心內復習匯總

心內復習匯總2024/1/42IntroductionPalpationofthepulseMeasurmentofarterialbloodpressureAuscultationofbloodvessels2024/1/43PalpationofThePulseRadialarteryisusuallyselectedPatient’shandplacedwiththepalmupwardPhysician’sfirstthreefingersontheradialarteryIndexfingernearesttheheart2024/1/44CharacteristicsofThePulse

RateIntensityTypeofwaveRhythmTension2024/1/45RATE

-Pulsefrequency(rapidorslow)Varieswithage,sex,physicalactivity,emotionalstatusNormalrange:60-100bpminadults;90-120bpminchildren2024/1/46Rateincrease(tachycardia心動過速):severeanemia,highfever,massivehemorrhage(大出血),varioustypesofcardiacarrhythmias,hyperthyroidism,andattimesincongestiveheartfailure.2024/1/47Ratedecrease(bradycardia心動過緩):increasedintracranialpressure(顱高壓),SSS,aboveⅡAVB,hypothyroid(甲減),Digoxin(地高辛),etc2024/1/48RhythmThemorecommondisturbancesofrhythmcanandshouldbedetectedbypalpatingthepulse.Auscultationoftheheartisamoreaccuratemethodfordeterminingtherhythm.SomeofthemorecomplexarrhythmiascanbediagnosedonlybyEKG.2024/1/49Commonirregularpulse:Sinusarrhythmia(竇不齊)Prematurebeat(早搏)Atrialfibrillation(房顫)Bigeminalpulse(二聯律)Trigeminalpulse(三聯律)Paroxysmalatrial,ventriculartachycardiaHeartblock(傳導阻滯)2024/1/410TensionThetensionofpulsedependsonthelevelofthearterialsystolicpressure.2024/1/411IntensityTheintensitydependsonthecardiacoutput,pulsepressureandtheresistanceofperipheralvessels.2024/1/412Pulsusmagnus(boundingpulse洪脈):increasedcardiacoutput,highpulsepressure,lowresistance.aorticinsufficiency,highfever,hyperthyroid2024/1/413Smallpulse(threadypulse細脈):decreasedcardiacoutput,lowpulsepressure,highresistance.aorticstenosis,heartfailure,shock.2024/1/414WaveformThearterialpulsestartsattheinstantaorticvalveopens,resultsinanabruptsharpriseinaorticpressure.Duringsystolealargepartofbloodistemporarilystoredintheproximalaorta.Oncetheaorticpressurereachesapeakitbeginstofall,andbloodcontinuesitsflowintheperipheralarteriesinlatersystoleanddiastole.2024/1/415Normalpulsewave:AscendinglimbPeakDescendinglimbsmallnotch(onthedescendinglimb)Smallnotch(ontheascendinglimb)2024/1/4162024/1/417Theupstrokeispromptandsmooth,buttheanacroticnotchisnotpalpableinmostnormalpersons.Thepeakisroundedandsmooth.Thedescendinglimbismoregradualandlesssteep.Thedicroticnotchinmostnormalpersonscannotbepalpatedbutcanbesensedasachangeintheslopeofthedownstroke.2024/1/418TypeofWaveAbnormalpulsewaveWaterhammerpulse(水沖脈)Pulsustardus(遲脈)Dicroticpulse(重搏脈)Pulsusalternans(交替脈)Paradoxicalpulse(奇脈)Asphygmia(無脈)2024/1/419Waterhammerpulse（水沖脈）Astrongboundingpulsewithatallrapidascendinglimbandanequallyrapiddescendinglimb.Itisalsocalledcollapsingpulse.Duetoincreasingpulsepressure,itisCommonlyfoundinAI,PDA,hyperthyroidandsevereanemia.2024/1/4202024/1/421PulsusTardus（遲脈）AsmallweakpulsewithadelayedsystolicpeakItoccursinthepresenceofnarrowpulsepressure,increasedperipheralvascularresistance,lowSVCommoninaorticstenosis,mitralstenosis,LVheartfailureafterAMI.2024/1/4222024/1/423DicroticPulse（重搏脈）Therearetwoimpulsesthatarepalpableduringsystoleanddiastolerespectively.Itusuallyoccursinthepresenceofhighfeverandtyphoid(傷寒).2024/1/4242024/1/425PulsusAlternans（交替脈）Itischaracterizedbyaregularlyalternatingpulse,inwhicheverybeatisweakerthantheprecedingbeat.Itiseasytobedetectedwhenthepatientissittingorstanding.Itisavaluableindicationofleftventricularfailure.Severearterialhypertension.2024/1/4262024/1/427Paradoxicalpulse （奇脈）Adecreaseintheamplitudeoranactualimperceptibilityofthepulseduringinspiration.Commonlyfoundinmassivepericardialeffusion,constrictivepericarditis,andseverepulmonaryemphysema.2024/1/428Asphygmia（無脈）SevereshockPrimaryarteritisoftheaortaanditsmainbranches(pulseless)2024/1/429ConsistencyofArterialWallNormallythewallofradialarteryissoftandpliableInarteriosclerosis(動脈硬化),moreresistancetocompressionbythepalpatingfinger,andthevesselmayberolledeasilybetweentheexamingdigits.2024/1/430MeasurementofArterial

BloodPressureMethodsformeasuringthebloodpressure:DirectmethodIndirectmethod2024/1/431DefinitionsandClassificationofBloodPressureLevelsCategorysystolic(mmHg)diastolic(mmHg)Normal＜120＜80High-normal120-13980-89Hypertension≥140≥90Isolatedsystolic≥140＜90hypertension2024/1/432AbnormalBloodPressureHypertensionHypotensionSignificantdifferenceintwoupperextremitiesSignificantdifferenceinupperandlowerextremitiesAbnormalityinpulsepressure2024/1/433HypertensionEssentialhypertensionSymptomatichypertensionRenalcauses,endocrinecauses,etc2024/1/434LowBloodPressure

Systolicpressure＜90mmHgdiastolicpressure＜60mmHgDecreaseincardiacoutput:acutemyocardialinfarction,pericarditiswitheffusion,heartfailure,followinghemorrhageDecreaseinperipheralresistance:septicemia(敗血癥),Addison’sdisease,drugintoxications2024/1/435SignificantDifferenceintheUpperExtremitiesLittleornosignificantdifferenceDifferenceofpressureabove10mmHgPrimaryarteritis(動脈炎)oftheaortaanditsmainbranches,obstructionoftheinnominateartery(無名動脈),aorticaneurysm2024/1/436SignificantDifferenceintheUpperandLowerExtremitiesOrdinarilythesystolicpressureisslightlyhigherinthelowerextremitiesthanintheupper(20~40mmHg)Mostcommonincoarctationoftheaorta(congenitalnarrowing)2024/1/437AbnormalityinPulsePressureThepulsepressureisthedifferencebetweenthesystolicanddiastolicpressuresandnormallyamountsto30or40mmHg.Pulsepressureincreased:＞40mmHgatherosclerosisoftheaorta(大動脈硬化),hyperthyroidism,aorticregurgitation(返流),arteriovenousfistula(動靜脈瘺),severeanemia,PDA2024/1/438Pulsepressuredecreased:＜30mmHgAorticstenosis,hypotension,heartfailureandmassivepericardialeffusion2024/1/439Auscultationofvein

Venoushumoverthejugularvein(頸靜脈):asoftlow-pitchedcontinuousmurmur,decreaseordisappearinsupineposition,especiallyincasesofmarkedanemiaLoudmurmurheardoverdilatedveininlivercirrhosis(肝硬化)2024/1/440AuscultationofArteriesNormalarterysoundPistol–shotsoundDurozier’ssoundPathologicalsound:includingsystolicandcontinuousmurmer2024/1/441Pistol-shotSoundInaorticinsufficiency,aloudfirstsound(pistol-shotsound)maybeheardoverthefemoralarteries(股動脈)withoutexertingpressure2024/1/442Durozier’sSignOnpressingt