心内复习汇总.ppt

心内复习汇总心内复习汇总2024/5/24 周五2IntroductionPalpation of the pulseMeasurment of arterial blood pressureAuscultation of blood vessels2024/5/24 周五3Palpation of The PulseRadial artery is usually selectedPatients hand placed with the palm upwardPhysicians first three fingers on the radial arteryIndex finger nearest the heart2024/5/24 周五4Characteristics of The Pulse RateIntensityType of waveRhythmTension2024/5/24 周五5RATE-Pulse frequency(rapid or slow)Varies with age,sex,physical activity,emotional statusNormal range:60-100bpm in adults;90-120bpm in children 2024/5/24 周五6Rate increase(tachycardia心动过速):severe anemia,high fever,massive hemorrhage(大出血),various types of cardiac arrhythmias,hyperthyroidism,and at times in congestive heart failure.2024/5/24 周五7Rate decrease(bradycardia心动过缓):increased intracranial pressure(颅高压),SSS,above AVB,hypothyroid(甲减),Digoxin(地高辛),etc2024/5/24 周五8RhythmThe more common disturbances of rhythm can and should be detected by palpating the pulse.Auscultation of the heart is a more accurate method for determining the rhythm.Some of the more complex arrhythmias can be diagnosed only by EKG.2024/5/24 周五9Common irregular pulse:Sinus arrhythmia(窦不齐)Premature beat(早搏)Atrial fibrillation(房颤)Bigeminal pulse(二联律)Trigeminal pulse(三联律)Paroxysmal atrial,ventricular tachycardiaHeart block(传导阻滞)2024/5/24 周五10Tension The tension of pulse depends on the level of the arterial systolic pressure.2024/5/24 周五11Intensity The intensity depends on the cardiac output,pulse pressure and the resistance of peripheral vessels.2024/5/24 周五12Pulsus magnus(bounding pulse洪脉):increased cardiac output,high pulse pressure,low resistance.aortic insufficiency,high fever,hyperthyroid2024/5/24 周五13Small pulse(thready pulse细脉):decreased cardiac output,low pulse pressure,high resistance.aortic stenosis,heart failure,shock.2024/5/24 周五14Wave formThe arterial pulse starts at the instant aortic valve opens,results in an abrupt sharp rise in aortic pressure.During systole a large part of blood is temporarily stored in the proximal aorta.Once the aortic pressure reaches a peak it begins to fall,and blood continues its flow in the peripheral arteries in later systole and diastole.2024/5/24 周五15Normal pulse wave:Ascending limbPeakDescending limbsmall notch(on the descending limb)Small notch(on the ascending limb)2024/5/24 周五162024/5/24 周五17The upstroke is prompt and smooth,but the anacrotic notch is not palpable in most normal persons.The peak is rounded and smooth.The descending limb is more gradual and less steep.The dicrotic notch in most normal persons cannot be palpated but can be sensed as a change in the slope of the down stroke.2024/5/24 周五18Type of WaveAbnormal pulse waveWater hammer pulse(水冲脉)Pulsus tardus(迟脉)Dicrotic pulse(重搏脉)Pulsus alternans(交替脉)Paradoxical pulse(奇脉)Asphygmia(无脉)2024/5/24 周五19Water hammer pulse（水冲脉）A strong bounding pulse with a tall rapid ascending limb and an equally rapid descending limb.It is also called collapsing pulse.Due to increasing pulse pressure,it is Commonly found in AI,PDA,hyperthyroid and severe anemia.2024/5/24 周五202024/5/24 周五21 Pulsus Tardus（迟脉）A small weak pulse with a delayed systolic peakIt occurs in the presence of narrow pulse pressure,increased peripheral vascular resistance,low SV Common in aortic stenosis,mitral stenosis,LV heart failure after AMI.2024/5/24 周五222024/5/24 周五23Dicrotic Pulse（重搏脉）There are two impulses that are palpable during systole and diastole respectively.It usually occurs in the presence of high fever and typhoid(伤寒).2024/5/24 周五242024/5/24 周五25Pulsus Alternans（交替脉）It is characterized by a regularly alternating pulse,in which every beat is weaker than the preceding beat.It is easy to be detected when the patient is sitting or standing.It is a valuable indication of left ventricular failure.Severe arterial hypertension.2024/5/24 周五262024/5/24 周五27Paradoxical pulse（奇脉）A decrease in the amplitude or an actual imperceptibility of the pulse during inspiration.Commonly found in massive pericardial effusion,constrictive pericarditis,and severe pulmonary emphysema.2024/5/24 周五28Asphygmia（无脉）Severe shockPrimary arteritis of the aorta and its main branches(pulseless)2024/5/24 周五29Consistency of Arterial WallNormally the wall of radial artery is soft and pliable In arteriosclerosis(动脉硬化),more resistance to compression by the palpating finger,and the vessel may be rolled easily between the examing digits.2024/5/24 周五30Measurement of Arterial Blood PressureMethods for measuring the blood pressure:Direct methodIndirect method2024/5/24 周五31Definitions and Classification of Blood Pressure LevelsCategory systolic(mmHg)diastolic(mmHg)Normal 120 80High-normal 120-139 80-89 Hypertension 140 90Isolated systolic 140 90 hypertension2024/5/24 周五32Abnormal Blood PressureHypertensionHypotensionSignificant difference in two upper extremitiesSignificant difference in upper and lower extremitiesAbnormality in pulse pressure2024/5/24 周五33Hypertension Essential hypertensionSymptomatic hypertension Renal causes,endocrine causes,etc2024/5/24 周五34Low Blood PressureSystolic pressure90mmHg diastolic pressure60mmHgDecrease in cardiac output:acute myocardial infarction,pericarditis with effusion,heart failure,following hemorrhageDecrease in peripheral resistance:septicemia(败血症),Addisons disease,drug intoxications2024/5/24 周五35Significant Difference in the Upper ExtremitiesLittle or no significant difference Difference of pressure above 10mmHgPrimary arteritis(动脉炎)of the aorta and its main branches,obstruction of the innominate artery(无名动脉),aortic aneurysm2024/5/24 周五36Significant Difference in the Upper and Lower ExtremitiesOrdinarily the systolic pressure is slightly higher in the lower extremities than in the upper(2040mmHg)Most common in coarctation of the aorta(congenital narrowing)2024/5/24 周五37Abnormality in Pulse PressureThe pulse pressure is the difference between the systolic and diastolic pressures and normally amounts to 30 or 40mmHg.Pulse pressure increased:40mmHgatherosclerosis of the aorta(大动脉硬化),hyperthyroidism,aortic regurgitation(返流),arteriovenous fistula(动静脉瘘),severe anemia,PDA2024/5/24 周五38Pulse pressure decreased:30mmHgAortic stenosis,hypotension,heart failure and massive pericardial effusion2024/5/24 周五39Auscultation of veinVenous hum over the jugular vein(颈静脉):a soft low-pitched continuous murmur,decrease or disappear in supine position,especially in cases of marked anemiaLoud murmur heard over dilated vein in liver cirrhosis(肝硬化)2024/5/24 周五40Auscultation of ArteriesNormal artery soundPistolshot soundDuroziers soundPathological sound:including systolic and continuous murmer2024/5/24 周五41Pistol-shot Sound In aortic insufficiency,a loud first sound(pistol-shot sound)may be heard over the femoral arteries(股动脉)without exerting pressure2024/5/24 周五42Duroziers Sign On pressing the stethoscope firmly over the femoral artery in aortic insufficiency,this double intermittent murmur may be heard.It is also seen in severe anemia,hyperthyroid.2024/5/24 周五43Review异常脉搏波的产生机制和临床意义测量血压的方法及高血压标准血管杂音及周围血管征的意义2024/5/24 周五44Key WordsWater Hammer PulseDicrotic PulsePulsus AlternansParadoxical PulsePistol Shot SoundDuroziezs SignCapillary Pulsation2024/5/24 周五45标准配伍型题A.水冲脉 B.重搏脉C.交替脉 D.奇脉E.无脉吸气时脉搏明显减弱或消失节律规则而强弱交替脉搏消失脉搏骤起骤落2024/5/24 周五46X型题关于测量血压方法的论述正确的是A.测量前半小时内禁烟、禁咖啡B.测量前至少休息5分钟C.被检查者肘部置于心脏同一水平D.气袖下缘在肘窝以上46cmE.成人标准气袖宽911cm2024/5/24 周五47X型题关于血压的论述正确的是A.理想血压为收缩压120mmHg,舒张压80mmHgB.正常血压为收缩压140mmHg,舒张压90mmHgC.单纯收缩期高血压为收缩压140mmHg,舒张压90mmHgD.正常双侧上肢血压差别达1020mmHgE.正常下肢血压高于上肢血压达1020mmHg