《体格检查血管ppt课件》由会员分享，可在线阅读，更多相关《体格检查血管ppt课件（13页珍藏版）》请在金锄头文库上搜索。
1、Chapter V ThoraxD. Heart and blood vessels Blood Vessel by Dr. Zhuo-ren Lu1. Inspection(1)VenousbloodpressurelWhenthevenouspressureiselevated,anengorgedexternaljugularveincanbeseenabovetheloweronethirdofthedistancebetweensuperclavicleandtheangleofthejawwithpatientsittingerect,andabovethe lower two t
2、hird of the distance between superclavicleandtheangleofthejawatsupineposition.lIt often indicatesthe elevatedpressure in the rightatriumandisanimportantsignofcongestiveheartfailure, pericardial constriction, and pericardialeffusion.(2)ThevisiblepulsationintheneckveinsvIt indicates the regurgitation
3、of tricuspid valve and the visible pulsation of carotid artery occurs in aortic regurgitation. vThe level of visible pulsation in the neck veins descends on normal inspiration and rises on expiration. vThe pulsation of jugular vein looks diffuse, but the point of carotid artery pulse is limited. vIt
4、 requires much greater pressure to eliminate the carotid artery pulse with a distinct pulse feeling. (3)HepatojugularrefluxCompression of the right upper abdominalquadrantfor30to45secondswillresultinmoreprominentdistensionofexternaljugularvein.lItusuallyisanimportantsignofrightventricularfailure or
5、pericardial effusion or constriction,becausebloodisbeingtransmittedfromthelivertothesuperiorvenacavewithoutreturningbacktorightatriummore.Itisusuallyusedtodistinguishhepotohemiafromhepatitis,hepotoma,hepatocirrhosis.(4)CapillarypulsationCheckcapillarypulsationbypressingonnailsorlipswithaclearglassan
6、dlookingatthechangeofcolorfrompinktowhite.Capillarypulsationoccursinaorticregurgitationandotherabnormalitiesassociatedwithwidepulsepressure.2. Palpation(1)Examinerplacefingersovertheradialarteryandcanfeelthestrongarterypulsating.Itisstillaboundingpulsewhenelevatingthepatientsarmoverhishead.Itiscalle
7、daswater-hammerpulseandoftenoccursinaorticregurgitationandotherabnormalitiesassociatedwithwidepulsepressure.(2)Pulsusparadoxus(paradoxicalpulse)isanimportantsign of cardiac tamponade with tense pericardialeffusionandlessfrequentlywithchronicconstrictivepericarditis.Thetermreferstoweakeningofthepulse
8、duringdeepinspiration.4. Arterial blood pressure(1)Measurebloodpressure(Bp)onrightarm.lThepointinwhichBpistobemeasuredshouldbeattheleveloftheheart.lPlacecuffincorrectlocation23cmabovetheelbowjointandmakeonefingeradmittedunderthecuff.lThemercurycolumnonthemanometershouldbeproperlycalibratedwiththepoi
9、nterat“0beforethecuffisinflated.lThestethoscopeisplacedfirmlyoverthebrachialartery.l The examiner inflated the cuff slowly but steadily until the brachial artery pulse disappears and 2030mmHg higher. Deflate the cuff slowly at the rate of about 2mmHg/min. l The number where the examiner hears the fi
10、rst pulse is the systolic pressure. The number where the pulse sound disappears is the diastolic pressure. If the difference between weakening of the sound and its disappearance is 20mmHg or greater, these two numbers should be recorded. l One minute later, the same procedure may be followed for a s
11、econd measurement of Bp. The lowest pressure is recorded as the patients Bp. (2) Under the normal circumstances there is little or no significant difference in Bp (5 10mmHg) in the two upper extremities. The systemic pressure is slightly higher, 20 40mmHg in the lower extremities by placing the cuff
12、 around the lower third of the thigh and the stethoscope over the popliteal artery than in the upper. It is important to mearsur Bp in the low extremities when the femoral and popliteal pulses are either weak or absent and in order to rule out coarctation of the aorta.Definitionsandclassificationofb
13、loodpressurelevels(mmHg)byWHO/ISH1999 Category Systolic DiastolicOptimal 120 80Normal 130 85High normal 130- 85-89Grade 1 hypertension (mild) 140-159 90-99 Subgroup: borderline 140-149 90-94Grade 2 hypertension(moderate) 160-179 100-109Grade 3 hypertension (severe) 180 110Isolated systolic hypertens
14、ion 140 90 subgroup:borderline 140-149 90 l Some serious causes of low Bp include acute myocardial infarction, hemorrhage, and shock. l Increased pulse pressure happens frequently in hyperthyroidism, aortic valve regurgitation, etc.l In elderly persons the most common cause for an elevated SP and normal DP is aortic atherosclerosis or arteriosclerosis. The decreased pulse pressure may be resulted from pericardial effusion, constrictive pericarditis, aortic stenosis, mitral stenosis, and heart failure.
