[医学]H心脏检查C.pptVIP

physical examination心脏检查(3)Cardiac Examination cardiac murmurs 心脏杂音 vascular examination 血管检查 heart disease 心脏疾病 Auscultation of Murmurs心脏杂音听诊 mechanisms 产生机制 characterization 听诊要点 clinical meaning 临床意义 Mechanisms杂音产生机制 turbulent flow→vortices→murmur 湍流→旋涡→杂音 Stenosis or insufficiency of valves 瓣膜狭窄或关闭不全 Abnormal pathway (shunt) 异常通道(分流) Floating materials in circulation 心腔内漂浮物 Stenosis or dilation of blood vessels 血管腔扩大或狭窄 Enhanced bloodflow velocity 血流加速 Diminished viscosity 血液粘度降低 Organic Relative器质性与相对性 Organic: valve disease 器质性: 瓣膜本身病变 stenosis 狭窄 insufficiency 关闭不全 Relative: pathway wide 相对性: 通道扩大 stenosis 狭窄 insufficiency 关闭不全 Characterization of Murmurs杂音听诊要点 Location Duration Pitch and Quality Intensity and Timing Transmission or radiation Effect murmurs of factor 杂音的部位 杂音的时期 杂音的性质 杂音的强度 杂音的传导 影响杂音的因素 Location杂音部位 Apical area: mitral valve Aortic area: aortic valve Pulmonic area: pulmonic valve Inferior sternum: tricuspid valve 3rd, 4th ICS, LSB: ventricular septal defect 2nd, 3rd ICS, LSB: patent ductus arteriosus 杂音出现和最响部位与 病变部位 血流方向 传导介质相关 心尖部: 二尖瓣 主动脉瓣听诊区: 主动脉瓣 肺动脉瓣听诊区: 肺动脉瓣 胸骨下端: 三尖瓣 胸骨左缘 3 4 肋间: 室间隔 胸骨左缘 2 3 肋间: 动脉导管 Duration杂音时期 Systolic murmur (SM) Holosystolic Early Midsystolic Late Diastolic murmur (DM) Holodiastolic Early Middiastolic Late (presystolic) Continuous 收缩期杂音 全收缩期 收缩早期 收缩中期 收缩晚期 舒张期杂音 全舒张期 舒张早期 舒张中期 舒张晚期 连续性杂音 Distinguish Duration时期的区分 systolic murmur 收缩期杂音 appear between S1 and S2, same as apical impulse 在第一心音与第二心音之间出现 与心尖搏动一致 diastolic murmur 舒张期杂音 appear between S2 and S1, nonsame as apical impulse 在第 2 心音与第 1 心音之间出现 与心尖搏动不一致 Both Phase and Continues Murmur双期杂音与连续性杂音 Both phase murmur 双期杂音 Cause: mitral stenosis and insufficiency 疾病: 二狭二闭 Heart murmur appears in systole and diastole respectively. 收缩舒张期分别出现杂音 Auscultation: Quality different and S2 still