1、Physical Examinationof Cardiovascular SystemFOR MBBS STUDENTSDepartment of DiagnosticsThe First Affiliated Hospital of Guangxi Medical University1General Considerationn nDuring lifetime,the heart contracts more than 4 billion times.n nPumping 200 million L blood to systemic circulation.n nCardiac ou
2、tput varies under physiologic conditions from 3 to 30L/min.Heart rate varies from 60 to 150 beats/min.2Physical Examination of Cardiovascular Physical Examination of Cardiovascular systemsystem In the present era of technological advances,particularly in the v a r i o u s i m a g i n g modalities,ph
3、ysical examination of the heart still provides useful i n f o r m a t i o n.3Physical Examination of Cardiovascular system n n It is simple,convenient,cheap as premier assessment of the severity and an etiology of the lesions and also serves as an clue to use advanced techniques for the diagnosis of
4、 CVD.4 Review the Anatomy5Routine and Techniques of PE of the HeartPatients exposure and position(sitting or lying down),with enough light and appropriate temperatureFour parts:inspection,palpation,percussion,and auscultation 6Part oneInspection 7Inspection Precordium is the region of the anterior s
5、urface of the body covering the heart and lower thorax.8Contents of Inspectionn nThoracic cage deformitynApical impulse n nAbnormal pulsations in precordium9Methods of InspectionnInspect the obverse side.n nThen obverse the patients lateral surface 10Thoracic Cage Deformity（inspection）Asymmetry of t
6、he thoracic cage due to a convex bulging of the precordium suggests the presence of heart disease since childhood11Thoracic Cage Deformity（inspection）such as congenital heart disease and rheumatic heart disease,with skeletal molding to accommodate cardiac enlargement.12Apical Impulse（inspection）nApi
7、cal impulse mainly results from the left ventricular contraction,when LV contracts,the apical knocks at the correspondent position of anterior chest wall,resulting in intercostal impulse outward movement.13Apical Impulse（inspection）Normal apical impulsenPosition:left border of sternum,fifth intercos
8、tal space,inside the midclavicular line 0.51.0cmnRange:22.5cm in diameter14Apical Impulse（inspection）nApical impulse displacementn nChanges of intensity and area of apical impulsen nInward impulse15Apical Impulse（inspection）Apical impulse displacement(1).extra-heart factors(2).cardiac enlargement(3)
9、body posture16Apical Impulse Displacement Extra-heart factors:Obesity,pregnancy,etc.cause elevation of diaphragm,apical impulse shifts to outward and upward,at left the 4th intercostal space outside midclavicular line.17Apical Impulse Displacement Extra-heart factors:Abdominal disease:abdominal tum
10、or,a large number of ascites,etc.elevation of diaphragm,apical impulse shifts to outward and upward 18Apical Impulse Displacement Extra-heart factors:Leptosome;severely pulmonary emphysema.Then apical impulse shifts to inward and downward,reaches at the 6th intercostal space.19Apical Impulse Displac
11、ement Extra-heart factors:Single side pleural thickening,or adhesion,or atelectasis result in mediastinum and heart shifting to the sick side,and the apical impulse shifts to the sick side,too.aortic arch LV to the sick side20NormalApical Impulse Displacementheart shifts to the healthy sidePleural e
12、ffussion in the rightto the healthside21Apical Impulse DisplacementCardiac enlargementnRight ventricle enlargement.Apical impulse shifts to the left but not downward.nLeft ventricle enlargement.Apical impulse shifts to the left and downward at the same time.22Left Ventricle EnlargementNormal LV enla
13、rgement23Both Ventricles EnlargementBoth ventricles enlargementNormal24Apical Impulse DisplacementBody posturenDorsal decubitus.Apical impulse moves a little upward,if left lateral decubitus the apical impulse shifts to the left 23cm.nRight lateral decubitus.The apical impulse shifts to the right 12
14、5cm.25Apical Impulse（inspection）Changes of intensity and area of apical impulse(1).Physical conditions(2).Pathological conditions26 Physical conditionsn nThickness of the chest wall n nEmotion excitedn nStrong physical activity Changes of Intensity and Area of Apical Impulse27Changes of intensity a
15、nd area of apical impulsePathological conditionsconditionsEnhanced apical impulse:n left ventricular enlargementn hyperthyroidismn fever,anemiaPathological conditionsconditionsWeakened apical impulse:n dilated myocardiopathy,n hydropericardium,nleft pleural effusion,n pulmonary emphysema28Inward Imp
16、ulse Inward impulse.The apex depresses far from the chest instead of striking the chest during systole.Broadbents sign is of value in the diagnosis of adherent pericardium.It is also seen in RVH.29Abnormal Pulsations in Precordiumn nRight vertricular hypertophy(RVH).The impulse is clearly seen in le
17、ft third fourth intercostal space.n nPulmonary emphysema with RVH,usually the pulsation can be found inferior the xiphoid process30Abnormal Pulsations in Precordiumn nIn ascending or arch aortic aneurysm,one may detects abnormal pulsations in aortic area,with bulging or pulsation in systole.Pulmonar
18、y hypertension with dilatation the pulsation in systole may be detected in left second intercostal space to the edge of sternum.31Abnormal Pulsations in Precordiumn nMarked pulsation at the base of the heart is seen in aortic insufficiency,in a dilated aorta or a saccular aneurysm.32Referencen n诊断学第8版，全国规划教材，陈文彬 主编，人民卫生出版社，2013年n n诊断学医学英文原版改编双语教材，吕卓人 主编，科学出版社，2006年n nHistory and Examination,James Marsh,Chief Editor,科学出版社，2007年3334
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