦性心律不齐窦性心律不齐窦性心律不齐窦性心律不齐: : : : 吸快呼慢吸快呼慢吸快呼慢吸快呼慢n nPremature beat: appear ahead and Premature beat: appear ahead and Premature beat: appear ahead and Premature beat: appear ahead and intermission behindintermission behindintermission behindintermission behind 期前收缩期前收缩期前收缩期前收缩: : : : 提前出现提前出现提前出现提前出现 后有间歇后有间歇后有间歇后有间歇n nAtrial fibrillation: arrhythmia absolutely, heart Atrial fibrillation: arrhythmia absolutely, heart Atrial fibrillation: arrhythmia absolutely, heart Atrial fibrillation: arrhythmia absolutely, heart sound intensity differing and pulse deficit sound intensity differing and pulse deficit sound intensity differing and pulse deficit sound intensity differing and pulse deficit 心房颤动心房颤动心房颤动心房颤动: : : : 心律绝对不整心律绝对不整心律绝对不整心律绝对不整 心音强度弱不等心音强度弱不等心音强度弱不等心音强度弱不等 心率大于脉率心率大于脉率心率大于脉率心率大于脉率( ( ( (脉搏短绌脉搏短绌脉搏短绌脉搏短绌) ) ) )next presentationnext presentationnext presentationnext presentation预告下次内容预告下次内容n nauscultation of heart soundsauscultation of heart soundsauscultation of heart soundsauscultation of heart sounds 心音听诊心音听诊心音听诊心音听诊姚孟英姚孟英 TEL:13592665719ymy13592665719@THANKS。