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MindMap Gallery Diagnosis-Heart Examination Mind Map

Diagnosis-Heart Examination Mind Map

This is a mind map about diagnosis-cardiac examination. Cardiac examination is an important means of evaluating and diagnosing heart diseases. It includes a variety of examination items, each with different characteristics and purposes.

Edited at 2023-11-02 19:33:02

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Diagnosis-Heart Examination Mind Map

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Outline

heart checkup

Basic conditions

Quiet environment Appropriate light, preferably from the patient’s left side The patient is in a supine position, the doctor is on the right side Stethoscope: ear-fitting, bell-shaped or drum-shaped chest piece

Inspection

Visual inspection method

1. Looking straight at the tangential position of the thorax 2. Oriental observation

Inspection content

Thoracic deformity

Normal precordium: left and right symmetry

Precordial bulge: the local bulge in the lower segment of the sternum and the 3, 4, and 5 intercostal spaces on the left edge of the sternum. Mechanism: caused by right ventricular hypertrophy squeezing the thorax. Common diseases: congenital heart disease, acquired heart disease, childhood chronic pericarditis. Full precordium: massive pericardial effusion.

Precordial depression: pectus excavatum costophrenic groove

Apical beat

Definition: The apex of the heart impacts the lower left chest wall of the precordium, causing local outward pulsation. Location: scope:

Apical beat displacement

Physiological: Postural changes, obesity, children, pregnancy, breathing

pathological

Heart disease: enlargement of the right ventricle, enlargement of the left ventricle, and enlargement of both ventricles.

Extracardiac causes: mediastinal shift, diaphragm shift.

Changes in apical beat intensity and range

weaken

Physiological: chest wall hypertrophy, breast hanging, intercostal space narrowing

Pathological: Various myocardial lesions, pericardial effusion, constrictive pericarditis, massive left pleural effusion, pneumothorax, emphysema

Enhance

Physiological: thin chest wall, widened intercostal space, movement, excitement

Pathological: fever, hyperthyroidism, anemia, left ventricular hypertrophy

Negative apical beat

Concept: When the heart contracts, the apex of the chest wall pulsates inward. Significance: Adhesive pericarditis or extensive adhesions between the pericardium and surrounding tissues, severe right ventricular hypertrophy

Precordial beat

1. Intercostal pulses at 3-4 on the left sternal edge: right ventricular hypertrophy. 2. Subxiphoid pulse: right ventricular hypertrophy, abdominal aortic aneurysm 3. Low heart beat: 2 intercostal spaces on the left edge of the sternum - pulmonary artery dilation, pulmonary hypertension, 2 intercostal spaces on the right edge of the sternum - aortic arch aneurysm, dilatation of the ascending aorta.

palpation

Supplementary verification clinic visit Check for apical pulse, tremor, and pericardial friction Can determine whether the heart is in systole or diastole First use the whole palm of your right hand, and then use the hypothenar muscle or the index finger and middle finger to palpate.

Apical beat and precordial beat

Normal situation: Same vision diagnosis

abnormal situation

Apical lifting pulse: seen in left ventricular hypertrophy Is a reliable sign of left ventricular hypertrophy

Other pulsations: Same vision diagnosis Differentiation between cardiac pulsation and abdominal aortic pulsation

tremor

Definition: A small vibrating sensation felt on palpation, similar to the respiratory tremor felt in a cat's throat.

Mechanism: blood flow passes through a narrow or insufficiently closed valve orifice, and the abnormal channel flows to a wide part, causing turbulence, which causes the vibration of the blood vessel wall, heart wall, and valve to be transmitted to the chest wall. It is one of the signs of organic heart disease. Generally, it is directly proportional to the degree of the disease (it will weaken when it is too severe).

pericardial friction sensation

Definition: The vibration caused by the friction between the two layers of the pericardial visceral wall is transmitted to the chest wall

Mechanism: During pericarditis, the second layer of the visceral wall is rough, causing vibrations caused by friction.

Meaning: Various types of pericarditis

Palpation characteristics: The palpation site is in the precordium area, obvious at the 3rd and 4th intercostal spaces on the left sternal edge. It can be palpated during both systole and diastole, and is easier to palpate during systole. It is obvious when leaning forward when sitting or at the end of expiration, such as increased pericardial effusion. , the friction feeling disappears.

percussion

Overview

Purpose: Determine the size and shape of the heart

relative voiced area Absolutely voiced world The relative dullness boundary represents the actual size of the heart

Percussion method

1. Use the middle finger of your left hand as a percussion finger, level with the precordial area to be percussed; 2. When the subject is in a sitting position, the thumb finger is perpendicular to the intercostal space; when the subject is in the supine position, the thumb finger is parallel to the intercostal space; 3. Move the middle finger of the right hand and the right wrist joint to tap the ring finger, and determine the boundary of heart dullness by hearing the sound change from unvoiced to voiced. Use even force, use light tapping method on the left side, and heavier tapping method on the right side; 4. The distance the wrench finger moves each time should not be too large.

Percussion sequence

First left and then right, from top to bottom, from outside to inside; Starting from the left side 2-3cm outside the apex beat, tap to the second intercostal space Right, start from the first rib above the liver and tap to the second intercostal space.

Normal heart dullness boundary

In a normal human heart, the left border of the heart is almost consistent with the left edge of the sternum at the second intercostal space. The heart border below the third intercostal space gradually forms an outward convex arc, reaching the fifth intercostal space.

The right boundary is almost consistent with the right edge of the sternum except for the fourth intercostal space which is slightly deviated from the right edge of the sternum.

In normal adults, the distance from the left midclavicular line to the anterior midline is 8-10cm.

The composition of various parts of the heart voice field

Left border: 2 intercostal spaces: pulmonary artery segment 3 intercostal space: left atrial appendage 4th and 5th intercostal space: left ventricle

Right border: 2 intercostal spaces: ascending aorta and superior vena cava 3 below the intercostal space: right atrium

Bottom of the heart: Above the 2 intercostal spaces is the bottom of the heart Between the aorta and the left ventricle is the lumbar region of the heart The apex of the heart is composed of the left ventricle

Changes in cardiac dullness boundary and their clinical significance

heart disease

Left ventricular enlargement: the heart boundary expands downward and to the left, and the waist of the heart is obviously sunken, resembling a boot shape. Right ventricular enlargement: the heart boundary expands to the left, Biventricular enlargement: enlargement to both sides and lower left side, Left atrial enlargement and pulmonary artery segment dilation, Pericardial effusion: bilateral enlargement of the heart boundary,

Extracardiac factors

Pneumothorax and pleural effusion: The heart boundary on the affected side cannot be touched and the healthy side is enlarged. Pleural thickening and atelectasis: the heart boundary moves to the affected side. Emphysema: The area of heart dullness shrinks. Huge tumor or ascites in the abdominal cavity: the heart moves upward into a transverse position, and the dullness boundary expands to the left. There are solid lesions in the chest: the heart boundary on the affected side cannot be felt.