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1、心臟查體復(fù)習(xí)視診心前區(qū)外形心尖搏動正常心尖搏動異常心尖搏動（移位、彌散、反向）心前區(qū)異常搏動觸診心尖搏動正常異常（抬舉性，移位）心前區(qū)搏動震顫與臨床意義心包摩擦感心臟查體復(fù)習(xí)叩診手法順序正常心濁音界心濁音界改變及對應(yīng)的臨床意義聽診5個聽診區(qū)位置聽診順序6個聽診內(nèi)容心臟聽診復(fù)習(xí)正常心率范圍心律不齊類型心音構(gòu)成,心動周期劃分,強度變化,心音分裂及其臨床意義額外心音及其臨床意義舒張期:奔馬律,開瓣音,心包扣擊音,腫瘤撲落音收縮期:A&P噴射音,喀喇音雜音及其臨床意義5要素概念5聽診區(qū)兩期中雜音的臨床意義常見心臟病癥狀體征MitralstenosisMitralregurgitationAo
2、rticstenosisAorticregurgitationPericardialeffusionHeartfailure收縮期心臟瓣膜舒張期心臟瓣膜二尖瓣狹窄HistoryDyspneaaccompanywithcough&wheezingHemoptysisSystemicembolismPEMitralfaciesApex:TrillofMSLargedRVS1,P2>A2,spiltS2,OS,lowpitchedrumblingDMofMS，GrahamSteell二尖瓣關(guān)閉不全HistoryNosymptomsforyearsWhenLVfailuredyspneawe
3、akness，fatiguePEApexpulsemovetoleftApex:Liftingpulse&TrillofMSLeftBorder:toLeftandlowerS1,high-pitchedblowingSM,radiationtoaxilla主動脈瓣狹窄HistoryAngina(5y)Syncope(3y)Heartfailure(2y)SuddendeathPE(-)/ApexpulsemovetoleftApex:LiftingpulseA2area:TrillofMSLeftBorder:toLeftandlowerA2,P2>A2,reversespiltS
4、2A1area:SM主動脈瓣關(guān)閉不全HistoryDizzinessPalpitationHeartfailurePEcarotisA.pulseApex:leftandlower/liftingpulseWaterhammerpulseLeftBorder:toleftandlowerA2area:decrescendoDMAustinFlint,Pistolshotsound心包積液History癥狀取決于積液的速度和量CoughordyspneaDysphagiaPaininchestweekandfeverPEApexpulse:Apexpulse:DoubleBorder:
5、enlargedEwartsignLittleeffusion:Pericardialfrictionsound.Largeeffusion:HRS1S2,Pericardialknock左心衰竭HistoryExertionaldyspneaOrthopneaParoxysmalnocturnaldyspneaCoughWeakPECyanosis,polypnea,sweatPulsealternansDoubleBorder:enlargedPulmonaryrales,P2Galloprhythm右心衰竭HistoryAnorectic,VomitusAbdominaldis
6、tensionUropeniaPEEdemaHepatojugularrefluxCongestivehepatomegalyRVenlargedHydrothorax,AscitesGalloprhythm課程回顧心臟查體視診,觸診,叩診,聽診(6項)血管檢查脈搏,血壓,血管雜音,周圍血管征常見心臟病癥狀體征心臟瓣膜病,心包積液,心衰THANKYOU
