心脏检查专题知识.pptVIP

心脏检查专题知识

AuscultationofMurmurs

心脏杂音听诊mechanisms产生机制characterization听诊要点clinicalmeaning临床意义

Mechanisms

杂音产生机制

OrganicRelative

器质性与相对性Organic:valvedisease器质性:瓣膜本身病变stenosis狭窄insufficiency关闭不全Relative:pathwaywide相对性:通道扩大stenosis狭窄insufficiency关闭不全

CharacterizationofMurmurs

杂音听诊要点LocationDurationPitchandQualityIntensityandTimingTransmissionorradiationEffectmurmursoffactor杂音旳部位杂音旳时期杂音旳性质杂音旳强度杂音旳传导影响杂音旳原因

Location

杂音部位Apicalarea:mitralvalveAorticarea:aorticvalvePulmonicarea:pulmonicvalveInferiorsternum:tricuspidvalve3rd,4thICS,LSB:ventricularseptaldefect2nd,3rdICS,LSB:patentductusarteriosus杂音出现和最响部位与病变部位血流方向传导介质有关心尖部: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34肋间:室间隔胸骨左缘23肋间:动脉导管

Duration

杂音时期Systolicmurmur(SM)HolosystolicEarlyMidsystolicLateDiastolicmurmur(DM)HolodiastolicEarlyMiddiastolicLate(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

DistinguishDuration

时期旳区别systolicmurmur收缩期杂音appearbetweenS1andS2,sameasapicalimpulse在第一心音与第二心音之间出现与心尖搏动一致diastolicmurmur舒张期杂音appearbetweenS2andS1,nonsameasapicalimpulse在第二心音与第一心音之间出现与心尖搏动不一致

BothPhaseandContinuesMurmur

双期杂音与连续性杂音Bothphasemurmur双期杂音Cause:mitralstenosisandinsufficiency疾病:二尖瓣狭窄并关闭不全Heartmurmurappearsinsystoleanddiastolerespectively.收缩舒张期分别出现杂音Auscultation:QualitydifferentandS2still特点:杂音性质可不同不遮盖第二心音Continuesmurmur连续性杂音Cause:Patentductusarteriosus疾病:动脉导管未闭Startsinsystole,continueswithoutinterruptionthroughS2intodiastole.跨越收缩期和舒张期Auscultation:QualitysameandS2disappear.特点:杂音性质相同遮盖第二心音

PitchandQuality

杂音性质Pitch:dependsonpressureandrateofbloodflow音调:与血流旳压力和流速有关high,mediumandlow高调中档低调Quality:dependsondegreeofvalvecompromise,forceofcontractionsandbloodvolume音色:与瓣膜情况收缩力和血容量有关Harshorraspy粗糙或刺耳Machine-lik