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1、2018/10/2,1,Examination of Blood Vessels,2018/10/2,2,Introduction,Palpation of the pulse Measurment of arterial blood pressure Auscultation of blood vessels,2018/10/2,3,Palpation of The Pulse,Radial artery is usually selected Patients hand placed with the palm upward Physicians first three fingers o
2、n the radial artery Index finger nearest the heart,2018/10/2,4,Characteristics of The Pulse,Rate Intensity Type of wave Rhythm Tension,2018/10/2,5,RATE,-Pulse frequency (rapid or slow)Varies with age, sex, physical activity, emotional status Normal range: 60-100bpm in adults; 90-120bpm in children,2
3、018/10/2,6,Rate increase (tachycardia心动过速): severe anemia, high fever, massive hemorrhage(大出血), various types of cardiac arrhythmias, hyperthyroidism, and at times in congestive heart failure.,2018/10/2,7,Rate decrease (bradycardia心动过缓): increased intracranial pressure(颅高压), SSS, above AVB, hypothyr
4、oid(甲减), Digoxin(地高辛), etc,2018/10/2,8,Rhythm,The more common disturbances of rhythm can and should be detected by palpating the pulse. Auscultation of the heart is a more accurate method for determining the rhythm. Some of the more complex arrhythmias can be diagnosed only by EKG.,2018/10/2,9,Commo
5、n irregular pulse: Sinus arrhythmia(窦不齐) Premature beat(早搏) Atrial fibrillation(房颤) Bigeminal pulse(二联律) Trigeminal pulse(三联律) Paroxysmal atrial, ventricular tachycardia Heart block(传导阻滞),2018/10/2,10,Tension,The tension of pulse depends on the level of the arterial systolic pressure.,2018/10/2,11,I
6、ntensity,The intensity depends on the cardiac output, pulse pressure and the resistance of peripheral vessels.,2018/10/2,12,Pulsus magnus (bounding pulse洪脉): increased cardiac output , high pulse pressure, low resistance. aortic insufficiency, high fever, hyperthyroid,2018/10/2,13,Small pulse (threa
7、dy pulse细脉): decreased cardiac output , low pulse pressure, high resistance. aortic stenosis, heart failure, shock.,2018/10/2,14,Wave form,The arterial pulse starts at the instant aortic valve opens, results in an abrupt sharp rise in aortic pressure. During systole a large part of blood is temporar
8、ily stored in the proximal aorta. Once the aortic pressure reaches a peak it begins to fall, and blood continues its flow in the peripheral arteries in later systole and diastole.,2018/10/2,15,Normal pulse wave: Ascending limb Peak Descending limb small notch ( on the descending limb) Small notch (o
9、n the ascending limb),2018/10/2,16,2018/10/2,17,The upstroke is prompt and smooth, but the anacrotic notch is not palpable in most normal persons. The peak is rounded and smooth. The descending limb is more gradual and less steep. The dicrotic notch in most normal persons cannot be palpated but can
10、be sensed as a change in the slope of the down stroke.,2018/10/2,18,Type of Wave,Abnormal pulse wave Water hammer pulse(水冲脉) Pulsus tardus(迟脉) Dicrotic pulse(重搏脉) Pulsus alternans(交替脉) Paradoxical pulse(奇脉) Asphygmia(无脉),2018/10/2,19,Water hammer pulse（水冲脉）,A strong bounding pulse with a tall rapid
11、ascending limb and an equally rapid descending limb. It is also called collapsing pulse. Due to increasing pulse pressure, it is Commonly found in AI, PDA, hyperthyroid and severe anemia.,2018/10/2,20,2018/10/2,21,Pulsus Tardus （迟脉）,A small weak pulse with a delayed systolic peak It occurs in the pr
12、esence of narrow pulse pressure, increased peripheral vascular resistance, low SV Common in aortic stenosis, mitral stenosis, LV heart failure after AMI.,2018/10/2,22,2018/10/2,23,Dicrotic Pulse（重搏脉）,There are two impulses that are palpable during systole and diastole respectively. It usually occurs
13、 in the presence of high fever and typhoid(伤寒).,2018/10/2,24,2018/10/2,25,Pulsus Alternans（交替脉）,It is characterized by a regularly alternating pulse, in which every beat is weaker than the preceding beat. It is easy to be detected when the patient is sitting or standing. It is a valuable indication
14、of left ventricular failure. Severe arterial hypertension.,2018/10/2,26,2018/10/2,27,Paradoxical pulse （奇脉）,A decrease in the amplitude or an actual imperceptibility of the pulse during inspiration. Commonly found in massive pericardial effusion, constrictive pericarditis, and severe pulmonary emphy
15、sema.,2018/10/2,28,Asphygmia（无脉）,Severe shock Primary arteritis of the aorta and its main branches (pulseless),2018/10/2,29,Consistency of Arterial Wall,Normally the wall of radial artery is soft and pliable In arteriosclerosis(动脉硬化), more resistance to compression by the palpating finger, and the v
16、essel may be rolled easily between the examing digits.,2018/10/2,30,Measurement of Arterial Blood Pressure,Methods for measuring the blood pressure: Direct method Indirect method,2018/10/2,31,Definitions and Classification of Blood Pressure Levels,Category systolic(mmHg) diastolic(mmHg) Normal 120 80 High-normal 120-139 80-89 Hypertension 140 90 Isolated systolic 140 90hypertension,
