VisualInspection

ofHeart心臟視診

解剖回顧

心臟體表投影主動(dòng)脈左肺動(dòng)脈左心室心尖部肺動(dòng)脈右心室右心房右肺動(dòng)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(dòng)

正常心尖搏動(dòng)正常人坐位時(shí)心尖搏動(dòng)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(dòng)

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

apicalbeat

Normalapicalbeat心尖搏動(dòng)的位置變化

生理因素Physiologicalfactors心尖搏動(dòng)位置變化Apicalpositionchanges體型BodyType超力型心尖搏動(dòng)向外上移位，無(wú)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(dòng)的位置變化

生理因素Physiologicalfactors心尖搏動(dòng)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(shí)下移，深吸氣時(shí)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(dòng)位置變化Apicalpositionchanges心臟疾病Heartdisease①左心室增大：心尖搏動(dòng)向左下移位

Leftventricularenlargement:apicaldisplacementtotheleft②右心室增大：心尖搏動(dòng)向左移位

Rightventricularenlargement:apicaldisplacementtotheleft③全心室增大：心尖搏動(dòng)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(dòng)點(diǎn)在胸骨右側(cè)

Congenitalrightheart:apicalpulsationattherightsideofthesternum心尖搏動(dòng)的位置變化

Apicalpositionchanges

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

onesideofpleuraleffusionorpneumothorax,apicaldisplacementtothehealthyside②一側(cè)肺不張或胸膜粘連，心尖搏動(dòng)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(dòng)上移Abdominaleffusionorabdominaltumorscancausetheapicalpulsationtomoveupward.心尖搏動(dòng)的位置變化

Apicalpositionchanges

左心室增大右心室增大心尖搏動(dòng)的位置變化

LeftventricularenlargementrightventricularenlargementApicalpositionchanges

心尖搏動(dòng)強(qiáng)度變化

增強(qiáng)：生理性：兒童、肋間隙增寬、劇烈運(yùn)動(dòng)、情緒激動(dòng)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(dòng)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(dòng)強(qiáng)度變化

負(fù)性心尖搏動(dòng)：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(dòng)

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(dòng)脈搏動(dòng)、腹主動(dòng)脈瘤、右心室肥厚窄Xiphoidprocess:abdominalaorticpulsation,abdominalaorticaneurysm,rightventricularhypertrophy

abnormalprecordialpulsation

心前區(qū)異常搏動(dòng)

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