Examination of Blood Vessels-仁济临床医学院诊断学课件.ppt

Examination of Blood Vessels Introduction Palpation of the pulse Measurment of arterial blood pressure Auscultation of blood vessels Palpation of The Pulse Radial artery is usually selected Patient’s hand placed with the palm upward Physician’s first three fingers on the radial artery Index finger nearest the heart Characteristics of The Pulse Rate Intensity Type of wave Rhythm Tension RATE -Pulse frequency (rapid or slow) Varies with age, sex, physical activity, emotional status Normal range: 60-100bpm in adults; 90-120bpm in children Rate increase (tachycardia心动过速): severe anemia, high fever, massive hemorrhage(大出血), various types of cardiac arrhythmias, hyperthyroidism, and at times in congestive heart failure. Rate decrease (bradycardia心动过缓): increased intracranial pressure(颅高压), SSS, above Ⅱ AVB, hypothyroid(甲减), Digoxin(地高辛), etc Rhythm The more common disturbances of rhythm can and should be detected by palpating the pulse. Auscultation of the heart is a more accurate method for determining the rhythm. Some of the more complex arrhythmias can be diagnosed only by EKG. Common irregular pulse: Sinus arrhythmia(窦不齐) Premature beat(早搏) Atrial fibrillation(房颤) Bigeminal pulse(二联律) Trigeminal pulse(三联律) Paroxysmal atrial, ventricular tachycardia Heart block(传导阻滞) Tension The tension of pulse depends on the level of the arterial systolic pressure. Intensity The intensity depends on the cardiac output, pulse pressure and the resistance of peripheral vessels. Pulsus magnus (bounding pulse): increased cardiac output , high pulse pressure, low resistance. aortic insufficiency, high fever, hyperthyroid Small pulse (thready pulse): decreased cardiac output , low pulse pressure, high resistance. aortic stenosis, heart failure, shock. Wave form The arterial pulse starts at the instant aortic valve opens, results in an abrupt sharp rise in aortic pressure. During systole a large part of blood is temporarily stored in the proximal aorta. Onc