心脏检查 CARDIOVASCUIAR EXAMINATION

课堂目标 learning oblectives 说出正常心尖搏动的位置和范围 To state the range and site of apical impulse 阐述震颤的概念、产生机制及临床意义 To elaborate the concept, mechanism and clinical significance of thrill 描述正常心脏相对浊音界的范围 To describe the border of relative dullness 说出心脏瓣膜听诊区的概念及位置 To state the concept and site of auscultatory cardiac valve areas 比较S1、S2心音的产生机制、特点与临床意义 To compare the difference between S1 and S2 about their mechanism, character and clinical significance 陈述杂音的概念与分级 To state the concept and grade of heart murmurs

概 述 introduction 运用视、触、叩、听等检查方法初步判定有无心脏疾病，判断心脏病的病因、性质、部位及程度．在临床上具有重要的意义。 To use inspection, palpation, percussion and auscultation to determine whether heart diseases exist and what the causes may be, the site and the characters if heart diseases exist .So CARDIOVASCUIAR EXAMINATION has great significance .

检查的注意事项 matters needing attention in the examination 一般采取仰卧位或坐位； dorsal position or sitting position is often used; 环境应安静； 光线充足，最好是来源于左侧， The environment should be quiet and bright; it will be better if light source comes from left side; 室温不低于20℃； Temperature should be higher than 20 ℃

心脏视诊 lnspection of the heart (一)心前区隆起与凹陷 eminence or introcession in precordial region (二)心尖搏动 apical impulse (三)心前区异常搏动 Abnormal precordial pulsation

心脏触诊 Palpation of the heart 检查者常用右手，以全手掌、手掌尺侧(小鱼际)或示指、中指和无名指并拢以指腹触诊。 The whole palm, antithenar eminence or fingertips of Right hand is often used when Palpation. 检查震颤常用手掌尺侧，检查心尖搏动常用2-4指指腹。 antithenar eminence is often used for thrill Palpation, while fingertips are often used for apical impulse Palpation

Palpation of the heart (一)心尖搏动 apical impulse (二)震颤:概念;产生机制 Thrill: concept; mechanism (三)心包摩擦感:概念;产生机制;特点 sense of pericardial friction :concept; mechanism; character

心脏叩诊 Percussion of the heart 心脏叩诊用以确定心界，判定心脏大小、形状及在胸腔位置的一种方法。 Percussion of the heart is used to find the border of the heart; 相对浊音界反映心脏的实际大小,具有重要的临床意义. border of relative dullness present the true size of the heart,so it has more clinical significance .

(二)正常心脏相对浊音界 the normal border of relative dullness Right border（ cm） intercostal space Left border （cm） 2-3 3-4 II III IV V 2 – 3 3.5 – 4.5 5 - 6 7 - 9

听 诊 auscultation 用膜型胸件听诊 Auscultate with diaphragm •肺动脉瓣区（胸骨左缘第2肋间隙） •主动脉瓣区（胸骨右缘第2肋间隙） •主动脉瓣第二听诊区（胸骨左缘第3、4肋间隙） •二尖瓣区（心尖部） •三尖瓣区（胸骨左缘第4、5肋间隙或胸骨体下端稍偏右） •Pulmonary area (second left ICS) •Aortic area (second right ICS) •Second aortic area (third and fourth left ICS) •Mitral area (Apical area) •Tricuspid area (fourth, fifth left ICS, LSB and RSB)

听 诊 auscultation 用钟型胸件听诊 Auscultate with bell •肺动脉瓣区 •主动脉瓣区 •主动脉瓣第二听诊区 •二尖瓣区 •三尖瓣区 •Pulmonary area •Aortic area •Second aortic area •Mitral area (Apical area) •Tricuspid area

心脏瓣膜听诊区 auscultatory cardiac valve areas 与各瓣膜的解剖位置并不完全一致。 cardiac valves are not exactly located in the auscultatory cardiac valve areas . 心脏瓣膜听诊区为四个瓣膜五个区。 We have four valves but five auscultatory cardiac valve areas

心脏瓣膜听诊区 auscultatory cardiac valve areas

心 音 cardiac sounds 心音有四个，第一心音(S1)，第二心音(S2),第三心音(S3)和第四心音(S4)。 Four kinds of cardiac sounds :S1,S2,S3,S4 通常只能听到S1和S2，在某些健康儿童和青少年也可听到S3。S4般听不到，如能听到可能为病理性。 S1 and S2 can be heard in all people, S3 can be heard in some healthy children and teenager, but S4 is often has pathological significance.

S1 and s2 S1比S2响亮; S1 is louder than S2; S1与S2的产生机制 The mechanism of S1 and S2;

心 脏 杂 音 cardiac murmurs 产生机制; mechanism 特点 Character 分级:6级 Grade: Ⅰ~ Ⅵ

心包摩擦音 pericardial friction sound 产生机制 Mechanism 思考题:如何区分心包摩擦音与胸膜摩擦音？ Question: how to distinguish the and pericardial friction sound and pleural friction rub

QUESTIONS？