呼吸循环系体格检查.docVIP

physical examination心脏检查(1)Cardiac Examination inspection 视诊 palpation 触诊 percussion 叩诊 auscultation 听诊 一.The projection of the heart at the anterior chest wall. 二.The auscultatory area of cardial valves and the direction of the blood flow through the various valves 1. The mitral valve area: The blood flow pass from the posterasuperior to the anterainferior left ---the auculatory area is at apex area. 三、Precordium: 1.The superior border is below the left third intercostal space 2. The right border is at the midsternum line 3.The left border is at the left midclavicular line 4.The inferior border is above the diaphragm The heart examination Inspection of the Heart 心脏视诊 The focal point of inspection include: precordium shape 心前区外形 normal apical impulse 正常心尖搏动 abnormal apical impulse 异常心尖搏动 precordial abnormal impulse 心前区异常搏动 Precordium Shape心前区外形 Precordial bulge 心前区隆起 Features: bony bulge 特点:骨骼突起 Clinical importance: Congenital heart disease with right ventricular enlargement 提示:先天性心脏病右室大 Precordial fullness 心前区饱满 Features: intercostal region fullness 特点:肋间软组织外突 Clinical importance: mass of pericardial effusion 提示:大量心包积液 Normal Apical Impulse正常心尖搏动 一、Inspection In most persons ,one can see,synchronous with cardic systolic,an outward movement of a small portion of the left chest wall caused by the beat of the cardic apex.This is the cardic or apex impulse. It should be studied with the patient upright and lying in various position since in many instances the impalse may be fairly diffuse Normal Apical Impulse正常心尖搏动 Location: the 5th intercastal space 0.5~1.0 cm inside the left midclavicular line. Range: 2~2.5cm Direction: outward when ventricular systole begins and it coincide with the left cardic border 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 提示心脏大小与心 脏的左缘一致 Abnormal Apical Impulse异常心尖搏动 (1) Abnormal location 位置改变 Physical: posture, pregnancy, etc