1 / 127

Cardiovascular Examination

Cardiovascular Examination. Deling Zou. Medical ppt. http://hastaneciyiz.blogspot.com. Anatomy. Inspection. 1 Precardial projection and excavation 2 Apical impulse 3 Abnormal pulsations of precardium. Inspection. 1 Precardial projection and excavation 1) Precardial projection

Download Presentation

Cardiovascular Examination

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.


Presentation Transcript

  1. Cardiovascular Examination Deling Zou Medical ppt http://hastaneciyiz.blogspot.com

  2. Anatomy

  3. Inspection 1 Precardial projection and excavation 2 Apical impulse 3 Abnormal pulsations of precardium

  4. Inspection 1 Precardial projection and excavation 1) Precardial projection • congenital heart disease: tetralogy of Fallot • Valvular heart disease-- MS,PS • pericardial effusion (large , childhood)

  5. The second right intercostal space(2nd ICS-RS) • aneurysm of aortic arch • dilatation of ascending aorta 2) flat chest 3) pigeon chest/funnel chest

  6. Inspection 2 Apical impulse *Normal: • position—the fifth left intercostal space 0.5-1.0cm medial to the midclavicular line range—2.0-2.5cm in diameter

  7. *Abnormal1) Location #diaphragm: • “transverse position” upper,outward • obesity ,child, pregnacy; • ascites; tumor of abdominal cavity • “vertical position” (thin, high, emphysema) inferior,inner

  8. #mediastinum: • one side pleural effusion or pneumothorax—to the healthy side • one side atelectesis or pleural adhesion—to the affected

  9. #enlargement of the heart • right ventricular dilatation –left or slightly upper • left ventricular dilatation—left inferior • LV &RV dilatation –left inferior (both side dilatation)

  10. #Posture: • recumbent position—upper • left lateral position—to the left 2-3cm • right lateral position—to the right 1.0-2.5cm • Dextrocardia: 5-ICS—RS

  11. Inspection- apical impulse - abnormal 2)Intensity and extent changes

  12. Inspection -apical impulse - abnormal 3)Inward impulse: • apex excavation in the systole • seen: adhensive pericarditis prominent RV hypertrophy

  13. Inspection • Abnomal pulsations of • percardium 1)left third-forth intercostal space lateral to the sternum(3,4ICS-LS) • seen: RV hypertrophy

  14. 2)hypoxiphoid process seen: difference deep inspiration RV hypertrophy ↑ abdominal aorta (aneurysm)↓

  15. 3)basal part of the heart • 2 ICS-LS: dilatation of the pulmonary artery or pulmonary hypertensin, occasionally healthy young man • 2 ICS-RS: aneurysm of aortic arch or dilatation of ascending aorta

  16. Palpation 1 Apical impulse and pulsation of precardium 2 Thrill 3 Pericardial friction rub

  17. Palpation 1 Apical impulse and pulsation of precardium • Exact position of apex • The beginning of systole of ventricle first sound • Heaving apex impulse: reliable of LV hypertrophy

  18. 2 Thrill • One of characteristic signs of organic heart disease. • Mechanism : the flow of blood→narrowed orifice→vortices→ vibration→chest wall • thrill-high frequency murmurs-low frequency • Method:position,phase of cardiac cycle,clinical significance • seen: CHD or valvular stenosis , occasionally insurficiency

  19. CHD:congenital heart disease

  20. 3 Pericardil friction rub 1)Precardium-4th ICS-LS 2) both phases of the cardiac cycle 3) systolic period, sitting erect and leaning forward, the end of expiration 4)mechanism: rub of the visceral and parietal layers of pleura 5)seen:acute pericarditis

  21. Percussion • Aim:to determine the size and shape of the heart . • Absolute dullness: contain no gas Relative dullness : real size

  22. 1 murneuver of percussion • patient in erect position –the pleximeter is vertical with the intercostal space • patient in the recumbent position –the pleximeter is parallel with the intercostal space

  23. 2 order : • left—right ; upwards ; inward • left margin : from 2-3 cm lateral to the apex beat up to the 2nd ICS • right margin : one intercostal space higher than the border of liver dullness up to the 2nd ICS • size: vertical distance from margin to the anterior midline

  24. Percussion

  25. Percussion

  26. (2)The upper border –the lower border of the anterior end of the third rib↑ (3)The basal part —the second intercostal space upward left: aortic node and PA (4)Concave part –between the aorta and the left ventricle

  27. Percussion 5 Changes in the area of cardiac dullness and its significance Cardiac factors : 1)LV enlargement: “boot shape” Seen:aortic valvular disease , hypertension heart disease

  28. 2)RV enlargement :slightly↑--absolute dullness↑ Prominent↑--relative dullness↑ to the left side prominently Seen:PHD, MS 3)Two ventricle ↑: “generally enlarged heart” seen:DCM , Kashan cardiomyopathy

  29. 4)LA and/or pulmonary artery:LA:concave part disappear LA+PA:2,3 ICS-LS outwards “pear shape” Seen: MS--- “mitrial type”

  30. 5)pericardial effusion: enlargement of both sides of the border body’s position: • recumbent position:widening of base of the heart • erect position:“triangular shape”

  31. 6)dilatation of the aorta /ascending aortic aneurysm: widening if the dull area of first and second intercostal space (with systolic pulsation)

  32. Extacardial factors :1)large pleural effusions and pneumothorax → to the healthy side2)atelectasis /pleural pachynsis →to the affected3)a large amount of ascites or big abdominal tumor: diaphragm elevated→transverse position →left side enlargement

  33. Ausclutation

  34. 1 Ausclutatoty valve areas 1)ausclutatory mitral area: apical area2)ausclutatory pulmonary area:2 ICS-LS3)ausclutatory aortic area: 2 ICS-RS4)second ausclutatory aortic area: 3rd ICS-LS—Erb area5)tricuspid area :4,5 ICS-LS

  35. 2 Order: MV---PV---AV1---AV2---TV 3 Contents:1) rate 2)rhythm 3)heart sound 4)extra heart sound 5)murmurs 6)pericardial friction sound

  36. 1)heart rate: • 60~100bpm F>M • child (<3 years) > 100bpm • tachycardia: normal adult >100bpm child(<3 years) >150bpm • bradycardia: HR <60 bpm

  37. Ausclutation heart rate:60-100bmp

  38. 2)cardiac rhythm:*sinus arrythmia—affected by breath*premature beat: classification:atrial~ ventricular ~ • junctional ~ • frequently:>6 bpm • occasionally: <6 bpm • bigeminy trigeminy

  39. *atrial fibrillation: absolute irregular rhythm S1 intensity inequality Pulse deficitseen:MS,CHD,hyperthyroidism, PHD,DCM

  40. Ausclutation atrial fibrillation

  41. 3)cardiac sound

  42. Ausclutation content cardiac sound • S1: • S2:

  43. 4)Abnormal cardiac sound*Intensity: • position of the atrioventricular valve • Ventricular contractility and output • Valvular integrity and activity

  44. S1: Accentuation: • MS • HR↑contractility↑ fever,anemia,hyperthyroidism • complete AVB →cannon sound

More Related