1、Physical Examinationof Cardiovascular System,FOR MBBS STUDENTS,Ma Guotian,M.D.Professor of Cardiology,Department of DiagnosticsThe First Affiliated Hospital of Guangxi Medical University,1,第一页，共三十五页。,General Consideration,During lifetime,the heart contracts more than 4 billion times.Pumping 200 mill
2、ion L blood to systemic circulation.Cardiac output varies under physiologic conditions from 3 to 30L/min.Heart rate varies from 60 to 150 beats/min.,2,第二页，共三十五页。,Physical Examination of Cardiovascular system,In the present era of technological advances,particularly in the various imaging modalities,
3、physical examination of the heart still provides useful information.,3,第三页，共三十五页。,Physical Examination of Cardiovascular system,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 o
4、f CVD.,4,第四页，共三十五页。,Review the Anatomy,5,第五页，共三十五页。,Routine and Techniques of PE of the Heart,Patients exposure and position(sitting or lying down),with enough light and appropriate temperatureFour parts:inspection,palpation,percussion,and auscultation,6,第六页，共三十五页。,Part oneInspection,7,第七页，共三十五页。,In
5、spection,Precordium is the region of the anterior surface of the body covering the heart and lower thorax.,8,第八页，共三十五页。,Contents of Inspection,Thoracic cage deformityApical impulse Abnormal pulsations in precordium,9,第九页，共三十五页。,Methods of Inspection,Inspect the obverse side.Then obverse the patients
6、 lateral surface,10,第十页，共三十五页。,Thoracic Cage Deformity（inspection）,Asymmetry of the thoracic cage due to a convex bulging of the precordium suggests the presence of heart disease since childhood,11,第十一页，共三十五页。,Thoracic Cage Deformity（inspection）,such as congenital heart disease and rheumatic heart d
7、isease,with skeletal molding to accommodate cardiac enlargement.,12,第十二页，共三十五页。,Apical Impulse（inspection）,Apical 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 out
8、ward movement.,13,第十三页，共三十五页。,Apical Impulse（inspection）,Normal apical impulsePosition:left border of sternum,fifth intercostal space,inside the midclavicular line 0.51.0cmRange:22.5cm in diameter,14,第十四页，共三十五页。,Apical Impulse（inspection）,Apical impulse displacementChanges of intensity and area of a
9、pical impulseInward impulse,15,第十五页，共三十五页。,Apical Impulse（inspection）,Apical impulse displacement(1).extra-heart factors(2).cardiac enlargement(3).body posture,16,第十六页，共三十五页。,Apical Impulse Displacement,Extra-heart factors:Obesity,pregnancy,etc.cause elevation of diaphragm,apical impulse shifts to o
10、utward and upward,at left the 4th intercostal space outside midclavicular line.,17,第十七页，共三十五页。,Apical Impulse Displacement,Extra-heart factors:Abdominal disease:abdominal tumor,a large number of ascites,etc.elevation of diaphragm,apical impulse shifts to outward and upward,18,第十八页，共三十五页。,Apical Impu
11、lse Displacement,Extra-heart factors:Leptosome;severely pulmonary emphysema.Then apical impulse shifts to inward and downward,reaches at the 6th intercostal space.,19,第十九页，共三十五页。,Apical Impulse Displacement,Extra-heart factors:Single side pleural thickening,or adhesion,or atelectasis result in media
12、stinum and heart shifting to the sick side,and the apical impulse shifts to the sick side,too.,aortic arch,LV,to the sick side,20,第二十页，共三十五页。,Normal,Apical Impulse Displacement,heart shifts to the healthy side,Pleural effussion in the right,to the healthside,21,第二十一页，共三十五页。,Apical Impulse Displaceme
13、nt,Cardiac enlargementRight ventricle enlargement.Apical impulse shifts to the left but not downward.Left ventricle enlargement.Apical impulse shifts to the left and downward at the same time.,22,第二十二页，共三十五页。,Left Ventricle Enlargement,Normal,LV enlargement,23,第二十三页，共三十五页。,Both Ventricles Enlargemen
14、t,Both ventricles enlargement,Normal,24,第二十四页，共三十五页。,Apical Impulse Displacement,Body postureDorsal decubitus.Apical impulse moves a little upward,if left lateral decubitus the apical impulse shifts to the left 23cm.Right lateral decubitus.The apical impulse shifts to the right 12.5cm.,25,第二十五页，共三十五
15、页。,Apical Impulse（inspection）,Changes of intensity and area of apical impulse(1).Physical conditions(2).Pathological conditions,26,第二十六页，共三十五页。,Physical conditionsThickness of the chest wall Emotion excitedStrong physical activity,Changes of Intensity and Area of Apical Impulse,27,第二十七页，共三十五页。,Chang
16、es of intensity and area of apical impulse,Pathological conditionsEnhanced apical impulse:left ventricular enlargement hyperthyroidism fever,anemia,Pathological conditionsWeakened apical impulse:dilated myocardiopathy,hydropericardium,left pleural effusion,pulmonary emphysema,28,第二十八页，共三十五页。,Inward Impulse,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.,2