2 Thrill One of characteristic signs of organic heart diseas ·Mechanism:the flow of blood→narrowed orifice→vortices-→ vibration→chest wall thrill-high frequency murmurs-low frequency Method:position,phase of cardiac cycle,clinical significance seen:CHD or valvular stenosis, occasionally insurficiency 21
21 2 Thrill • One of characteristic signs of organic heart disease. • Mechanism : the flow of blood→narrowed orifice→vortices→ vibration→chest wall • thrill-high frequency murmurs-low frequency • Method:position,phase of cardiac cycle,clinical significance • seen: CHD or valvular stenosis , occasionally insurficiency
Clinical significance of thrill Location phase Disease 2 ICS-RS Systole AS (RHD,CHD,senile) 2 ICS-LS Systole PS(CHD) 3,4 ICS-LS Systole VSD(CHD) Apex Systole MI(severe) Apex Diastole MS(RHD) 2 ICS-LS Continous PDA CHD:congenital heart disease 3
22 Clinical significance of thrill Location phase Disease 2 ICS-RS Systole AS (RHD,CHD,senile) 2 ICS-LS Systole PS (CHD) 3,4 ICS-LS Systole VSD (CHD) Apex Systole MI (severe) Apex Diastole MS (RHD) 2 ICS-LS Continous PDA CHD:congenital heart disease
3 Pericardil friction rub 1)Precardium-4th ICS-LS 2)both phases of the cardiac cycle 3)systolic period,sitting erect and leaning forward,the end of expiration 4)mechanism:rub of the visceral and parietal layers of pleura 5)seen:acute pericarditis
23 1)Precardium-4 th ICS-LS 2) both phases of the cardiac cycle 3) systolic period, sitting erect and leaning forward, the end of expiration 4)mechanism: rub of the visceral and parietal layers of pleura 5)seen:acute pericarditis 3 Pericardil friction rub
Percussion Aim:to determine the size and shape of the heart Absolute dullness:contain no gas Relative dullness real size
24 Percussion • Aim:to determine the size and shape of the heart . • Absolute dullness: contain no gas Relative dullness : real size
murneuver of percussion patient in erect position -the pleximeter is vertical with the intercostal space patient in the recumbent position -the pleximeter is parallel with the intercostal space
25 1 murneuver of percussion • patient in erect position –the pleximeter is vertical with the intercostal space • patient in the recumbent position –the pleximeter is parallel with the intercostal space