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1、1 Department of Diagnostics 1st Affiliated Hospital Chen Ming 2 Equipment 器材 Stethoscope 听诊器 Position 体位 Supine 卧位 or seated 坐位 a patient standing to the right side of the patient an examiner Environment 环境 Quiet 安静 Exposure 暴露 Strip to waist 腰部 Lightening 光线 Good left side tangent 切线 Knowledge of a
2、natomy 解剖知识 thorough 全面 Considerate and gentle Physical examination of heart 心脏检查 Preparation 3 Midsternal line 胸骨中线 or Anterior midline 前正中线 Midclavicular lines 锁骨中线 Anterior middle and posterior axillary lines 腋前 中 后线 Sternal angle 胸骨角 connected with 2th costal cartilage 与第二肋软骨相连 Intercostal space
3、 肋间隙 Physical examination of heart 心脏检查 landmarks of topographic anatomy 解剖标 志 4 Inspection 望诊 Palpation 触诊 Percussion 叩诊 Auscultation 听诊 心 脏 检 查 Physical examination of heart 心脏检查 5 Tangent lightening 切线方向光线 Same height as thorax 与胸廓同高 Inspection 望诊 gist 要点 6 Precordial prominence 心前区隆起 Right ventr
4、icular hypertrophy at puberty 儿童发育完成前右心室肥大 Congenital heart disease 先天性心脏病 Rheumatic heart disease 风湿性心脏病 Massive pericardial effusion in the adult 成人大量心包积液 Inspection 望诊 Deformity of thoraxes 胸廓畸形 7 Inspection 望诊 Apical impulse 心尖搏动 Definition 定义 Heart contracts 心脏收缩 impacts corresponding site of f
5、ront chest 心尖向前冲击前胸壁相 应位置 apical impulse 心尖搏动 8 Inspection 望诊 Normal apical impulse 正常心尖搏动 Location The 5th intercostal space 第五肋间 0 5 1 0 cm medial to left midclavicular line 左锁骨中线内侧 0 5 1 0 cm Diameter 2 0 2 5 cm Inspection 望诊 Apical impulse 心尖搏动 9 Physiological factors 生理性因素 Left lateral position
6、 左侧卧位 extend to the left 向左移 for 2 0 3 0 cm Right lateral position 右侧卧位 extend to the right 向右移 for 1 0 2 5 cm Inspection 望诊 Displacement of apical impulse 心尖搏动移位 10 Pathological factors 病理性因素 Heart itself 心脏本身 Enlargement of left ventricle 左 心室增大 extend to left and downwards 左下移位 Inspection 望诊 Disp
7、lacement of apical impulse 心尖搏动移位 11 Pathological factors 病理性因素 Heart itself 心脏本身 Enlargement of right ventricle 右 心室增大 extend to left but not downwards 向左不向下移位 Enlargement of both ventricles 左 右室均增大 extend to both left and right Inspection 望诊 Displacement of apical impulse 心尖搏动移位 12 Pathological fa
8、ctors 病理性因素 Displacement of mediastinum 纵隔移 位 Pleural adhesion 胸膜粘连 pulmonary atelectasis of one side 肺 不张 displacement of apical impulse toward the diseased side 移向 患侧 Pleural effusion 胸腔积液 pneumothorax of one side 气胸 displacement of apical impulse toward the opposite side 移向健侧 Inspection 望诊 Displa
9、cement of apical impulse 心尖搏动移位 13 Pathological factors 病理性因素 Displacement of diaphragm 横隔移位 Massive ascites 大量腹水 huge tumor of abdominal cavity 腹腔巨大 肿瘤 displacement of apical impulse to left 移向左侧 Severe emphysema 肺气肿 displacement of apical impulse inward and downward 移向内下 Inspection 望诊 Displacement
10、 of apical impulse 心尖搏动移位 14 Physiological factors 生理性因素 Thick chest wall 胸壁肥厚 weak and narrow 减弱 缩小 Thin chest wall 胸壁薄 strong and wide 增强 较大 Inspection 望诊 Changes of intensity and range in apical impulse 心尖搏动强度与范围的改变 15 Pathological factors 病理性因素 Increase in intensity of apical impulse 心尖搏动增强 feve
11、r 发热 anemia 贫血 hyperthyroidism 甲状腺机能亢进 Decrease in intensity of apical impulse 心尖搏动减弱 dilated cardiomyopathy 扩张型心肌病 acute myocardial infarction 急性心肌梗死 pericardial effusion 心包积液 emphysema 肺气肿 Inspection 望诊 Changes of intensity and range in apical impulse 心尖搏动强度与范围的改变 16 Inspection 望诊 Inward impulse 负
12、性心尖搏动 Definition 定义 invagination 内陷 of apical impulse when contracting Significance 意义 adhesive pericarditis 粘连性心包积液 17 Inspection 望诊 precordial impulse 心前区搏动 Impulse at 3th 4th left intercostal space just lateral to sternum 胸骨左 缘3 4肋间 right ventricular hypertrophy 右室肥 大 Impulse at xiphoid process 剑
13、突下搏 动 right ventricular hypertrophy beating of abdominal aorta 腹主动脉搏 动 18 Impulse at base of heart 心底部搏动 2nd left intercostal space just lateral to sternum 胸骨左缘2肋间 dilation of pulmonary artery pulmonary hypertension 2nd right intercostal space just lateral to sternum 胸骨右缘2肋间 dilation of ascending ao
14、rta 升主动 脉扩张 Inspection 望诊 precordial impulse 心前区搏动 19 Inspection 望诊 contents 内容 Deformity of thoraxes 胸廓畸形 Apical impulse 心尖搏动 Precordial impulse 心前区搏动 20 Palpation 触诊 Importance of palpation 触诊意义 To confirm the observations made during inspection 进一步证实望诊所见 To detect invisible pulsatile movements 发现
15、望诊看不见的搏动 To reveal thrill and pericardial friction rubs 发现震颤和心包摩擦感 21 Palpation 触诊 method 方法 Right palm first 先用右手手掌 detecting thrills 检查震颤 Fingertips then 后用指尖 detecting pulsations 检查搏动 22 Definition 定义 Slow and forceful beat in apex 心尖区徐缓 有力的搏动 lift finger tip 可使手指尖端抬起 Significance 意义 Sign of left
16、 ventri cular hypertrophy 左室肥大的体征 Palpation 触诊 heaving apex impulse 抬举样心尖搏动 23 Palpation 触诊 thrills 震颤 Definition 定义 Tiny vibrations felt by palm 手掌感觉到的一种细小震动感 somewhat similar to the sensations on the throat of a purring cat therefore also called purring 与在猫喉部摸到的呼 吸震颤类似 故亦称猫喘 Mechanism The same as cardiac murmurs 同杂音 24 Significance 意义 Signs of organic heart diseases 器质 性心脏病的体征 always Thrill cardiac murmur not always Cardiac murmur thrill Usually congenital heart disease 先天性心脏病 valvular stenosi
