Presentation on theme: "Percussion The chest is percussed to confirm the cardiac borders, size, contour and position in the thorax. Relative cardiac dullness(心相对浊音界) Absolute."— Presentation transcript:
1PercussionThe chest is percussed to confirm the cardiac borders, size, contour and position in the thorax.Relative cardiac dullness(心相对浊音界)Absolute cardiac dullness(心绝对浊音界)
2Method of percussion for heart Patient should lie supine on an examining table or sit on the chair, with the physician at his right side. Usually we employ indirect percussion(间接叩诊法) for percussing heart borders.
3Many beginners, in attemptng to outline the cardiac dullness, strike too forcibly and thus fail to hear the slight change in the percussion note caused by the thin layer of overlying lung.
4One should use the lightest percussion possible and, with experience, rely more and more upon the vibratory sense.
5Percussion with finger parallel to cardiac outlines
6Percussion with finger at right angle to cardiac outline
7The orthopercussion(直指叩诊法) method of Plesch is carried out by flexing the left middle finger to a right angle, placing the pulp of the finger on the area to be percussed, and then striking the flexed finger at the distal end of the first phalanx.
8This method is recommended in the percussion of absolute cardiac dullness, and give excellent results comparing with ordinary methods.
9It is outlined by percussing in the 5th, 4th, 3rd and 2nd interspace on the left sequentially, starting near the axilla and moving medially until cardiac dullness is encountered.
10PercussionThe beginner should mark with a skin pencil where the note changes. The distance from midsternal line to the left border should be measured and recorded, measurement should be made along a straight line paralleled to the transverse diameter in the thorax.
20In the later months of pregnancy the diaphragm is pushed upward, causing the heart to lie more horizontally and closer to the chest wall, thus increasing the area of cardiac dullness.
21Cardiac dullness in abdominal distention A variety of pathologic conditions such as ascites, an ovarian cyst(卵巢囊肿), or peritonitis(腹膜炎) may cause an elevation of the diaphragm with an increase in the area of cardiac dullness.
22Changes in position of cardiac dullness A left-sided pleural effusion(胸腔积液) will push the heart to the right, and increase the cardiac dullness to the right of sternum, the left border in such cases can usually not be made out. A right-sided pleural effusion increase the cardiac dullness on left side.
23In pneumothorax the heart is displaced toward the normal side, but in massive collapse of the lung(肺萎缩) the heart is displaced toward the affected side.
24Pleural adhesions(胸膜粘连) may pull the heart to the affected side with resulting changes in cardiac dullness similar to those produced by collapse of the lung.
25Decrease in the area of cardiac dullness A decrease in the relative cardiac dullness may occur in pulmonary emphysema(肺气肿). The absolute cardiac dullness is usually decreased in such cases, since the lung is increased in size and covers a greater area of the heart than normal.
26Increase in the area of cardiac dullness An increase in the area of cardiac dullness is most strikingly seen in patients with cardiac disease. we cannot detect by percussion an appreciable increase of the cardiac dullness in hypertrophy of the heart unless there is an accompanying dilatation.
27Cardiac enlargementEnlargement of the left ventricle produces an increase in the relative cardiac dullness to the left and often downward on this side.
29Enlargement of the left ventricle appears in aortic insufficiency, in aortic stenosis, in mitral insufficiency, in longstanding hypertension and in chronic nephritis(慢性肾炎). It is called aortic heart(主动脉型心).
30Right ventricular enlargement, the cardiac dullness will extended to left and upward. If the right ventricular is severely enlarged, the right border of the heart will extend to the right. It is seen in cor pulmonale, in mitral stenosis, in tricuspid insufficiency etc.
31Both the left atrium and pulmonary artery enlarged, the pulmonary artery will be exaggerated to leftward. The cardiac silhouette is like a pear and called mitral heart(二尖瓣型心), it is frequently seen in mitral valve stenosis.
33Aortic dilation(主动脉扩张), aneurysm of aorta(主动脉瘤), pericardial effusion, all those diseases may cause the base border of heart enlargement, so that the base border of the heart will be widened.
34Congestive heart failure, severe myocarditis, Keshan disease(克山病), dilated myocardiopathy(扩张性心肌病) may cause the heart silhouette extending both to right and left(普大心).
35Pericardial effusionThe cardiac dullness is increased in all directions and assumes the form of a triangle with the apex at the level of the first or second intercostal space or a general globular enlargement.
38Adhesive pericarditis The degree of enlargement depends on the extent of the adhesive process. The relative, and especially the absolute, cardiac dullness are both markedly increased to left and to the right.
39Increase in the absolute cardiac dullness Increase in the absolute cardiac dullness without demonstrable cardiac enlargement occurs when the left lung is retracted and a larger area of the ventricle is exposed.
40It also occurs in mediastinal tumors when the heart is pushed up against the chest wall and a large area of the ventricle comes into direct contact with the anterior surface of the chest.