EXAMINATION OFBLOOD VESSELS*1INTRODUCTIONPalpation of the pulseMeasurment of arterial blood pressureAuscultation of blood vesselsDate2PALPATION OF THE PULSERadial artery is usually selectedPatients hand placed with the palm upwardPhysicians first three fingers on the radial arteryIndex finger nearest the heartDate3CHARACTERISTICS OF THE PULSE RateSizeType of waveRhythmTensionDate4RATE-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, etcDate5RHYTHM-pulsus regularis or irregularis Pulsus irregularis Sinus arrhythmia Premature contractions Aterial fibrillation Bigeminal pulse Trigeminal pulse Paroxysmal atrial tachycardia Heart blockDate6TENSION-Pulsus hard or softCorresponds to the diastolic blood pressureDate7SIZEPulsus magnus (high pulse pressure)- aortic insufficiencyPulsus parvus(low pulse pressure)-aortic stenosisDate8TYPE OF WAVENormal pulse wave:Ascending limbPeakDescending limbDicrotic notch ( on the descending limb)Date9TYPE OF WAVEAbnormal pulse wave Water hammer pulse Pulpus tardus Dicrotic pulse Pulsus alternans Pulsus paradoxus AsphygmiaDate10PULPUS TARDUSA small weak pulse with a delayed systolic peakCommon in aortic stenosisDate11DICROTIC PULSEDicrotic wave becomes exaggerated and can be felt as a small wave immediately following the pulse waveCommon in feverDate12PULSUS ALTERNANSA decrease in the size of the pulse during inspirationCommonly found in constrictive pericarditis, also in tumor of the midiastinum, heart failure, myocarditis, pericardial effusion and pulmonary emphysemaDate13ASPHYGMIASevere shockMultiple aorto-arteritis (pulseless)Date14CONSISTENCY OF ARTERIAL WALLNormally the wall of radial artery is soft and pliable In arterosclerosis, more resistance to compression by the palpating fingerDate15MEASUREMENT OF ARTERIAL BLOOD PRESSUREMethods for measuring the blood pressure:Direct methodIndirect methodDate16INDIRECT METHODS FOR MEASURING BPPATIENTPhysically relaxed and emotionally at easeSeated or recliningThe arm should be at the heart level, relaxed, slightly fixed and support on a firm surfaceDate17INDIRECT METHODS FOR MEASURING BPBLOOD PRESSURE CUFFDeflated prior to examWrapped about he armLower margine of the cuff be placed 2 to 3cm above the antecubital fossaDate18KOROTKOFF -AUSCULTATORY METHOD Beats become audible - the systolic pressureSound of beats become louderBlowing murmerSound of beats gradually diminishSound disappear - the diastolic blood pressureDate19AUSCULTATORY GAPFirst detect the sounds at a high levelSuddenly disappearedReappear at a lower levelMay results in misdiagnosisDate20THE NORMAL BLOOD PRESSUREJNC-VI(1997) WHO/ISH(1999)systolic(mmHg) diastalic(mmHg) 理想血压 120 80 Normal 130 85 正常高值 130-190 85-89 Date21ABNORMAL BLOOD PRESSUREHypertensionHypotensionSignificant difference in two upper extremitiesSignificant difference in upper and lower extremitiesAbnormality in pulse pressureDate22ELEVATION OF BLOOD PRESSUREEndocrine causesRenal causesEssential hypertensionDate23LOW BLOOD PRESSUREDecrease in cardiac output : acute myocardial infarction, pericarditis with effusion, heart failure, following hemorrhageDecrease in peripheral risistence: septicemia, acute adenal insufficiency, drug intoxicationsDate24SIGNIFICANT DIFFERENCE IN THE UPPER EXTREMITIESAortic aneurysmObstruction of the innominate artery (thromboangiitis obliterans, etc)Date25SIGNIFICANT DIFFERENCE IN THE UPPER AND LOWER EXTREMITIESMost common in coarctation of the aorta -Elevated systolic pressure in the arms and a lower systolic pressure in the legsDate26ABNORMALITY IN PULSE PRESSUREPulse pressure increased: atherosclerosis of the aorta, hyperthyroidism, aortic valve regurgitation, arteriovenou fistula,etcPulse pressure decreased:aortic stenosis, mitral stenosis, heart failure and massive pericardial effusionDate27AUSCULTATION OF BLOOD VESSELS- veinVenous hum over the jungular vein in cases of marked anemia and hyperthyroidismLoud murmers heard over dilated vein in liver cirrhosisDate28AUSCULTATION OF BLOOD VESSELS -arteriesNormal artery soundPistolshot soundDuroziezs soundPathological sound: including systolic and continuous murmerDate29PISTOL-SHOT SOUNDIn aortic insufficiency, a loud first sound (pistol-shot sound) may be heard over the femoral arteries without exerting pressureDate30DUROZIEZS SIGNOn pressing the stethoscope firmly over the femoral artery in aortic insufficiency, this double intermittent murmur may be heardDate31