《健康評估》課件-修 心臟視診

VisualInspection

ofHeart心臟視診

解剖回顧

心臟體表投影主動脈左肺動脈左心室心尖部肺動脈右心室右心房右肺動脈上腔靜脈1

Heartsurface

projectionsuperiorvenacavarightpulmonaryarteryrightatriumrightventricleaorticorificeleftpulmonaryarterycardiacapexleftventricle

Anatomicalreview

pulmonaryartery

解剖回顧

心臟的瓣膜2

Anatomicalreview

valvularheartaortaTricuspidvalveRightAtriumRightVentricleLeftVentriclePulmonaryarteryLeftAtriumcardiacvalvesvalvulabicuspidalisaorticvalvepulmonaryvalve

解剖回顧

valvulabicuspidalispulmonaryvalvepulmonaryvalveaorticvalveTricuspidvalveLeftAtriumpulmonaryvein

Anatomicalreview

解剖回顧

瓣膜狹窄瓣膜關(guān)閉不全正常瓣膜打開正常瓣膜關(guān)閉

Anatomicalreview

NormalvalveopeningnormalvalveclosureValvularstenosisValvularinsufficiency心前區(qū)隆起與凹陷

心前區(qū)隆起心臟增大：先天性心臟病、

風(fēng)濕性心臟病等Enlargedheart:congenitalheartdisease,rheumaticheartdisease,etc.馬方綜合征Marfansyndrome部分二尖瓣脫垂病人Somepatientswithmitralvalveprolapse

Bulgeanddepressionofprecordialregionprecordialprominence心前區(qū)凹陷Precordialdepression心前區(qū)隆起與凹陷

心前區(qū)隆起雞胸：佝僂病pectuscapitatum：rickets心包積液pericardialeffusion馬方綜合征Marfansyndrome部分二尖瓣脫垂病人Somepatientswithmitralvalveprolapse

bulgeanddepressionofprecordialregionprecordialprominence心前區(qū)凹陷Precordialdepression心前區(qū)隆起心前區(qū)凹陷心前區(qū)隆起與凹陷

UpliftanddepressionofprecordialregionPrecordialdepressionprecordialprominence心尖搏動

正常心尖搏動正常人坐位時心尖搏動一般位于左側(cè)第5肋間隙鎖骨中線內(nèi)0.5～1.0cm處，Inthenormalsittingposition,theapicalpulsationisgenerallylocatedatthe0.5~1.0cminthemidlineoftheclavicleoftheleftfifthintercostalspace,

apicalbeat

Normalapicalbeat心尖搏動

正常心尖搏動距前正中線7.0～9.0cm,搏動范圍為直徑2.0～2.5cm。Thenormalapicalbeatis7.0～9.0cmfromtheanteriormedianline,andthebeatingrangeis2.0～2.5cmindiameter.

apicalbeat

Normalapicalbeat心尖搏動的位置變化

生理因素Physiologicalfactors心尖搏動位置變化Apicalpositionchanges體型BodyType超力型心尖搏動向外上移位，無力型者向內(nèi)下移位Thehyperdynamicapicalpulsationmovesoutwardandupward,whileinthepowerlesstype,theheartofinfantsandchildrenmovesinwardanddownward年齡Age嬰兒和兒童心臟常橫位，向外上移位theheartsofinfantsandchildrenmoveoutward

Apicalpositionchanges

心尖搏動的位置變化

生理因素Physiologicalfactors心尖搏動位置變化Apicalpositionchanges體位Bodyposition臥位較坐位高；右側(cè)臥位向右移，左側(cè)臥位向左移thesupinepositionishigherthanthesittingposition;therightsupinepositionshiftstotheright,theleftsupinepositionshiftstotheleft呼吸Respiration深呼氣時下移，深吸氣時上移downwardduringdeepexhalation,theheartmovesupward妊娠Pregnancy心臟常橫位，向外上移位theheartmovesupwardduringdeepinhalationApicalpositionchanges

病理因素Pathologicalfactors心尖搏動位置變化Apicalpositionchanges心臟疾病Heartdisease①左心室增大：心尖搏動向左下移位

Leftventricularenlargement:apicaldisplacementtotheleft②右心室增大：心尖搏動向左移位

Rightventricularenlargement:apicaldisplacementtotheleft③全心室增大：心尖搏動向左下移位，心界向兩側(cè)擴(kuò)大

Wholeventricularenlargement:apicaldisplacementtotheleft,cardiacboundarytobothsides④先天性右位心：心尖搏動點在胸骨右側(cè)

Congenitalrightheart:apicalpulsationattherightsideofthesternum心尖搏動的位置變化

Apicalpositionchanges

病理因素Pathologicalfactors心尖搏動位置變化Apicalpositionchanges胸部疾病Chestdisease①一側(cè)胸腔積液或氣胸，心尖搏動向健側(cè)移位

onesideofpleuraleffusionorpneumothorax,apicaldisplacementtothehealthyside②一側(cè)肺不張或胸膜粘連，心尖搏動向患側(cè)移位

onesideofatelectasisorpleuraladhesion,apicalmovementtotheaffectedside腹部疾病AbdominalDiseases大量腹腔積液或腹部腫瘤可使心尖搏動上移Abdominaleffusionorabdominaltumorscancausetheapicalpulsationtomoveupward.心尖搏動的位置變化

Apicalpositionchanges

左心室增大右心室增大心尖搏動的位置變化

LeftventricularenlargementrightventricularenlargementApicalpositionchanges

心尖搏動強(qiáng)度變化

增強(qiáng)：生理性：兒童、肋間隙增寬、劇烈運(yùn)動、情緒激動等病理性：左心室肥厚；甲亢、發(fā)熱、貧血等Enhancement:

physiology:children,wideningofintercostalspace,strenuousexercise,emotionalagitation

Pathology:leftventricularhypertrophy;hyperthyroidism,fever,anemia

apicalpulsationintensitychanges

心尖搏動強(qiáng)度變化

減弱：生理性：體胖、肋間隙變窄等病理性：急性心肌梗死、擴(kuò)張型心肌病、心包積液等；

左側(cè)胸腔大量積液、積氣，肺氣腫等Weakening:

physiology:obesity,narrowingofintercostalspace

Pathology:acutemyocardialinfarction,dilatedcardiomyopathy,pericardialeffusion,etc.Leftpleuraleffusion,gas,emphysema,etc.

apicalpulsationintensitychanges

心尖搏動強(qiáng)度變化

負(fù)性心尖搏動：粘連性心包炎、右心室明顯肥厚Negativeapicalpulsation:adhesivepericarditis,obviousrightventricularhypertrophy

apicalpulsationintensitychanges

心前區(qū)異常搏動

胸骨左緣第3、4肋間：消瘦、右心室持久壓力負(fù)荷所致右心室肥厚The3rdand4thintercostalsoftheleftmarginofthesternum:emaciation,rightventricularhypertrophycausedbypersistentpressureloadoftherightventricle劍突下：腹主動脈搏動、腹主動脈瘤、右心室肥厚窄Xiphoidprocess:abdominalaorticpulsation,abdominalaorticaneurysm,rightventricularhypertrophy

abnormalprecordialpulsation

心前區(qū)異常搏動

胸骨左緣第2肋間：肺動脈高壓、肺動脈擴(kuò)張Thesecondintercostalspaceoftheleftmarginofthesternum:pulmonaryhyperte