cardiovascular examination.分析课件

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1、CardiovascularExaminationDelingZou1Anatomy23Inspection1Precardialprojectionandexcavation2Apicalimpulse3Abnormalpulsationsofprecardium41Precardialprojectionandexcavation1)Precardialprojectioncongenitalheartdisease:tetralogyofFallotValvularheartdisease--MS,PSpericardialeffusion(

2、large,childhood)Inspection5Thesecondrightintercostalspace(2ndICS-RS)aneurysmofaorticarchdilatationofascendingaorta2)flatchest3)pigeonchest/funnelchest62Apicalimpulse*Normal:position—thefifthleftintercostalspace0.5-1.0cmmedialtothemidclavicularlinerange—2.0-2.5cmindiameterInsp

3、ection7*Abnormal1)Location#diaphragm:“transverseposition”upper,outwardobesity,child,pregnacy;ascites;tumorofabdominalcavity“verticalposition”(thin,high,emphysema)inferior,inner89onesidepleuraleffusionorpneumothorax—tothehealthysideonesideatelectesisorpleuraladhesion—totheaffe

4、cted#mediastinum:10#enlargementoftheheartrightventriculardilatation–leftorslightlyupperleftventriculardilatation—leftinferiorLV&RVdilatation–leftinferior(bothsidedilatation)1112#Posture:recumbentposition—upperleftlateralposition—totheleft2-3cmrightlateralposition—totheright1.0

5、-2.5cmDextrocardia:5-ICS—RS132)IntensityandextentchangesInspection-apicalimpulse-abnormal143)Inwardimpulse:apexexcavationinthesystoleseen:adhensivepericarditisprominentRVhypertrophyInspection-apicalimpulse-abnormal15Inspection1)leftthird-forthintercostalspacelateraltothesternu

6、m(3,4ICS-LS)seen:RVhypertrophyAbnomalpulsationsofpercardium162)hypoxiphoidprocessseen:differencedeepinspirationRVhypertrophy↑abdominalaorta(aneurysm)↓173)basalpartoftheheart2ICS-LS:dilatationofthepulmonaryarteryorpulmonaryhypertensin,occasionallyhealthyyoungman2ICS-RS:aneurysm

7、ofaorticarchordilatationofascendingaorta18Palpation1Apicalimpulseandpulsationofprecardium2Thrill3Pericardialfrictionrub191ApicalimpulseandpulsationofprecardiumExactpositionofapexThebeginningofsystoleofventriclefirstsoundHeavingapeximpulse:reliableofLVhypertrophyPalpation202Thr

8、illOneofcharacteristicsignsoforganicheartdisease.Mechanism:th