第五章心脏检查.ppt

第五章:心脏检查CARDIO EXAMINATION ;概 述introduction ;检查的注意事项matters needing attention in the examination ;视诊Inspection;心脏视诊lnspection of the heart ;Inspection;1、正常心前区(Normal Precordium);2、心前区隆起与凹陷Precordial uplift and depression;心前区隆起 胸骨下段与胸骨左缘3、4、5肋间隆起见于： 法洛四联症(tetralogy of Fallot TOF) 肺动脉瓣狭窄 Pulmonary valve stenosis 风湿性二尖瓣狭窄 Rheumatic mitral stenosis 心包积液 Pericardial effusion 胸骨左缘2肋间隆起，见于： 主动脉弓动脉瘤 Aortic arch aneurysm 升主动脉扩张 Expansion of ascending aorta;心脏在外面的孩子;;胸部正位像 胸部侧位像;Tetralogy of Fallot;主要是自幼出现的进行性青紫和呼吸困难，易疲乏，劳累后常取蹲踞位休息。Occur mainly childhood sexual bruising and shortness of breath, easy fatigue, tiredness, often after the crouch position to take a break. 严重缺氧时可引起晕厥，长期右心压力增高及缺氧可发生心功能不全。患者除明显青紫外，常伴有柞状指（趾），心脏听诊肺动脉瓣第二心音减弱以致失，胸骨左缘常可闻及收缩期喷射性杂音。脑血管意外、感染性心内膜炎、肺部感染为本病常见并发症。  ;2、心前区隆起与凹陷;　;　;3、Apical impulse(心尖搏动);;;Pathological apex beat ;;;右侧肺野一致性密度增高影 上缘呈外高内低的弧形影;;;气胸pneumothorax;氣胸;手术Surgery;脊柱前凸 Lordosis;3.scoliosis脊柱侧凸;Before surgery ;After surgery ;;实验室和特殊检查;;缩窄性心包炎： 指心脏被致密厚实的纤维化心包所包围，使心脏舒张期充盈受限而产生一系列循环障碍的临床病征 Constrictive pericarditis: ????? Means the heart was pericardial fibrosis, dense surrounded by thick, so that diastolic filling period of limited circulation disorders arising from a series of clinical symptoms. ;　;(三)心前区异常搏动 Abnormal precordial pulsation 1．胸骨左缘第2肋间搏动 见于肺动脉高压，有时也可见于正常青年人。The left sternal edge of the first two intercostal pulse seen in pulmonary hypertension, is sometimes seen in normal young subjects. 2．胸骨左缘第3—4肋间搏动 见于右心室肥大。 The left sternal edge of the first intercostal beat 3-4 right ventricular hypertrophy is seen.;;剑突下搏动鉴别方法;Palpation (触诊）;;触诊Palpation;触诊方法： 右手手掌尺侧（小鱼际）触诊或食指、中指、环指指腹并拢触诊。;心脏触诊;;　心尖搏动的凸起，标志着心室收缩的开始 借此确定心音、杂音及震颤出现的时间。Apex beat of the bulge, marking the beginning of ventricular contraction. To identify heart sounds, noises and tremors occurred. ;　 震颤是用手触到的微细振动感，尤如触摸猫喘气的感觉，故又称猫喘。Tremor (thrill) is a micro-vibration of hand-touch sense, just like the feeling of touching the cat pan