小儿心脏疾病.ppt

Cardiac Examination Auscultation： －Rate and rhythm of heart beats －Normal heart sounds: S1, S2 (A2 P2), S3 , S4 －Abnormal heart sounds: splitting, intensity, ejection clicks, S3 , S4 －Murmurs: systolic, diastolic, continuous －Pericardial friction rub * ppt课件 Cardiac Examination Heart Rate and Rhythm Neonate 120～140 bpm Infancy 110～130 bpm Toddler’s age 100～120 bpm Preschool age 80～100 bpm School age 70 ～ 90 bpm * ppt课件 Cardiac Examination Differential diagnosis of heart murmur CHD Innocent location precordium 2～4LSB, apex phase SM, DM, CM SM, short quality harsh soft intensity gradeII gradeIII radiation extensive localized variation less more * ppt课件 Non-cardiac Examination Arterial pulse: －rate, rhythm, quality, amplitude, uniformity at limbs Arterial blood pressure: Extremities： －clubbing of fingers toes, edema Abdomen: －hepatomegaly, spleenomegaly * ppt课件 Arterial Blood Pressure Upper limbs： －Systolic BP (mmHg) = age×２+ 80 －Diastolic BP (mmHg) = 2/3 ×BPs Lower limbs： －BP is 20mmHg higher Abnormal BP： －20mmHg higher or lower than normal * ppt课件 Electrocardiogram EKG is essential in assessing hypertrophy of atria or ventricles, arrhythmias and disorders of conductive system * ppt课件 Enlargement of Atria Enlargement of left atrium： －P-wave ≥ 0.09 sec in duration －Double peaks of P-wave with interval of 0.04 sec or more Enlargement of right atrium： －P II ≥ 0.25 mv in amplitude －PV1 ≥ 0.20 mv in amplitude * ppt课件 Enlargement of Left Ventricle Rv5 ≥ 3.0 mv in amplitude Sv1 ≥ 1.5 mv in amplitude Rv5+Sv1 ≥ 4.5mv in amplitude QRS complex in lead V1 shown as QS * ppt课件 Enlargement of Right Ventricle The following signs shown in lead V1: － QRS complex presents as qR －R 0.7 mv －rsR’ complex with R’ 1.5 mv －Rs complex with R/s ratio as follows： 1yr 5 1-3yr 2.5 3-5yr 2 5-12yr 1.5 12y 1 * ppt课件 Roentgenogram Chest X-ray is essential in the evaluation of heart size and pulmonary vascularity * ppt课件 Echocardiography The maj