上海交通大学：《诊断学》课程PPT教学课件（英语版）Chapter 12 EXAMINATION OF

EXAMINATION OF BLOOD VESSELS 2021/2/23

2021/2/23 1 EXAMINATION OF BLOOD VESSELS

INTRODUCTION r Palpation of the pulse r Measurment of arterial blood pressure r auscultation of blood vessels 2021/2/23

2021/2/23 2 INTRODUCTION Palpation of the pulse Measurment of arterial blood pressure Auscultation of blood vessels

PALPATION OF THE PULSE Radial artery is usually selected r Patient's hand placed with the palm upward r Physician's first three fi igers on the adial artery r Index finger nearest the heart 2021/2/23

2021/2/23 3 PALPATION OF THE PULSE Radial artery is usually selected Patient’s hand placed with the palm upward Physician’s first three fingers on the radial artery Index finger nearest the heart

CHARACTERISTICS OF THE PULSE r Rate r Size r Type of wave r Rhythm tEnsion 2021/2/23

2021/2/23 4 CHARACTERISTICS OF THE PULSE Rate Size Type of wave Rhythm Tension

RATE Pulsus frequens or rarus(rapid or slow) r Varies with age, sex, physical activity, emotional status r Normal range: 60-100bpm in adults; 90 120bpm in children r Rate increase(tachycardia): severe anemia high fever, massive hemorrage etc r Rate decrease(bradycardia): syncope, heart block etc 2021/2/23

2021/2/23 5 RATE -Pulsus frequens or rarus(rapid or slow) Varies with age, sex, physical activity, emotional status Normal range: 60-100bpm in adults; 90- 120bpm in children Rate increase (tachycardia):severe anemia, high fever, massive hemorrage, etc Rate decrease (bradycardia):syncope, heart block, etc

RHYTHM pulsus regularis or irregularIs Pulsus irregularis r Sinus arrhythmia r Premature contractions r Aterial fibrillation r Bigeminal pulse r Trigeminal pulse r Paroxysmal atrial tachycardia r Heart block 2021/2/23

2021/2/23 6 RHYTHM -pulsus regularis or irregularis Pulsus irregularis Sinus arrhythmia Premature contractions Aterial fibrillation Bigeminal pulse Trigeminal pulse Paroxysmal atrial tachycardia Heart block

TENSION Pulsus hard or soft r Corresponds to the diastolic blood pressure 2021/2/23

2021/2/23 7 TENSION -Pulsus hard or soft Corresponds to the diastolic blood pressure

SIZE r Pulsus magnus(high pulse pressure)- aortic insufficiency r Pulsus parvus(low pulse pressure)- aortic stenosis 2021/2/23

2021/2/23 8 SIZE Pulsus magnus (high pulse pressure)- aortic insufficiency Pulsus parvus(low pulse pressure)- aortic stenosis

TYPE OF WAVE Normal pulse wave r Ascending limb r Peak r Descending limb r Dicrotic notch( on the descending limb) 2021/2/23

2021/2/23 9 TYPE OF WAVE Normal pulse wave: Ascending limb Peak Descending limb Dicrotic notch ( on the descending limb)

TYPE OF WAVE Abnormal pulse wave r Water hammer pulse r Pulps tardus r Dicrotic pulse r Pulsus alternans r Pulsus paradoxus r Asphygmia 2021/2/23

2021/2/23 10 TYPE OF WAVE Abnormal pulse wave Water hammer pulse Pulpus tardus Dicrotic pulse Pulsus alternans Pulsus paradoxus Asphygmia