心內(nèi)復(fù)習(xí)匯總

1、2024/2/17,1,Examination of Blood Vessels,,2024/2/17,2,Introduction,Palpation of the pulseMeasurment of arterial blood pressureAuscultation of blood vessels,2024/2/17,3,Palpation of The Pulse,Radial artery is usuall

2、y selectedPatient’s hand placed with the palm upwardPhysician’s first three fingers on the radial arteryIndex finger nearest the heart,2024/2/17,4,Characteristics of The Pulse,RateIntensityType of waveRhythmTen

3、sion,2024/2/17,5,RATE,-Pulse frequency (rapid or slow) Varies with age, sex, physical activity, emotional statusNormal range: 60-100bpm in adults; 90-120bpm in children,2024/2/17,6,Rate increase (tachycardia心動(dòng)過速): seve

4、re anemia, high fever, massive hemorrhage(大出血), various types of cardiac arrhythmias, hyperthyroidism, and at times in congestive heart failure.,2024/2/17,7,Rate decrease (bradycardia心動(dòng)過緩): increased intracranial pressur

5、e(顱高壓), SSS, above Ⅱ AVB, hypothyroid(甲減), Digoxin(地高辛), etc,2024/2/17,8,Rhythm,The more common disturbances of rhythm can and should be detected by palpating the pulse.Auscultation of the heart is a more accurate meth

6、od for determining the rhythm.Some of the more complex arrhythmias can be diagnosed only by EKG.,2024/2/17,9,Common irregular pulse:Sinus arrhythmia(竇不齊)Premature beat(早搏)Atrial fibrillation(房顫)Bigeminal pulse(二聯(lián)律)

7、Trigeminal pulse(三聯(lián)律)Paroxysmal atrial, ventricular tachycardiaHeart block(傳導(dǎo)阻滯),2024/2/17,10,Tension,The tension of pulse depends on the level of the arterial systolic pressure.,2024/2/17,11,Intensity,The intensity

8、depends on the cardiac output, pulse pressure and the resistance of peripheral vessels.,2024/2/17,12,Pulsus magnus (bounding pulse洪脈): increased cardiac output , high pulse pressure, low resistance. aortic insufficiency

9、, high fever, hyperthyroid,2024/2/17,13,Small pulse (thready pulse細(xì)脈): decreased cardiac output , low pulse pressure, high resistance. aortic stenosis, heart failure, shock.,2024/2/17,14,Wave form,The arterial pulse st

10、arts 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 beg

11、ins to fall, and blood continues its flow in the peripheral arteries in later systole and diastole.,2024/2/17,15,Normal pulse wave:Ascending limbPeakDescending limbsmall notch ( on the descending limb)Small notch (o

12、n the ascending limb),2024/2/17,16,2024/2/17,17,The 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 l

13、ess 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.,2024/2/17,18,Type of Wave,Abnormal pulse waveWater hammer pulse(水沖脈)Pulsus tardus(遲

14、脈)Dicrotic pulse(重搏脈)Pulsus alternans(交替脈)Paradoxical pulse(奇脈)Asphygmia(無脈),2024/2/17,19,Water hammer pulse（水沖脈）,A strong bounding pulse with a tall rapid ascending limb and an equally rapid descending limb. It is a

15、lso called collapsing pulse.Due to increasing pulse pressure, it is Commonly found in AI, PDA, hyperthyroid and severe anemia.,2024/2/17,20,2024/2/17,21,Pulsus Tardus （遲脈）,A small weak pulse with a delayed systolic peak

16、It 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.,2024/2/17,22,2024/2/17,23,Dicrotic Pulse（重搏脈）

17、,There are two impulses that are palpable during systole and diastole respectively.It usually occurs in the presence of high fever and typhoid(傷寒).,2024/2/17,24,2024/2/17,25,Pulsus Alternans（交替脈）,It is characterized by

18、 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 a

19、rterial hypertension.,2024/2/17,26,2024/2/17,27,Paradoxical pulse（奇脈）,A decrease in the amplitude or an actual imperceptibility of the pulse during inspiration.Commonly found in massive pericardial effusion, constricti

20、ve pericarditis, and severe pulmonary emphysema.,2024/2/17,28,Asphygmia（無脈）,Severe shockPrimary arteritis of the aorta and its main branches (pulseless),2024/2/17,29,Consistency of Arterial Wall,Normally the wall of rad

21、ial artery is soft and pliable In arteriosclerosis(動(dòng)脈硬化), more resistance to compression by the palpating finger, and the vessel may be rolled easily between the examing digits.,2024/2/17,30,Measurement of Arterial Blo

22、od Pressure,Methods for measuring the blood pressure:Direct methodIndirect method,2024/2/17,31,Definitions and Classification of Blood Pressure Levels,Category systolic(mmHg) diastolic(mmHg)Normal

23、 ＜120 ＜80High-normal 120-139 80-89 Hypertension ≥140 ≥90Isolated systolic ≥140 ＜90 hypertension,2024/2/17,32,Abnormal Blood Pressure,HypertensionHyp

24、otensionSignificant difference in two upper extremitiesSignificant difference in upper and lower extremitiesAbnormality in pulse pressure,2024/2/17,33,Hypertension,Essential hypertensionSymptomatic hypertension Re

25、nal causes, endocrine causes, etc,2024/2/17,34,Low Blood Pressure,Systolic pressure＜90mmHg diastolic pressure＜60mmHgDecrease in cardiac output : acute myocardial infarction, pericarditis with effusion, heart failure,

26、 following hemorrhageDecrease in peripheral resistance: septicemia(敗血癥), Addison’s disease, drug intoxications,2024/2/17,35,Significant Difference in the Upper Extremities,Little or no significant difference Difference

27、 of pressure above 10mmHgPrimary arteritis(動(dòng)脈炎) of the aorta and its main branches, obstruction of the innominate artery(無名動(dòng)脈), aortic aneurysm,2024/2/17,36,Significant Difference in the Upper and Lower Extremities,Ordi

28、narily the systolic pressure is slightly higher in the lower extremities than in the upper (20~40mmHg)Most common in coarctation of the aorta (congenital narrowing),2024/2/17,37,Abnormality in Pulse Pressure,The pulse p

29、ressure is the difference between the systolic and diastolic pressures and normally amounts to 30 or 40mmHg.Pulse pressure increased:＞40mmHgatherosclerosis of the aorta(大動(dòng)脈硬化), hyperthyroidism, aortic regurgitation(返流)

30、, arteriovenous fistula(動(dòng)靜脈瘺), severe anemia, PDA,2024/2/17,38,Pulse pressure decreased: ＜30mmHgAortic stenosis, hypotension, heart failure and massive pericardial effusion,2024/2/17,39,Auscultation of vein,Venous hum o

31、ver the jugular vein(頸靜脈): 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),2024/2/17,40,A

32、uscultation of Arteries,Normal artery soundPistol–shot soundDurozier’s soundPathological sound: including systolic and continuous murmer,2024/2/17,41,Pistol-shot Sound,In aortic insufficiency, a loud first sound (pis

33、tol-shot sound) may be heard over the femoral arteries(股動(dòng)脈) without exerting pressure,2024/2/17,42,Durozier’s Sign,On pressing the stethoscope firmly over the femoral artery in aortic insufficiency, this double intermitt

34、ent murmur may be heard. It is also seen in severe anemia, hyperthyroid.,2024/2/17,43,Review,異常脈搏波的產(chǎn)生機(jī)制和臨床意義測量血壓的方法及高血壓標(biāo)準(zhǔn)血管雜音及周圍血管征的意義,2024/2/17,44,Key Words,Water Hammer PulseDicrotic PulsePulsus AlternansParadoxic

35、al PulsePistol Shot SoundDuroziez’s SignCapillary Pulsation,2024/2/17,45,標(biāo)準(zhǔn)配伍型題,A. 水沖脈 B. 重搏脈C. 交替脈 D. 奇脈E. 無脈吸氣時(shí)脈搏明顯減弱或消失節(jié)律規(guī)則而強(qiáng)弱交替脈搏消失脈搏驟起驟落,2024/2/17,46,X型題,關(guān)于測量血壓方法的論述正確的是A. 測量前半小時(shí)內(nèi)禁煙、禁咖啡B. 測量

36、前至少休息5分鐘C. 被檢查者肘部置于心臟同一水平D. 氣袖下緣在肘窩以上4~6cmE. 成人標(biāo)準(zhǔn)氣袖寬9~11cm,2024/2/17,47,X型題,關(guān)于血壓的論述正確的是A. 理想血壓為收縮壓＜120mmHg,舒張壓＜80mmHgB. 正常血壓為收縮壓＜140mmHg,舒張壓＜90mmHgC. 單純收縮期高血壓為收縮壓≥140mmHg,舒張壓＜90mmHgD. 正常雙側(cè)上肢血壓差別達(dá)10~20mmHgE. 正常下肢血