1、煩惱有何懼怕，既然躲不掉，就調(diào)好心態(tài)與它共存。心向陽光，何懼風霜。茫茫人海你我相遇就是緣分，歡迎下載！PercussionMethod of percussion for heartd lie supine on an examining table or sit on the chair, with the physician at his right side. Usually we employ indirect percussion(間接叩診法) for percussing heart borders. s, in attemptng to outline the cardiac d

2、ullness, strike too forcibly and thus fail to hear the slight change in the percussion note caused by the thin layer of overlying lung.the lightest percussion possible and, with experience, rely more and more upon the vibratory sense.recommended in the percussion of absolute cardiac dullness, and gi

3、ve excellent results comparing with ordinary methods.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. Percuould mark with a skin pencil where the note changes. The distance from midster

4、nal line to the left border should be measured and recorded, measurement should be made along a straight line paralleled to the transverse diameter in the thorax. Heart bordersof the heartformed bysup vena(上腔靜脈), ascending aorta(升主動脈), right atrium(右心房)he heartformed byaorta arch(主動脈弓), pulmonary ar

5、terial trunk(肺動脈段), left atria appendage(左心房), LV(左心室)r of the heartformed byRV(右心室), lesser extent LVdullnessright(cm)ICS,MSL left(cm)2-3 2-32-3 3.5-4.53-4 5-67-9Normally from midsternal line to MCL is about 8-10cmPhysiologic changes in thiac dullnessf the heart, and with it the area of cardiac dul

6、lness, is influenced by the level of the diaphragm.ation the diaphragm descends, producing a decrease in cardiac dullness, while in forced expiration the diaphragm rises and produces an increase in the cardiac dullness.nths of pregnancy the diaphragm is pushed upward, causing the heart to lie more h

7、orizontally and closer to the chest wall, thus increasing the area of cardiac dullness.Cardiac dullness in astentionthologic conditions such as ascites, an ovarian cyst(卵巢囊腫), or peritonitis(腹膜炎) may cause an elevation of the diaphragm with an increase in the area of cardiac dullness.Changes in posi

8、tion ullnessax the heart is displaced toward the normal side, but in massive collapse of the lung(肺萎縮) the heart is displaced toward the affected side.ions(胸膜粘連) may pull the heart to the affected side with resulting changes in cardiac dullness similar to those produced by collapse of the lung. Decr

9、ease in the area ullnesshe relative cardiac dullness may occur in pulmonary emphysema(肺氣腫). The absolute cardiac dullness is usually decreased in such cases, since the lung is increased in size and covers a greater area of the heart than normal.Increase in the area ullnessthe area of cardiac dullnes

10、s is most strikingly seen in patients with cardiac disease. we cannot detect by percussion an appreciable increase of the cardiac dullness in hypertrophy of the heart unless there is an accompanying dilatation.Cardiac enf the left ventricle produces an increase in the relative cardiac dullness to th

11、e left and often downward on this side.f the left ventricle appears in aortic insufficiency, in aortic stenosis, in mitral insufficiency, in longstanding hypertension and in chronic nephritis(慢性腎炎). It is called aortic heart(主動脈型心).ular enlargement, the cardiac dullness will extended to left and upw

12、ard. If the right ventricular is severely enlarged, the right border of the heart will extend to the right. It is seen in cor pulmonale, in mitral stenosis, in tricuspid insufficiency etc.trium and pulmonary artery enlarged, the pulmonary artery will be exaggerated to leftward. The cardiac silhouett

13、e is like a pear and called mitral heart(二尖瓣型心), it is frequently seen in mitral valve stenosis.n(主動脈擴張), aneurysm of aorta(主動脈瘤), pericardial effusion, all those diseases may cause the base border of heart enlargement, so that the base border of the heart will be widened. Pericardillness is increas

14、ed in all directions and assumes the form of a triangle with the apex at the level of the first or second intercostal space or a general globular enlargement. Adhesive penlargement depends on the extent of the adhesive process. The relative, and especially the absolute, cardiac dullness are both mar

15、kedly increased to left and to the right.Increase in the absolullnesse absolute cardiac dullness without demonstrable cardiac enlargement occurs when the left lung is retracted and a larger area of the ventricle is exposed. in mediastinal tumors when the heart is pushed up against the chest wall and a large area of the ventricle comes into direct contact with the anterior surface of the chest.復復的組成心臟濁音界改變及臨床意義重重要要心二尖瓣型心(梨形心)燒瓶形心球形心單單A. 一側大量胸水積液可使心界移向患