Cardiovacular Examination.分析课件.ppt

 Cardiovascular Examination Anatomy Inspection 1 Precardial projection and excavation 1) Precardial projection congenital heart disease: tetralogy of Fallot Valvular heart disease-- MS,PS pericardial effusion (large , childhood) The second right intercostal space(2nd ICS-RS) aneurysm of aortic arch dilatation of ascending aorta 2) flat chest 3) pigeon chest/funnel chest 2 Apical impulse *Normal: position—the fifth left intercostal space 0.5-1.0cm medial to the midclavicular line range—2.0-2.5cm in diameter *Abnormal1) Location #diaphragm: “transverse position” upper,outward obesity ,child, pregnacy; ascites; tumor of abdominal cavity “vertical position” (thin, high, emphysema) inferior,inner  #mediastinum: one side pleural effusion or pneumothorax—to the healthy side one side atelectesis or pleural adhesion—to the affected  #enlargement of the heart  right ventricular dilatation –left or slightly upper left ventricular dilatation—left inferior LV RV dilatation –left inferior (both side dilatation) #Posture: recumbent position—upper left lateral position—to the left 2-3cm right lateral position—to the right 1.0-2.5cm  Dextrocardia: 5-ICS—RS 3)Inward impulse: apex excavation in the systole seen: adhensive pericarditis prominent RV hypertrophy Inspection 1)left third-forth intercostal space lateral to the sternum(3,4ICS-LS) seen: RV hypertrophy 2)hypoxiphoid process seen: difference deep inspiration RV hypertrophy ↑ abdominal aorta (aneurysm) ↓  3)basal part of the heart  2 ICS-LS: dilatation of the pulmonary artery or pulmonary hypertensin, occasional