[医学]heart exam 1.pptVIP

Examination of the Heart Jin Yu-hua Dept. of Geriatrics Examination of the Heart Technological advances Various imaging modalities Bedside physical examination is unnecessary and does not provide useful information? It should be emphasized, however, that for proper application and interpretation of various new and old tests that are available for cardiovascular evaluation in a given patient. Bedside clinical examination should be performed and practiced in the same way following similar sequences. Preparing the patient The heart examination should be made as easy as possible for the patient. The physician is considerate and gentle. The ideal examining room is private, warm enough to avoid chilling, and free from distracting noise and sources of interruption. Adequate light is essential. The examining table may be placed with its head against the wall, but both sides (particularly the right) and the foot should be accessible to the examiner. Landmarks and topographic  anatomy Certain basic landmarks midsternal line(前正中线) midclavicular lines(锁骨中线) anterior, middle, and posterior axillary lines(腋前、中、后线) suprasternal notch（胸骨上窝） identification of various ribs and intercostal space precordium（心前区） Inspection Inspection of the precordium should begin at the foot of the bed. The subject should be supine with the leg horizontal and the head and trunk elevated to approximately 15-30 degrees. Asymmetry of the thoracic cage due to a convex bulging of the precordium suggests the presence of heart disease since childhood, such as congenital heart disease and rheumatic heart disease. In the adult, precordial bulge may be produced from the massive pericardial effusion（心包积液）. apical impulse（心尖搏动） Most part of apex is left ventricle. The apex strikes the chest during systole. The apex impulse is normally located in or about the fifth costal interspace inside the left midclavi