Western Diagnosis----Physical examination

----- Cardiovascular System

Western Diagnosis ------ Physical examination-- Heart

HEART EXAMINATIONInspection and Palpation

1. The Apex-beat5th intercostal space, 0.5-1 cm in the

middle side of midclavicular line, scope diameter 2.0-2.5cm

2. Alteration in the Width and Strength of the Apex-beat

3. The Neighborhood of the Heart in general

Western Diagnosis ------ Physical examination -- Heart

HEART EXAMINATIONPercussion

1. Normal Percussion Figure of the Heart .Right boundary (cm) Intercostal space Left boundary (cm)

2-3 II 2-3

2-3 III 3.5-4.5

3-4 IV 5-6

V 7-9

It is about 8-10 cm from midline to Left midclavicular line

Western Diagnosis ------ Physical examination -- Heart

HEART EXAMINATION

Percussion

2. Enlargement of the Area of Heart-dullness (Hypertrophy and dilatation of the left ventricle, Fluid in the pericardium)

Western Diagnosis ------ Physical examination -- Heart

HEART EXAMINATION

Percussion

3. Diminution or Loss of Heart-dullness (emphysema of the lungs 肺气肿, pneumo-pericardium 心包积气)

Western Diagnosis ------ Physical examination -- Heart

HEART EXAMINATION

Percussion4. Displacement (dislocation) of the Heart-

dullness (chest flattened or pressed in, Emphysema

of the lungs, pleurisy胸膜炎, Shrinking of the lungs)

Western Diagnosis ------ Physical examination -- Heart

HEART EXAMINATION

Auscultation1. Method

1. Aortic valve : 2nd intercostal space, right of sternum.

2. Pulmonic valve : 2nd intercostal space, left of sternum

3. Tricuspid valve :left sternal border4. Mitral valve : Apex

Western Diagnosis ------ Physical examination -- Heart

HEART EXAMINATIONAuscultation

2. Normal ConditionThe first and second heart-sounds1st sound : Closure of the mitral and the

tricuspid valves and ventricular contraction.

2d sound : Closure of aortic and pulmonary valve.

Western Diagnosis ------ Physical examination -- Heart

HEART EXAMINATION

Auscultation3. Abnormal Condition

• Abnormalities of the First Heart Sound• Abnormalities of the Second Heart

Sound• Systolic Clicks• Diastolic Opening Snaps• Murmurs