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1、CardiacBasicExamination心脏基本检查inspection视诊palpation触诊percussion叩诊auscultation听诊InspectionoftheHeart心脏视诊precordiumshape心前区外形normalapicalimpulse正常心尖搏动abnormalapicalimpulse异常心尖搏动precordialabnormalimpulse心前区异常搏动PrecordiumShape心前区外形Precordialbulge心前区隆起Features
2、:bonybulge特点:骨骼突起Clinicalimportance:Congenitalheartdiseasewithventricularenlargement提示:先天性心脏病右室大Precordialsatiety心前区饱满Features:intercostalregionstickingout特点:肋间软组织外突Clinicalimportance:massofpericardialeffusion提示:大量心包积液NormalApicalImpulse正常心尖搏动Location:0.
3、5~1cmtotheleftmidclavicularlineatthe5thICSoutsideLSB.Range:2~2.5cmDirection:outwardwhenventricularsystolebegins位置第5肋间左锁骨中线内0.5~1cm范围2~2.5cm方向收缩时向外搏动意义提示心尖位置代表收缩期提示心脏大小AbnormalLocationofApicalImpulse心尖搏动位置改变Physical:posture,pregnancy,etc.生理因素:体位妊娠Heartdis
4、eases心脏病变L.VandB.Venlargement:inferiorleft左室或双室扩大:左下移位R.Venlargement:left右室扩大:向左移位Chestandabdominaldiseases肺部或腹部疾病AbnormalApicalImpulse异常心尖搏动Abnormalrangeorintensity范围强度异常Increasedintensity:LVhypertrophy,hyperthyroidism,fever,anemia,etc.搏动增强:左室肥厚甲亢发热贫血De
5、creased:myocardialdiseases,pericardialeffusion,pleuraleffusionofleftthoraxorleft-sidepneumothorax,emphysema.搏动减弱:心肌病变心包积液肺气肿左胸腔积液或气胸Abnormaldirection方向改变Inwardimpulse:adhesivepericarditis.负性心尖搏动:心包粘连PrecordialAbnormalImpulse心前区异常搏动2ndICS,LSB:pulmonaryhyp
6、ertension,youth胸骨左缘第二肋间:肺动脉高压青年人2ndICS,RSB:aneurysmofascendingaorta胸骨右缘第二肋间:升主动脉瘤3rd,4thICS,LSB:R.Vhypertrophy胸骨左缘3,4肋间:右心室肥大xiphoidprocess:R.Vhypertrophy,abdominalaneurysm剑突下:右心室肥大腹主动脉瘤PalpationoftheHeart心脏触诊apicalimpulse心尖搏动thrill震颤pericardialfrictionf
7、remitus心包摩擦感ApicalImpulse心尖搏动Clinicalsignificance:signifyingthestartofthesystolicphase临床意义:指示收缩期的开始Locationandrange:sameasininspection位置和范围:与视诊相同Increased(heave):forcefulandsustained增强:搏动持续有力liftingapicalimpulse抬举性心脏搏动Decreased:cannotpalp.clearly减弱:不能清楚触
8、到AbnormalofApicalImpulse心尖搏动异常Increasedcauses:leftventricularpressureoverloadandconsequenthypertrophy增强原因:左室内压升高和肥厚Clinicalsignificance:leftventricularhypertrophy临床意义:左心室肥大Decreasedcauses:decreasedcontractibilityofthemyoca
