体格检查-血管PPT.pptVIP

Chapter V Thorax D. Heart and blood vessels Blood Vessel by Dr. Zhuo-ren Lu 1. Inspection (1) Venous blood pressure l???When the venous pressure is elevated, an engorged external jugular vein can be seen above the lower one third of the distance between super clavicle and the angle of the jaw with patient sitting erect, and above the lower two third of the distance between super clavicle and the angle of the jaw at supine position. l???It often indicates the elevated pressure in the right atrium and is an important sign of congestive heart failure, pericardial constriction, and pericardial effusion. (2) The visible pulsation in the neck veins It indicates the regurgitation of tricuspid valve and the visible pulsation of carotid artery occurs in aortic regurgitation. The level of visible pulsation in the neck veins descends on normal inspiration and rises on expiration. The pulsation of jugular vein looks diffuse, but the point of carotid artery pulse is limited. It requires much greater pressure to eliminate the carotid artery pulse with a distinct pulse feeling. ? (3) Hepatojugular reflux Compression of the right upper abdominal quadrant for 30 to 45 seconds will result in more prominent distension of external jugular vein. l? It usually is an important sign of right ventricular failure or pericardial effusion or constriction, because blood is being transmitted from the liver to the superior vena cave without returning back to right atrium more. It is usually used to distinguish hepotohemia from hepatitis, hepotoma, hepatocirrhosis. (4) Capillary pulsation Check capillary pulsation by pressing on nails or lips with a clear glass and looking at the change of color from pink to white. Capillary pulsation occurs in aortic regurgitation and other abnormalities associated with wide pulse pressure. (3) Pulsus alternans is characterized by a regularly alternating pulse, in which every other