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1、G心脏检查BPPT课件NormalHeartSounds正常心音originationofheartsounds心音产生机制differencesbetweenS1&S2第一心音和第二心音的区分OriginationofHeartSounds心音产生Systole收缩Diastole舒张InfluenceFactorofSoundIntensity强度影响因素Soundproduction心音产生apexpart:valveelasticity,place,movementdegree,raisingspeedofpress
2、urecombinedwithventriclefillingdegreeandcontractingforce心尖部(S1)瓣膜弹性位置活动度压力上升速度(心室充盈度和收缩力)basepart:valvedisorders,pressureinartery心底部(S2)瓣膜病变动脉内压力Soundconduction心音传导conductingdistance:pericardium,lungandchestwallthickness传导距离:心包肺脏胸壁厚度ChangesofS1Intensity第一心音强度改变Incr
3、ease:增强mitraland/ortricuspidstenosis二尖瓣狭窄Hyperdynamiccirculatorystatessuchasfever,anemia,hyperthyroidism.血流加速如发热贫血甲亢ShortingofthePRintervalorcompleteheartblockonECG.P-R间期缩短或完全房室传导阻滞Decrease:减弱Myocardialdiseases.心肌病Mitraland/ortricuspidregurgitation.二尖瓣关闭不全Prolongat
4、ionofPRinterval.P-R间期延长Aorticvalvesregurgitation.主动脉瓣关闭不全心房→瓣膜→心室ChangesofS2Intensity第二心音强度改变S2hastwoelements,A2andP2.第二心音分为主动脉瓣第二音和肺动脉瓣第二音A2increase:hypertension,aortosclerosis.主动脉瓣第二音增强:高血压主动脉硬化P2increase:mitralsternosisorinsufficiency,L.Vfailure,andcongenitalhea
5、rtdiseaseswithlefttorightshunt.肺动脉瓣第二音增强:二尖瓣狭窄及关闭不全左心功能不全先天性心脏病左向右分流A2decrease:aorticstenosisorinsufficiency主动脉瓣第二音减弱:主动脉瓣狭窄及关闭不全P2decrease:pulmonicstenosisorinsufficiency肺动脉瓣第二音减弱:肺动脉瓣狭窄及关闭不全动脉←瓣膜←心室ChangesofS1andS2IntensitySimultaneously第一和第二心音强度同时改变Increase:bloo
6、dvelocityisincreased,asinanemia,fever,hyperthyroidism,anxiety,andduringexercise.增强:血流加速如贫血发热甲亢焦虑和运动Decrease:bloodvelocityisdecreased,asmyocardialdiseases,increasedoverlyingtissue,fat,orfluidobscuresounds.减弱:血流缓慢如心肌病传导受阻如肺气肿心包积液脂肪增厚ChangesofQuality心音性质改变ChangesofS1q
7、uality:S1sameasS2(blankness)第一心音性质改变:第一心音与第二心音相同(单调)Diastolicphaseshorten:sameassystolic(singlerule)舒张时限缩短:收缩期与舒张期时限相同(单律)Characteristic:pendularrhythm,embryocardia听诊特点:钟摆律胎心律Clinicalmeaning:myocardialdamageseverely,asacutemyocardialinfarction,severemyocarditis,.提示
8、:心肌严重受损如急性心肌梗塞重症心肌炎SplittingofHeartSounds心音分裂firstheartsoundsplitting第一心音分裂secondheartsoundsplitting第二心音分裂SplittingofFirstHeartSounds第一心音分裂Areafo
