Download 心脏体格检查 - 上海交通大学医学院精品课程

上海交通大学医学院仁济临床医学院
理论课教案
第 2 次课 教学方式 Lecture
学时 3 专业 diagnostics 班级 04 级英文班 2007 年 4 月 30 日
题
Examination of the heart
目
本
课
目
的
要
求
本
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的
重
点
、
难
点
本
课
使
用
教
材
及
参
考
书
本
次
课
应
用
教
具
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电
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材
1.Master the basic maneuver of inspection, palpation and
percussion of heart.
2.Master the normal manifestation of heart examination.
3.Master the clinic significance of abnormal changes of heart
examination.
1.Location and range of normal apical impulse.
2.Mechanism and clinic significance of thrills as well as the
difference between thrills and murmus.
3.Accurate maneuver and sequence of percussion, normal dullness
of the heart and the clinic significance of abnormal changes.
“Diagnostics” (英文版) 上海第二医科大学诊断学教研室
“诊断学” 第四版 人民卫生出版社
多媒体
1
教学程序、时间分配及主要内容
备注
Total time for course: 2hours
Inspection
1. Observe precordium
2. Apical impulse
In adults the apical impulse normally is located in the left fifth intercostal space,
either at or medial to the mvl and about 2-2.5 cm diameter, it serves the examiner
as a marker for the onset of cardiac contraction.
Displacement of the apical impulse:
a) Heart disease:
b) Abdominal disease:
c) Thoracic disease:
d) The apical impulse may have increased amplitued and duration in those
persons with a thin chest, anemia, fever, hyperthyroidism and anxiety.
Abnormal pulsations in the other areas.
a) Right vertricular hypertophy (RBH).
b) Pulmonary emphysema with RVH: inferior the xiphoid process.
c) Asending or arch aortic aneurysm: in aortic area, with bulging or
pulsation in systole.
d) Pulmonary hypertension: in left second intercostal space to the edge of
sternum.
palpation
1)
2)
3)
Usage of the palpation confirms the precordial pulsation’s location.
Thrills are actually palpable fine vibrations, most commonly produced
by blood from one chamber of the heart to another through a restricted or
narrowed orifice.
Pericardial friction rub is a to-and-fro grating sensation.
Percussion
1) Main point: Usually we employ indirect percussion. It is outlined by
percussing in the 5th, 4th, 3rd and 2nd interspace on the left sequentially, starting
near the axilla and moving medially until cardiac dullness is encountered.
2) The heart borders
(1). The base of the heart:
(2). The right border of the heart:
(3). The left border of heart:
(4). The inferior border:
3) Normal relative dullness of the heart
Right
Intercostal space
Left (cm)
2-3
II
2-3
2-3
III
3.5-4.5
3-4
IV
5-6 (cm)
V
7-9
In normal person the distance from the 5th to the midsternal line is about 7-9 cm.
4) Changing cardiac dullness
Heart disease
Left ventricular enlargement, the cardiac dullness will be extended to the left and
downward.
Right ventrucular enlargement, the cardiac dullness will extended to left and
upward.
Both the left artrium and pulmonary artery enlarged. It is frequentlyseen in mitral
valve stenosis.
The base border of heart enlargement: Aortic dilation, aneurysm of aorta,
pericardial effusion
Heart silhouette extending both to right and left: Congestive heart failure,
myocarditis, myocardiopathy and pericardial effusion.
2
Inspection
小结
要点
及复
习思
考题
Observe precordium
Apical impulse
1.Normal location and range: in the left fifth intercostal space, either at or medial to
the mvl and about 2-2.5 cm diameter.
2.Displacement of the apical impulse
3.Abnormal pulsations in the other areas
Palpation
1.Usage: confirms the precordial pulsation’s location
2.Thrills; palpable fine vibrations produced by blood from one chamber of the heart to
another through a restricted or narrowed orifice.
3.Pericardial friction rub
Percussion
1.Main point: It is outlined by percussing in the 5th, 4th, 3rd and 2nd interspace on the left
sequentially, starting near the axilla and moving medially until cardiac dullness is
encountered.
2.The heart borders: base, right border, left border and inferior border
3.Normal relative dullness of the heart
4.Changing cardiac dullness
Question:
Tell the common diseases with systolic thrills and different locations.
下次
课预
习范
围及
后续
课程
介绍
撰写人
金玉华
教研室
诊断学
撰写日期
2007 年 4 月 28 日
3