常见心脏病症状与体征.pptVIP

心脏查体复习 视诊 心前区外形 心尖搏动 正常心尖搏动 异常心尖搏动 （移位、弥散、反向） 心前区异常搏动 触诊 心尖搏动 正常 异常（抬举性，移位） 心前区搏动 震颤与临床意义 心包摩擦感 心脏查体复习 叩诊 手法 顺序 正常心浊音界 心浊音界改变 及对应的临床意义 听诊 5个听诊区位置 听诊顺序 6个听诊内容 心脏听诊复习 正常心率范围 心律不齐类型 心音 构成,心动周期划分,强度变化,心音分裂及其临床意义 额外心音及其临床意义 舒张期:奔马律,开瓣音,心包扣击音,肿瘤扑落音 收缩期:AP喷射音,喀喇音 杂音及其临床意义 5要素概念 5听诊区两期中杂音的临床意义 常见心脏病症状体征 Mitral stenosis Mitral regurgitation Aortic stenosis Aortic regurgitation Pericardial effusion Heart failure 收缩期心脏瓣膜 舒张期心脏瓣膜 二尖瓣狭窄 History Dyspnea accompany with coughwheezing Hemoptysis Systemic embolism PE Mitral facies Apex: Trill of MS Larged RV S1 , P2A2, spilt S2, OS, lowpitched rumbling DM of MS，Graham Steell 二尖瓣关闭不全 History No symptoms for years When LV failure dyspnea weakness，fatigue PE Apex pulse move to left Apex: Lifting pulse Trill of MS Left Border : to Left and lower S1 , high-pitched blowing SM, radiation to axilla 主动脉瓣狭窄 History Angina(5y) Syncope(3y) Heart failure(2y) Sudden death PE (-) / Apex pulse move to left Apex: Lifting pulse A2 area: Trill of MS Left Border : to Left and lower A2 , P2A2, reverse spilt S2 A1 area: SM 主动脉瓣关闭不全 History Dizziness Palpitation Heart failure PE carotis A. pulse Apex: left and lower/ lifting pulse Water hammer pulse Left Border: to left and lower A2 area: decrescendo DM Austin Flint, Pistol shot sound 心包积液 History 症状取决于积液的速度和量 Cough or dyspnea Dysphagia Pain in chest week and fever PE Apex pulse: Apex pulse: Double Border: enlarged Ewart sign Little effusion: Pericardial friction sound. Large effusion: HR S1 S2, Pericardial knock 左心衰竭 History Exertional dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cough Weak PE Cyanosis, polypnea, sweat Pulse alternans Double Border: enlarged Pulmonary rales, P2 Gallop rhythm 右心衰竭 History Anorectic, Vomitus Abdominal distension Uropenia PE Edema Hepatojugular reflux Congestive hepatomegaly RV enlarged Hydrothorax, Ascites Gallop rhythm 课程回顾 心脏查体 视诊,触诊,叩诊,听诊(6项) 血管检