心脏检查心脏检查CARDIOVASCUIAR EXAMINATIOCARDIOVASCUIAR EXAMINATIO

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课堂目标课堂目标learning oblectiveslearning oblectives

说出正常心尖搏动的位置和范围说出正常心尖搏动的位置和范围 To state the range and site of To state the range and site of apical impulseapical impulse

阐述震颤的概念、产生机制及临床意义阐述震颤的概念、产生机制及临床意义 To To elaborateelaborate the concept, mechanism and clinical s the concept, mechanism and clinical significance of thrillignificance of thrill

描述正常心脏相对浊音界的范围描述正常心脏相对浊音界的范围 To describe the To describe the border of relative dullnessborder of relative dullness

说出心脏瓣膜听诊区的概念及位置说出心脏瓣膜听诊区的概念及位置 To state the concept and site of To state the concept and site of auscultatory auscultatory cardiac cardiac valve areasvalve areas

比较比较 SS11 、、 SS22 心音的产生机制、特点与临床意义心音的产生机制、特点与临床意义 To compare the difference between S1 and S2 about their mechanism, character To compare the difference between S1 and S2 about their mechanism, character

and clinical sand clinical significance ignificance

陈述杂音的概念与分级陈述杂音的概念与分级 To state the concept and grade of heart murmursTo state the concept and grade of heart murmurs

概 述概 述introductionintroduction

运用视、触、叩、听等检查方法初步判定有无心运用视、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．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。在临床上具有重要的意义。 To use inspection, palpation, percussion and auscultation to To use inspection, palpation, percussion and auscultation to

determine whether heart diseases exist and what the causes mdetermine whether heart diseases exist and what the causes may be, the site and the characters if heart diseases exist .ay be, the site and the characters if heart diseases exist .So CARDIOVASCUIAR EXAMINATION has great significance .So CARDIOVASCUIAR EXAMINATION has great significance .

检查的注意事项检查的注意事项matters needing attention in the examinationmatters needing attention in the examination

一般采取仰卧位或坐位；一般采取仰卧位或坐位；dorsal position or sitting position is often used;dorsal position or sitting position is often used;

环境应环境应安静安静；； 光线光线充足，最好是来源于左侧，充足，最好是来源于左侧，The environment should be quiet and bright; it will be better The environment should be quiet and bright; it will be better

if if light source comes from left side;light source comes from left side;

室温室温不低于不低于 20℃20℃；；Temperature should be higher than 20 ℃Temperature should be higher than 20 ℃

心脏视诊心脏视诊lnspection of the heartlnspection of the heart

(( 一一 )) 心前区隆起与凹陷心前区隆起与凹陷

eminenceeminence or introcession in or introcession in precordial regionprecordial region

(( 二二 )) 心尖搏动心尖搏动

apical impulseapical impulse

(( 三三 )) 心前区异常搏动心前区异常搏动

Abnormal precordial pulsationAbnormal precordial pulsation

心脏触诊心脏触诊Palpation of the heartPalpation of the heart

检查者常用右手，以全手掌、手掌尺侧检查者常用右手，以全手掌、手掌尺侧 (( 小鱼际小鱼际 )) 或示指、或示指、

中指和无名指并拢以指腹触诊。中指和无名指并拢以指腹触诊。

The whole palm, The whole palm, antithenar eminence or antithenar eminence or fingertips fingertips

of of Right hand is often used when Palpation.Right hand is often used when Palpation.

检查震颤常用手掌尺侧，检查心尖搏动常用检查震颤常用手掌尺侧，检查心尖搏动常用 2-42-4 指指腹。指指腹。

antithenar eminence is often used for thrill antithenar eminence is often used for thrill PalpationPalpation, whil, whil

e fingertips are often used for apical impulse e fingertips are often used for apical impulse PalpationPalpation

Palpation of the heartPalpation of the heart (( 一一 )) 心尖搏动心尖搏动apical impulseapical impulse (( 二二 )) 震颤震颤 :: 概念概念 ;; 产生机制产生机制Thrill: concept; mechanism Thrill: concept; mechanism (( 三三 )) 心包摩擦感心包摩擦感 :: 概念概念 ;; 产生机制产生机制 ;; 特点特点sense of pericardial friction :concept;sense of pericardial friction :concept; mechani mechani

sm; charactersm; character

心脏叩诊心脏叩诊Percussion of the heartPercussion of the heart

心脏叩诊用以确定心界，判定心脏大小、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。形状及在胸腔位置的一种方法。

Percussion of the heart is used to find the borPercussion of the heart is used to find the border of the heart;der of the heart;

相对浊音界反映心脏的实际大小相对浊音界反映心脏的实际大小 ,, 具有重要具有重要的临床意义的临床意义 ..

border of relative dullness present the true sizborder of relative dullness present the true size of the heart,so it has more clinical significe of the heart,so it has more clinical significance .ance .

(( 二二 )) 正常心脏相对浊音界正常心脏相对浊音界the normal the normal border of relative dullnborder of relative dulln

essess Right

border （ cm ）

intercostal space

Left

border

（ cm ） 2-3 2-3

2-3 2-3

3-4 3-4

II II

III III

IV IV

V V

2 – 3 2 – 3

3.5 – 3.5 – 4.5 4.5

5 - 6 5 - 6

7 - 9 7 - 9

听 诊auscultation

用膜型胸件听诊 用膜型胸件听诊 Auscultate with diaphragmAuscultate with diaphragm•• 肺动脉瓣区（胸骨左缘第肺动脉瓣区（胸骨左缘第 22 肋间隙）肋间隙）•主动脉瓣区（胸骨右缘第•主动脉瓣区（胸骨右缘第 22 肋间隙）肋间隙）•主动脉瓣第二听诊区（胸骨左缘第•主动脉瓣第二听诊区（胸骨左缘第 33 、、 44 肋间隙）肋间隙）•二尖瓣区（心尖部）•二尖瓣区（心尖部）•三尖瓣区（胸骨左缘第•三尖瓣区（胸骨左缘第 44 、、 55 肋间隙或胸骨体下端稍偏肋间隙或胸骨体下端稍偏右）右）•• Pulmonary area (second left ICS)Pulmonary area (second left ICS)

•Aortic area (second right ICS)•Aortic area (second right ICS)

•Second aortic area (third and fourth left ICS)•Second aortic area (third and fourth left ICS)

•Mitral area (Apical area)•Mitral area (Apical area)

•Tricuspid area (fourth, fifth left ICS, LSB and RSB)•Tricuspid area (fourth, fifth left ICS, LSB and RSB)

听 诊auscultation

用钟型胸件听诊 用钟型胸件听诊 Auscultate with bellAuscultate with bell

•• 肺动脉瓣区肺动脉瓣区•主动脉瓣区•主动脉瓣区•主动脉瓣第二听诊区•主动脉瓣第二听诊区•二尖瓣区•二尖瓣区•三尖瓣区•三尖瓣区•• Pulmonary areaPulmonary area

•Aortic area•Aortic area

•Second aortic area•Second aortic area

•Mitral area (Apical area)•Mitral area (Apical area)

•Tricuspid area•Tricuspid area

心脏瓣膜听诊区 auscultatory auscultatory cardiac cardiac valve areavalve area

ss 与各瓣膜的解剖位置并不完全一致。 cardiac cardiac valves are not exactly located in the auvalves are not exactly located in the au

scultatory scultatory cardiac cardiac valve areas . valve areas .

心脏瓣膜听诊区为四个瓣膜五个区。 We have four valves but five auscultatory auscultatory cardicardi

ac ac valve areasvalve areas

心脏瓣膜听诊区 auscultatory auscultatory cardiac cardiac valve areavalve area

ss

心 音cardiac sounds

心音有四个，第一心音 (S1) ，第二心音 (S2), 第三心音 (S

3) 和第四心音 (S4) 。 Four kinds of cardiac sounds :S1,S2,S3,S4 :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 so

me healthy children and teenager, but S4 is often has path

ological significance.

S1 and s2S1 and s2

S1S1 比比 S2S2 响亮响亮 ;; S1 is louder than S2;S1 is louder than S2; S1S1 与与 S2S2 的产生机制的产生机制 The mechanism of S1 and S2;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 pericard

ial friction sound and pleural friction rub and pleural friction rub