Name: cardiac exam i: checking the chest first
Uploaded: 2023-04-30T06:37:11.000Z
Duration: 7 min 39 s
Channel: JoVE

K12 Standards

Florida Department of Education

High School

Life Science

SC.912.L.14

SC.912.L.14.38

Cardiac Exam I: Inspection and Palpation

1. 引言
<ol>
	<li>与检查任何患者之前一样，需先用肥皂和水彻底洗手，或使用抗菌洗手液清洁双手。</li>
	<li>进入检查室后向患者自我介绍，并说明将要进行心脏检查。</li>
</ol>
2. 定位
<ol>
	<li>让患者脱去腰部以上的衣物（女性保留内衣）。</li>
	<li>将患者置于检查床上，体位呈30至45度角，从患者右侧进行检查。</li>
	<li>首先整体观察患者，注意其是否舒适或有无任何痛苦表现。</li>
</ol>
3. 外周检查
<ol>
	<li>让患者将双手举起，并评估以下内容：
	<ol>
		<li>毛细血管再充盈：用食指按压患者的指甲甲床，同时用拇指托住患者手指的另一侧。指甲下的皮肤会变白（呈现白色）。测量恢复红色所需的时间，正常应少于2秒，提示外周循环良好。</li>
		<li>杵状指，定义为指甲与甲床之间夹角减小。杵状指可能是右向左分流性疾病或细菌性心内膜炎（心脏瓣膜感染）的体征：请患者将两侧拇指并拢放置，观察其内侧是否形成菱形空隙。若存在杵状指，则此菱形无法形成。</li>
		<li>细菌性心内膜炎的体征：甲下裂片状出血（指甲下出现细小的红色出血点）、奥斯勒结节（Osler's nodes，常出现在手指末端的疼痛性红色丘疹）、贾内韦病变（Janeway lesions，常出现在手掌的无痛性红色斑疹）。</li>
	</ol>
	</li>
	<li>用食指和中指触诊桡动脉搏动，评估每分钟搏动次数、节律规整性、搏动幅度和搏动特征。搏动微弱或难以触及提示低血流状态，如脓毒症。异常强而有力的&#34;水冲样&#34;搏动可见于贫血和充血性心力衰竭等疾病。</li>
	<li>检查上肢皮肤是否存在黄色瘤沉积，此类病变常出现在肘部附近，可能是高脂血症的体征。</li>
	<li>检查患者头部是否存在心脏疾病的体征：
	<ol>
		<li>德穆塞征（de Musset's sign）：与主动脉瓣反流相关的头部&#34;点头样&#34;运动。</li>
		<li>颧部潮红（Malar flush）：面部潮红或发红，提示二尖瓣狭窄。</li>
		<li>检查角膜是否存在角膜弓（corneal arcus），即角膜周围出现的灰白色变色，是高脂血症的体征。</li>
		<li>检查眼周皮肤是否存在称为睑黄瘤（xanthelasma）的黄色胆固醇沉积。</li>
		<li>检查眼底是否存在视网膜病变（常见于心血管疾病和糖尿病）以及罗斯斑（Roth's spots，细菌性心内膜炎时出现的中心苍白的视网膜出血点）。</li>
		<li>请患者张口并伸出舌头。舌的颜色应为粉红/红色。若呈青紫色，则提示中心性发绀。</li>
	</ol>
	</li>
	<li>用前两指轻柔触诊颈动脉搏动，评估其幅度和特征。缓慢上升的脉搏是主动脉瓣狭窄的体征。</li>
	<li>颈静脉压（JVP）是反映右心房压力的天然压力计，在充血性心力衰竭时升高。
	<ol>
		<li>测量JVP时，让患者头部向左偏转，体位保持在45度倾斜。</li>
		<li>观察右侧颈内静脉在胸锁乳突肌两个头（胸骨头和锁骨头）之间出现的双重搏动。有时在瘦弱患者中可见的颈动脉搏动为单次搏动，且可触及，而颈静脉搏动则不可触及。</li>
		<li>定位路易角（angle of Louis，即胸骨柄与胸骨体连接处），其位置约高于右心房中心5 cm。</li>
		<li>从可见颈内静脉搏动的最高点，水平放置一个长条形物体（如一张卡片）。</li>
		<li>使用垂直放置的直尺测量从路易角到卡片的距离，并将该数值加上5 cm（路易角至右心房的距离），计算出JVP。</li>
		<li>另一种观察颈内静脉的方法是在右上腹肋缘下方轻柔按压，此操作可诱发所谓的肝颈静脉反流（腹腔血管血液转移至右心房）。正常情况下，JVP短暂升高后即下降；若JVP持续升高，则见于充血性心力衰竭及其他疾病，如三尖瓣反流和缩窄性心包炎。</li>
	</ol>
	</li>
</ol>
4. 胸部视诊
<ol>
	<li>前后检查患者胸部是否有可见的疤痕。注意是否存在胸骨正中切开术疤痕（提示曾进行冠状动脉旁路移植术或主动脉瓣手术）。位于左乳头下方较偏外侧的疤痕则提示既往可能进行过二尖瓣手术。</li>
</ol>
5. 触诊
<ol>
	<li>心尖搏动，也称为最大脉冲点（PMI），对应于心脏的左下缘。它是可触及心搏的最下和最外侧位置。
	<ol>
		<li>通过从胸骨角旁的第二肋间隙向下计数，找到锁骨中线第五肋间隙中的PMI。</li>
		<li>用前两个手指进行触诊。</li>
		<li>如果无法触及，可让患者向左侧卧。若心脏增大（心室肥大），心尖搏动将向外侧移位。</li>
	</ol>
	</li>
	<li>接下来，触诊有无抬举感和震颤（震颤是一种可触及的杂音）。
	<ol>
		<li>将手掌分别置于胸前区的四个心脏区域，然后置于左上和右上胸壁。震颤的感觉类似于手掌下的振动或嗡鸣感。</li>
		<li>将手置于左侧胸骨边缘。胸骨旁抬举感是右心室增大的体征，感觉为手掌下有一种&#34;抬起感&#34;。</li>
	</ol>
	</li>
</ol>
6. 心脏叩诊
<ol>
	<li>与其他许多检查不同，叩诊在心脏系统的检查中很少使用；然而，几十年前，医生会通过叩诊心脏边界来评估是否存在心脏肥大。</li>
</ol>
7. 其他检查与触诊
<ol>
	<li>使用双手并排平行放置，触诊腹部中线处是否存在腹主动脉瘤。</li>
	<li>观察下肢，评估是否存在水肿迹象。</li>
	<li>触诊股动脉、腘动脉、胫前动脉和足背动脉处的外周脉搏。</li>
</ol>
<div class="chapter_text" id="script_0">
	心脏评估是每位医生在接诊患者时必须进行的核心体格检查之一。心脏系统的正常功能对生命至关重要，而与之相关的疾病是全球范围内住院治疗最常见的原因之一。因此，掌握如何进行全面而细致的心脏检查，对任何临床医生而言都至关重要。
	许多医生在进行心脏检查时会本能地直接使用听诊器。然而，在听诊之前，通过细致的视诊和触诊可以获得大量信息。本视频将详细回顾心脏检查中的这两个方面。
</div>
<div class="chapter_text" id="script_1">
	让我们回顾一下心脏系统评估中的视诊和触诊步骤顺序及其预期发现。检查前，应彻底洗手。进入检查室后，向患者自我介绍，并简要说明将要进行的操作。请患者脱去上身衣物，仅保留下装。指导患者仰卧于检查床上，床面调整至30–45°的倾斜角度，检查者应从患者的右侧开始检查。 
	首先检查肢体末端。让患者举起一只手，按压其指甲并观察甲床变白的情况，然后松开压力，估计甲床恢复红色所需的时间。此即毛细血管再充盈时间，可作为外周循环状况的指标。完成毛细血管再充盈试验后，嘱患者将两个拇指的指甲并排紧贴，以检查是否存在杵状指。注意观察是否形成菱形空隙，若形成则表明无杵状指。若未形成空隙，则可能提示存在慢性缺氧状态，如右向左分流性疾病或细菌性心内膜炎。为检查细菌性心内膜炎的其他体征，请观察指甲下是否有称为裂片状出血的红色出血灶。接着寻找奥斯勒结节（Osler's nodes），表现为手指末端疼痛性红色丘疹。同时检查是否存在杰氏病灶（Janeway lesions），表现为手掌上无痛性红色斑疹。随后移至手腕部位，触诊桡动脉搏动 用食指和中指评估脉率、节律规整性、脉搏容积及脉搏特征。接着检查上肢皮肤，尤其是肘部附近，观察是否存在称为黄瘤的黄色沉积物，此为高脂血症的体征。 
	检查完外周后，观察患者头部是否存在 de Musset 征，表现为与心跳同步的节律性点头，此体征与主动脉瓣反流相关。检查患者面部是否存在颧部红斑，即面部潮红，提示二尖瓣狭窄。接着检查眼周皮肤是否存在称为睑黄瘤的黄色胆固醇沉积。然后检查角膜是否存在角膜环状混浊（corneal arcus），即灰白色变色，提示高脂血症。完成面部检查时，请患者张口并伸出舌头，观察其颜色以判断是否存在发绀。 
	进入颈部区域。首先触诊颈动脉，颈动脉位于气管两侧，约在下颌角下方2 cm处，可用前两指轻柔按压此位置，评估脉搏的容积与特征。随后测量颈静脉压（JVP）。为此，需定位右侧颈内静脉和路易斯角（Angle of Louis），后者为胸骨柄与胸骨体连接处形成的前向夹角。颈内静脉走行于胸锁乳突肌的胸骨头与锁骨头之间，这两者与锁骨下缘共同构成一个三角形区域。为定位该静脉，嘱患者将头转向左侧，观察是否存在由右侧颈内静脉产生的双重搏动。接下来通过触诊定位路易斯角，其位置大约在右心房中心上方5 cm处，毗邻第二肋间隙。确定路易斯角后，从可见颈内静脉搏动的最高点水平延伸一个长条状物体（如卡片），再使用直尺测量从路易斯角到该卡片的水平距离（cm）。所测得的距离加5即为颈静脉压（JVP），正常值通常为6至8。
	完成JVP测量后，从前方和后方检查患者胸部是否存在提示既往心脏手术的可见瘢痕。下一步是定位心尖搏动点（PMI）。以路易氏角为解剖标志，向下数至第5肋间隙，在锁骨中线上触诊心尖搏动点。若在坐位无法触及，嘱患者向左侧卧位后再行触诊。需注意，在心脏肥大情况下，心尖搏动点会向侧方移位。随后，用手掌触诊心前区的四个心脏听诊区以及左、右侧上胸部胸壁，注意手下是否存在震颤或嗡鸣感，这可能提示存在震颤（thrills）。完成胸部触诊的最后一步是将手置于左侧胸骨边缘。若手下出现“抬举感”，则提示存在胸骨旁抬举（parasternal heave），这是右心室增大的体征。

关键词：JVP测量，胸部检查，心尖搏动点（PMI），路易氏角，第5肋间隙，触诊，心脏听诊区，震颤，胸骨旁抬举，右心室增大，心脏肥大 
	从胸部向下移动，用双手平行放置于腹部正中线，触诊有无腹主动脉瘤。接下来，视诊并触诊下肢，检查有无水肿迹象。最后，触诊股动脉、腘动脉、胫后动脉和足背动脉处的外周脉搏。至此，完成心脏检查中的视诊与触诊部分。
</div>
<div class="chapter_text" id="script_2">
	您刚刚观看了 JoVE 关于心脏系统视诊与触诊的视频。如果临床医生以谨慎、精确和全面的方式执行所有这些步骤，便可获得大量临床信息。通过学习完整的检查技术，医务人员能够打下坚实的基础，以培养临床技能，进而提前预测心脏病理变化。一如既往，感谢您的观看！
</div>

通过全面而细致地检查和触诊心血管系统，可以获得大量临床信息。检查者应能够判断患者是否患有多种可能的疾病，包括心房颤动、瓣膜性心脏病、心脏肥大、高脂血症以及细菌性心内膜炎。然而，在日常临床实践中，这些步骤常常被简化或省略。掌握完整的心脏查体技术，有助于医务人员在接触更多心脏病理病例的过程中，打下坚实的临床技能基础。通过系统化、分步骤地评估心血管系统，医生甚至在将听诊器置于患者体表之前，就可能作出初步诊断。

心脏检查 i：视诊与触诊

来源：<a href="https://www.jove.com/author/Suneel_Dhand">Suneel Dhand</a>，医学博士，内科主治医师，贝斯以色列女执事医疗中心
心脏评估是几乎所有医生在接诊患者时都会进行的核心检查之一。心脏系统疾病是导致住院的最常见原因之一，其病情范围从心肌梗死到充血性心力衰竭不等。因此，掌握全面而细致的心脏检查方法对每一位执业医师而言至关重要。
如果心脏或循环系统存在病理变化，其后果也可能表现在其他身体部位，包括肺部、腹部和腿部。许多医生在进行心脏检查时会本能地直接拿起听诊器。然而，在听诊之前，通过正确的检查顺序（从视诊和触诊开始）可以获得大量信息。

心脏检查 I：视诊与触诊

来源：Suneel Dhand，医学博士，内科主治医师，贝斯以色列女执事医疗中心  
心脏评估是核心……

心脏评估是每位医生在接诊患者时必须进行的核心体格检查之一。心脏系统的正常功能对生命至关重要，而与之相关的疾病也是全球范围内住院治疗最常见的原因之一。因此，掌握如何进行全面而细致的心脏检查，对任何临床医生而言都至关重要。许多医生在进行心脏检查时，会本能地直接拿起听诊器。然而，在听诊之前，通过仔细的视诊和触诊可以获得大量信息。本视频将详细回顾心脏检查中的这两个方面。让我们回顾一下心脏系统评估中的视诊和触诊步骤顺序及其预期发现。检查前，彻底洗手。进入检查室后，向患者自我介绍，并简要说明将要进行的操作。让患者脱去腰部以上的衣物。指导患者仰卧于检查床上，床面调整至30-45°倾斜角，并从患者的右侧开始检查。首先检查肢体末梢。让患者举起一只手，按压其指甲甲床，观察甲床变白的情况，然后松开压力，评估甲床恢复红色所需的时间。此即毛细血管再充盈时间，可作为外周循环状况的指标。完成毛细血管再充盈试验后，嘱患者将两个拇指的指甲并排紧贴，以检查是否存在杵状指。注意观察是否形成菱形空隙，若形成则表明无杵状指。若未形成空隙，则可能提示存在慢性缺氧状态，如右向左分流性疾病或细菌性心内膜炎。为排查细菌性心内膜炎的其他体征，请检查指甲下是否有称为裂片状出血的红色出血灶。接着观察是否存在奥斯勒结节（Osler's nodes），即指尖部位疼痛的红色丘疹。同时检查是否可见杰氏病灶（Janeway lesions），即手掌上无痛性的红色斑疹。随后移至手腕部位，用示指和中指触诊桡动脉搏动，评估脉率、节律规整性、脉搏容量及脉搏特征。接下来，检查上肢皮肤，尤其是肘部附近，观察是否存在称为黄瘤（xanthoma）的黄色沉积物，此为高脂血症的体征。检查完周围部位后，观察患者头部是否存在德穆塞征（de Musset's sign），即头部随着心跳节律性地上下摆动，此体征与主动脉瓣反流相关。检查患者面部是否存在颧部潮红（Malar flush），即面部发红，提示二尖瓣狭窄。接着检查眼周皮肤是否有称为睑黄瘤（xanthelasma）的黄色胆固醇沉积。然后检查角膜是否存在角膜弓（corneal arcus），即角膜周围的灰白色变色，提示高脂血症。完成面部检查时，请患者张开嘴并伸出舌头，观察其颜色以判断是否存在发绀。继续检查颈部区域。首先触诊颈动脉，颈动脉位于气管两侧，约在下颌角下方 2 cm 处可触及。用前两根手指在此处轻压，评估脉搏的容积和特征。随后测量颈静脉压（JVP）。为此，需定位右侧颈内静脉和路易斯角（Angle of Louis），后者为胸骨柄与胸骨体连接处形成的前角。颈内静脉走行于胸锁乳突肌的胸骨头与锁骨头之间，这两者与锁骨下缘共同构成一个三角形区域。为定位该静脉，嘱患者将头部转向左侧，观察是否存在双重搏动，此搏动由右侧颈内静脉产生。接下来通过触诊定位路易斯角，其位置大约在右心房中心上方 5 cm 处，毗邻第二肋间隙。确定路易斯角后，从可见颈内静脉搏动的最高点水平延伸一个长条形物体（如一张纸片），再用直尺测量从路易斯角到纸片的垂直距离（cm）。所测距离加 5 即为颈静脉压（JVP），正常值通常为 6 至 8。完成颈静脉压（JVP）测量后，从前方和后方检查患者胸部，观察是否存在提示既往心脏手术的可见瘢痕。下一步是定位心尖搏动点（PMI）。以路易角为解剖标志，向下数至第5肋间隙，在锁骨中线上触诊心尖搏动点。若在坐位无法触及，可嘱患者向左侧卧位，再行触诊。需注意，在心脏扩大（心室肥大）的情况下，心尖搏动点会向侧方移位。接下来，用手掌触诊胸骨旁区的四个心脏听诊区以及左、右侧上胸部胸壁，注意手下是否有震颤或嗡鸣感，这可能提示存在震颤（thrills）。完成胸部触诊的最后一步是将手置于左侧胸骨边缘。若手下出现“抬举感”，则提示存在胸骨旁抬举，这是右心室增大的体征。从胸部向下移动，用双手平行放置于中线处触诊腹部，检查是否存在动脉瘤。接下来，视诊并触诊下肢，观察是否有水肿迹象。最后，触诊股动脉、腘动脉、胫后动脉和足背动脉处的外周脉搏。至此，心脏检查中的视诊与触诊部分结束。您刚刚观看了 JoVE 关于心脏系统视诊与触诊的视频。如果临床医生以谨慎、精确和全面的方式执行所有这些步骤，便可获得大量临床信息。通过学习完整的检查技术，医疗专业人员能够打下坚实的基础，以培养临床技能，进而提前预测心脏病理情况。一如既往，感谢观看！

Education

教育

JoVE Science Education

Clinical Skills

临床技能

Physical Examinations I

体格检查 I

心脏考试 i: 检查和触诊

cardiac exam i: checking the chest first

Cardiac exam inspection and palpation are the first steps in a careful heart assessment. These steps help a physician gather useful information before using a stethoscope. They are part of the core examination performed when a patient is first seen.

Heart and circulatory disorders are common reasons for hospital admission. They can include conditions such as myocardial infarction and congestive heart failure. Because of this, learning a complete cardiac examination is important for any practicing physician.

A heart problem may also show signs in other parts of the body. Changes can appear in the lungs, abdomen, and legs. That is why the exam starts with looking and feeling, not with listening right away.

Cardiac Exam I: Checking the Chest First

general approach to the physical exam

Why Physical Exams Still Matter

Physical examination remains an important part of medicine. Doctors have used the body exam for centuries to connect changes in body function with disease. Even with modern imaging and lab tests, the bedside exam still helps clinicians understand what may be happening in the patient. Physical examination is not a replacement for tests, and it does not answer every question. Some maneuvers that were once highly valued may have limited usefulness. Still, many conditions can only be found through...

observation and inspection

Clinical Observation in Physical Exam

Clinical observation is the starting point of a physical examination and begins at the first contact with a patient. Observation is a broad term for using the senses carefully to gather information. Inspection is a narrower term. It refers to what can be seen with the eyes, especially on the surface of the body, rather than to behavior. Skilled clinicians use more than sight when they examine a patient. They also rely on touch, through palpation and percussion, and on hearing, through...

palpation

How Hand Position Guides Palpation

Palpation uses touch to collect diagnostic information during the physical exam. It is one of the ways a healthcare provider uses the senses to learn more about a patient. The part of the hand used for palpation changes depending on the body area being examined. Finger pads are best for fine detail. Their dense sensory nerves help the examiner feel small features, such as the borders of masses or lymph nodes. The back of the hand, also called the dorsal surface, gives a rough sense of relative...

percussion

Clinical Percussion and Body Sound

Clinical percussion uses tapping to create sound and help assess what lies beneath the body surface. It is a simple bedside technique that depends on the way sound changes when it travels through different tissues. The method began with Leopold Auenbrugger, an Austrian inn-keeper's son, who found that tapping beer barrels could help him take inventory. He later applied the same idea to patients in Vienna and published the first description of its diagnostic use in 1761. Jean-Nicolas Corvisart...

auscultation

Stethoscope Sounds in Clinical Exam

Auscultation is a clinical exam method that lets a provider listen to sounds inside the body. Doctors use it to gather important diagnostic information from the chest, heart, abdomen, and blood vessels. For many years, auscultation meant immediate auscultation. In that method, the examiner placed an ear directly on the patient's skin. This approach was used for centuries, but it became less useful in nineteenth-century France because of social norms and poor diagnostic yield. René Laënnec...

proper adjustment of patient attire during the physical exam

proper-adjustment-of-patient-attire-during-the-physical-exam

Draping for a Better Physical Exam

Draping is an important part of a careful physical exam. It helps the provider examine the right body area while also protecting patient modesty. Good draping takes practice because the examiner must balance exposure with comfort. Correct technique also improves the accuracy of the exam. Skin lesions can be missed if inspection is done through clothing. Lung crackles may be reported by mistake when the chest is examined through a T-shirt, and subtle heart findings can be missed when...

blood pressure measurement

Manual Blood Pressure Reading Steps

Blood pressure reading uses an indirect method to measure the pressure of blood against vessel walls. Blood pressure, or BP, is a vital sign that is checked routinely in hospital and outpatient settings. It is one of the most common medical assessments performed around the world. The indirect method is non-invasive, safe, and easily reproducible, so it is used most often. BP can be measured automatically by oscillometry or manually by auscultation. Auscultation uses a sphygmomanometer, which...

measuring vital signs

Vital Sign Ranges and Patient Status

Vital signs are objective measurements that show a patient’s clinical status. The commonly accepted vital signs are blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation. In many practices, pain is also treated as the sixth vital sign and is documented with the others. Pain is different from the other vital signs because it is a subjective measurement. That means the pain scale can vary from one patient to another. A vital signs assessment includes heart rate, blood...

respiratory exam i: inspection and palpation

respiratory-exam-i-inspection-and-palpation

Checking Breathing Distress by Exam

Respiratory exam starts with looking for breathing distress and feeling the chest. Shortness of breath is a common reason for both outpatient and inpatient evaluation. Early inspection can reveal fast breathing or cyanosis, which is a bluish color change that can signal low oxygen. If a patient shows respiratory distress, the situation needs urgent attention and oxygen therapy. In many cases, careful clinical examination can help identify lung problems without relying only on tests. This is...

respiratory exam ii: percussion and auscultation

respiratory-exam-ii-percussion-and-auscultation

Respiratory Exam: Lung Sounds and Percussion

Respiratory exam skills include percussion and auscultation of the lungs. These techniques help identify lung problems during a physical exam. Percussion uses tapping to assess the chest, and auscultation uses a stethoscope to listen for breath sounds. Percussion is a useful skill that is often skipped in routine clinical practice. When it is done correctly, it can help a physician detect underlying lung pathology. Auscultation can also give an almost immediate clue to several acute pulmonary...

cardiac exam i: inspection and palpation

Cardiac exam inspection and palpation are the first steps in a careful heart assessment. These steps help a physician gather useful information before using a stethoscope. They are part of the core examination performed when a patient is first seen. Heart and circulatory disorders are common reasons for hospital admission. They can include conditions such as myocardial infarction and congestive heart failure. Because of this, learning a complete cardiac examination is important for any...

cardiac exam ii: auscultation

Listening for Normal and Abnormal Heart Sounds

Heart auscultation uses a stethoscope to listen to heart sounds and check for normal and abnormal patterns. For physicians, knowing how to hear these sounds and tell them apart is an essential skill. The sound heard at each spot on the chest relates to the closing of specific heart valves. The heart has two main sounds, called S1 and S2. S1 happens when the mitral and tricuspid valves, which are the atrioventricular valves, close after blood enters the ventricles. This marks the start of...

cardiac exam iii: abnormal heart sounds

Heart Murmurs and Gallop Sounds

Heart murmurs and gallop sounds are abnormal heart sounds that can be heard during auscultation, or listening to the heart with a stethoscope. A good understanding of normal heart sounds is the first step in telling normal sounds apart from abnormal ones. Murmurs usually have a swishing quality and point to turbulent blood flow across a heart valve. Murmurs can happen because a valve is too narrow, which is called stenosis, or because blood leaks backward across the valve, which is called...

peripheral vascular exam

Assessing PAD and Venous Signs

Peripheral vascular disease can affect blood flow in the arms and legs, and careful exam steps help reveal signs of disease. Peripheral artery disease (PAD) is linked to cardiovascular and cerebrovascular complications. Risk factors include diabetes, hyperlipidemia, hypertension, and tobacco use. Symptoms may appear as limb claudication, which is cramp-like muscle pain that gets worse with activity and better with rest. Chronic venous insufficiency (CVI) can cause lower extremity swelling,...

peripheral vascular exam using a continuous wave doppler

peripheral-vascular-exam-using-a-continuous-wave-doppler

Bedside Doppler for Leg Blood Flow Checks

Peripheral vascular disease affects the arteries and veins outside the heart, and it is common in older adults. History and physical exam can suggest the diagnosis, but Doppler ultrasound is now a routine part of the bedside vascular exam. This lesson focuses on bedside assessment of peripheral arterial disease and chronic venous insufficiency with a handheld continuous wave Doppler. A handheld Doppler is a simple tool that sends and receives ultrasound at the same time. It detects changes in...

physical examinations i

本系列为进行体检提供了基础;从测量血压或生命体征, 到关键的肺和心血管物理检查的技术不等。

Learn why inspection and palpation come first in a cardiac exam, and how these early steps can reveal signs of heart and circulatory problems.

Cardiac Exam I: Checking the Chest First | JoVE K12

new-york-state-science-learning-standards

New York State Science Learning Standards

Structure and Function

HS-LS1-3.

Suneel Dhand

Beth Israel Deaconess Medical Center

Overview

Steps for Cardiac Inspection and Palpation

Summary

What are Cells?

Cells are the smallest and basic units of life, whether it is a single cell that forms the entire organism, e.g., in a bacterium or trillions of them, ...

Characteristics of Life

Biology is a natural science that studies life and living organisms, including their structure, function, development, interactions, evolution, ...

https://cloudfront.jove.com/files/media/science-education/science-education-thumbs/10647.jpg

Animal and Plant Cell Structure

Animal and plant cells not only differ in their structure, function, and mode of nutrition but also in how they reproduce, specialize, and organize into ...

Eukaryotic Evolution

The endosymbiont theory is the most widely accepted theory of eukaryotic evolution; however, its progression is still somewhat debated. According to the ...

Cell Diversity

The concept of a cell started with microscopic observations of dead cork tissue by Robert Hooke in 1665. Hooke coined the term &#34;cell&#34; based on the ...

Chemistry of the Cell

The cell is chemically composed of water, organic molecules and inorganic ions.
Water
The polarity of the water molecule and its resulting hydrogen ...

Describe the scientific theory of cells (cell theory) and relate the history of its discovery to the process of science.

SC.912.L.14.1

Cell Size

Cell sizes vary widely among and within organisms. Bacterial cells range between 1-10 micrometers (&#x3BC;m)and are considerably smaller than most ...

Eukaryotic Compartmentalization

One of the distinguishing features of eukaryotic cells is that they contain membrane-bound organelles, such as the nucleus and mitochondria, that carry ...

Prokaryotic Cells

Prokaryotes are small unicellular organisms that include the domains&#x2014;Archaea and Bacteria. Bacteria include many common organisms, such as ...

Cytoplasm

The cytoplasm consists of organelles and a framework of protein scaffolds called the cytoskeleton suspended in an aqueous solution, the cytosol. The ...

The Nucleus

The nucleus is a membrane-bound organelle that acts as a control center in a eukaryotic cell. It contains chromosomal DNA, which controls gene expression ...

Endoplasmic Reticulum

Endoplasmic ReticulumThe endoplasmic reticulum (ER) is an extensive network of membranous sacs and tubules in eukaryotic cells, continuous with the outer ...

Ribosomes

Ribosomes translate genetic information encoded by messenger RNA (mRNA) into proteins. Both prokaryotic and eukaryotic cells have ribosomes. Cells that ...

Golgi Apparatus

As they leave the Endoplasmic Reticulum (ER), properly folded and assembled proteins are selectively packaged into vesicles. These vesicles are ...

Microtubules

There are three types of cytoskeletal structures in eukaryotic cells&#x2014;microfilaments, intermediate filaments, and microtubules. With a diameter of ...

Peroxisomes

Peroxisomes and mitochondria are two important oxygen-utilizing organelles in eukaryotic cells. Mitochondria carry out cellular respiration&#x2014;the ...

Gap Junctions

Multicellular organisms employ a variety of ways for cells to communicate with each other. Gap junctions are specialized proteins that form pores between ...

The Extracellular Matrix

In order to maintain tissue organization, many animal cells are surrounded by structural molecules that make up the extracellular matrix (ECM). Together, ...

Tissues

Cells with similar structure and function are grouped into tissues. A group of tissues with a specialized function is called an organ. There are four main ...

Plant Cell Wall

The plant cell wall gives plant cells shape, support, and protection. As a cell matures, its cell wall specializes according to the cell type. For ...

Plasmodesmata

The organs in a multicellular organism&#x2019;s body are made up of tissues formed by cells. To work together cohesively, cells must communicate. One way ...

What are Membranes?

A key characteristic of life is the ability to separate the external environment from the internal space. To do this, cells have evolved semi-permeable ...

Membrane Fluidity

Cell membranes are composed of phospholipids, proteins, and carbohydrates loosely attached to one another through chemical interactions. Molecules are ...

Fluid Mosaic Model

The fluid mosaic model was first proposed as a visual representation of research observations. The model comprises the composition and dynamics of ...

What is an Electrochemical Gradient?

Adenosine triphosphate, or ATP, is considered the primary energy source in cells. However, energy can also be stored in the electrochemical gradient of an ...

Diffusion

Diffusion is the passive movement of substances down their concentration gradients&#x2014;requiring no expenditure of cellular energy. Substances, such as ...

Osmosis

Approximately 60% to 95% of the weight of living organisms is attributed to water. Therefore, maintaining appropriate water balance within cells is of ...

Tonicity in Animals

The tonicity of a solution determines if a cell gains or loses water in that solution. The tonicity depends on the permeability of the cell membrane for ...

Tonicity in Plants

Tonicity describes the capacity of a cell to lose or gain water. It depends on the quantity of solute that does not penetrate the membrane. Tonicity ...

Introduction to Membrane Proteins

The cell membrane, or plasma membrane, is an ever-changing landscape. It is described as a fluid mosaic where various macromolecules are embedded in the ...

Facilitated Transport

The chemical and physical properties of plasma membranes cause them to be selectively permeable. Since plasma membranes have both hydrophobic and ...

Primary Active Transport

In contrast to passive transport, active transport involves a substance being moved through membranes in a direction against its concentration or ...

Secondary Active Transport

One example of how cells use the energy contained in electrochemical gradients is demonstrated by glucose transport into cells. The ion vital to this ...

Receptor-mediated Endocytosis

Overview

Receptor-mediated endocytosis is a process through which bulk amounts of specific molecules can be imported into a cell after binding to cell ...

Pinocytosis

Cells use energy-requiring bulk transport mechanisms to transfer large particles, or large amounts of small particles, into or out of the cell. The cells ...

Phagocytosis

Cells pull particles inward and engulf them in spherical vesicles in an energy-requiring process called endocytosis. Phagocytosis (&#x201C;cellular ...

Exocytosis

Exocytosis is used to release material from cells. Like other bulk transport mechanisms, exocytosis requires energy.

While endocytosis takes particles ...

Relate structure to function for the components of plant and animal cells. Explain the role of cell membranes as a highly selective barrier (passive and active transport).

SC.912.L.14.2

Cell Structure

Background
Cells represent the most basic biological units of all organisms, whether it be simple, single-celled organisms like bacteria, or large, ...

Compare and contrast the general structures of plant and animal cells. Compare and contrast the general structures of prokaryotic and eukaryotic cells.

SC.912.L.14.3

Overview of Microscopy Techniques

The early pioneers of microscopy opened a window into the invisible world of microorganisms. In 1830, Joseph Jackson Lister created an essentially modern ...

Introduction to Light Microscopy

The light microscope is an instrument used by researchers in many different fields to magnify specimens to as much as a thousand times their original ...

Overview of Electron Microscopy

The wavelengths of visible light ultimately limit the maximum theoretical resolution of images created by light microscopes. Most light microscopes can ...

phase-contrast-and-differential-interference-contrast-microscopy

Phase Contrast and Differential Interference Contrast Microscopy

Phase-Contrast Microscopes
In-phase-contrast microscopes, interference between light directly passing through a cell and light refracted by cellular ...

Confocal Fluorescence Microscopy

Confocal microscopy is an advanced microscopic technique. The prime advantage of the confocal microscope over other microscopy techniques is its ability ...

Introduction to Fluorescence Microscopy

Fluorescence microscopy is a very powerful analytical tool that combines the magnifying properties of light microscopy with visualization of fluorescence. ...

Super-resolution Fluorescence Microscopy

Super-resolution fluorescence microscopy (SRFM) provides a better resolution than conventional fluorescence microscopy by reducing the point spread ...

Compare and contrast structure and function of various types of microscopes.

SC.912.L.14.4

comparing-mitochondrial-chloroplast-and-prokaryotic-genomes

Comparing Mitochondrial, Chloroplast, and Prokaryotic Genomes

The present-day mitochondrial and chloroplast genomes have retained some of the characteristics of their ancestral prokaryotes and also have acquired new ...

the-tree-of-life-bacteria-archaea-eukaryotes

The Tree of Life - Bacteria, Archaea, Eukaryotes

The &#8220;tree of life&#8221; describes the evolution of life and the evolutionary relationships between organisms. The root of the tree is the common ...

The Anatomy of Chloroplasts

Green algae and plants, including green stems and unripe fruit, harbor specialized organelles called chloroplasts to carry out photosynthesis. They ...

Explain the evidence supporting the scientific theory of the origin of eukaryotic cells (endosymbiosis).

SC.912.L.14.5

An Overview of Genetics and Disease

Many human diseases are associated with mutations or variations in genetic sequences. Some of these genetic variants are heritable, passed down from ...

Factors Affecting Illness

When a person&#39;s physical, emotional, intellectual, social development or spiritual functioning is compromised, this deviation from a healthy normal ...

Gene-Environment Interactions

Gene expression is influenced by environmental factors such as radiation, temperature, behavior, nutrition, and stress.
The range of reaction suggests ...

Explain the significance of genetic factors, environmental factors, and pathogenic agents to health from the perspectives of both individual and public health.

SC.912.L.14.6

A. Cells have characteristic structures and functions that make them distinctive.

B. Processes in a cell can be classified broadly as growth, maintenance, reproduction, and homeostasis.

C. Life can be organized in a functional and structural hierarchy ranging from cells to the biosphere.

D. Most multicellular organisms are composed of organ systems whose structures reflect their particular function.

Cardiac Exam I: Checking the Chest First

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