2012-3-22 1
EXAMINATION
OF
BLOOD VESSELS
2012-3-22 2
INTRODUCTION
Palpation of the pulse
Measurment of arterial blood pressure
Auscultation of blood vessels
2012-3-22 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
2012-3-22 4
CHARACTERISTICS OF THE
PULSE
Rate
Size
Type of wave
Rhythm
Tension
2012-3-22 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
2012-3-22 6
RHYTHM
-pulsus regularis or irregularis
Pulsus irregularis
Sinus arrhythmia
Premature contractions
Aterial fibrillation
Bigeminal pulse
Trigeminal pulse
Paroxysmal atrial tachycardia
Heart block
2012-3-22 7
TENSION
-Pulsus hard or soft
Corresponds to the diastolic blood
pressure
2012-3-22 8
SIZE
Pulsus magnus (high pulse pressure)-
aortic insufficiency
Pulsus parvus(low pulse pressure)-
aortic stenosis
2012-3-22 9
TYPE OF WAVE
Normal pulse wave,
Ascending limb
Peak
Descending limb
Dicrotic notch ( on the descending limb)
2012-3-22 10
TYPE OF WAVE
Abnormal pulse wave
Water hammer pulse
Pulpus tardus
Dicrotic pulse
Pulsus alternans
Pulsus paradoxus
Asphygmia
2012-3-22 11
PULPUS TARDUS
A small weak pulse with a delayed
systolic peak
Common in aortic stenosis
2012-3-22 12
DICROTIC PULSE
Dicrotic wave becomes exaggerated
and can be felt as a small wave
immediately following the pulse wave
Common in fever
2012-3-22 13
PULSUS ALTERNANS
A decrease in the size of the pulse
during inspiration
Commonly found in constrictive
pericarditis,also in tumor of the
midiastinum,heart failure,myocarditis,
pericardial effusion and pulmonary
emphysema
2012-3-22 14
ASPHYGMIA
Severe shock
Multiple aorto-arteritis (pulseless)
2012-3-22 15
CONSISTENCY OF ARTERIAL
WALL
Normally the wall of radial artery is soft
and pliable
In arterosclerosis,more resistance to
compression by the palpating finger
2012-3-22 16
MEASUREMENT OF ARTERIAL
BLOOD PRESSURE
Methods for measuring the blood
pressure,
Direct method
Indirect method
2012-3-22 17
INDIRECT METHODS FOR
MEASURING BP
PATIENT
Physically relaxed and emotionally at
ease
Seated or reclining
The arm should be at the heart level,
relaxed,slightly fixed and support on a
firm surface
2012-3-22 18
INDIRECT METHODS FOR
MEASURING BP
BLOOD PRESSURE CUFF
Deflated prior to exam
Wrapped about he arm
Lower margine of the cuff be placed 2
to 3cm above the antecubital fossa
2012-3-22 19
KOROTKOFF
-AUSCULTATORY METHOD
Beats become audible - the systolic
pressure
Sound of beats become louder
Blowing murmer
Sound of beats gradually diminish
Sound disappear - the diastolic blood
pressure
2012-3-22 20
AUSCULTATORY GAP
First detect the sounds at a high level
Suddenly disappeared
Reappear at a lower level
May results in misdiagnosis
2012-3-22 21
THE NORMAL BLOOD
PRESSURE
JNC-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
2012-3-22 22
ABNORMAL BLOOD PRESSURE
Hypertension
Hypotension
Significant difference in two upper
extremities
Significant difference in upper and
lower extremities
Abnormality in pulse pressure
2012-3-22 23
ELEVATION OF BLOOD
PRESSURE
Endocrine causes
Renal causes
Essential hypertension
2012-3-22 24
LOW BLOOD PRESSURE
Decrease in cardiac output, acute
myocardial infarction,pericarditis with
effusion,heart failure,following
hemorrhage
Decrease in peripheral risistence,
septicemia,acute adenal insufficiency,
drug intoxications
2012-3-22 25
SIGNIFICANT DIFFERENCE IN
THE UPPER EXTREMITIES
Aortic aneurysm
Obstruction of the innominate artery
(thromboangiitis obliterans,etc)
2012-3-22 26
SIGNIFICANT DIFFERENCE IN
THE UPPER AND LOWER
EXTREMITIES
Most common in coarctation of the aorta
-Elevated systolic pressure in the arms
and a lower systolic pressure in the legs
2012-3-22 27
ABNORMALITY IN PULSE
PRESSURE
Pulse pressure increased,
atherosclerosis of the aorta,
hyperthyroidism,aortic valve
regurgitation,arteriovenou fistula,etc
Pulse pressure decreased:aortic
stenosis,mitral stenosis,heart failure
and massive pericardial effusion
2012-3-22 28
AUSCULTATION OF BLOOD
VESSELS- vein
Venous hum over the jungular vein in
cases of marked anemia and
hyperthyroidism
Loud murmers heard over dilated vein
in liver cirrhosis
2012-3-22 29
AUSCULTATION OF BLOOD
VESSELS -arteries
Normal artery sound
Pistol–shot sound
Duroziez’s sound
Pathological sound,including systolic
and continuous murmer
2012-3-22 30
PISTOL-SHOT SOUND
In aortic insufficiency,a loud first sound
(pistol-shot sound) may be heard over
the femoral arteries without exerting
pressure
2012-3-22 31
DUROZIEZ’S SIGN
On pressing the stethoscope firmly over
the femoral artery in aortic insufficiency,
this double intermittent murmur may be
heard
EXAMINATION
OF
BLOOD VESSELS
2012-3-22 2
INTRODUCTION
Palpation of the pulse
Measurment of arterial blood pressure
Auscultation of blood vessels
2012-3-22 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
2012-3-22 4
CHARACTERISTICS OF THE
PULSE
Rate
Size
Type of wave
Rhythm
Tension
2012-3-22 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
2012-3-22 6
RHYTHM
-pulsus regularis or irregularis
Pulsus irregularis
Sinus arrhythmia
Premature contractions
Aterial fibrillation
Bigeminal pulse
Trigeminal pulse
Paroxysmal atrial tachycardia
Heart block
2012-3-22 7
TENSION
-Pulsus hard or soft
Corresponds to the diastolic blood
pressure
2012-3-22 8
SIZE
Pulsus magnus (high pulse pressure)-
aortic insufficiency
Pulsus parvus(low pulse pressure)-
aortic stenosis
2012-3-22 9
TYPE OF WAVE
Normal pulse wave,
Ascending limb
Peak
Descending limb
Dicrotic notch ( on the descending limb)
2012-3-22 10
TYPE OF WAVE
Abnormal pulse wave
Water hammer pulse
Pulpus tardus
Dicrotic pulse
Pulsus alternans
Pulsus paradoxus
Asphygmia
2012-3-22 11
PULPUS TARDUS
A small weak pulse with a delayed
systolic peak
Common in aortic stenosis
2012-3-22 12
DICROTIC PULSE
Dicrotic wave becomes exaggerated
and can be felt as a small wave
immediately following the pulse wave
Common in fever
2012-3-22 13
PULSUS ALTERNANS
A decrease in the size of the pulse
during inspiration
Commonly found in constrictive
pericarditis,also in tumor of the
midiastinum,heart failure,myocarditis,
pericardial effusion and pulmonary
emphysema
2012-3-22 14
ASPHYGMIA
Severe shock
Multiple aorto-arteritis (pulseless)
2012-3-22 15
CONSISTENCY OF ARTERIAL
WALL
Normally the wall of radial artery is soft
and pliable
In arterosclerosis,more resistance to
compression by the palpating finger
2012-3-22 16
MEASUREMENT OF ARTERIAL
BLOOD PRESSURE
Methods for measuring the blood
pressure,
Direct method
Indirect method
2012-3-22 17
INDIRECT METHODS FOR
MEASURING BP
PATIENT
Physically relaxed and emotionally at
ease
Seated or reclining
The arm should be at the heart level,
relaxed,slightly fixed and support on a
firm surface
2012-3-22 18
INDIRECT METHODS FOR
MEASURING BP
BLOOD PRESSURE CUFF
Deflated prior to exam
Wrapped about he arm
Lower margine of the cuff be placed 2
to 3cm above the antecubital fossa
2012-3-22 19
KOROTKOFF
-AUSCULTATORY METHOD
Beats become audible - the systolic
pressure
Sound of beats become louder
Blowing murmer
Sound of beats gradually diminish
Sound disappear - the diastolic blood
pressure
2012-3-22 20
AUSCULTATORY GAP
First detect the sounds at a high level
Suddenly disappeared
Reappear at a lower level
May results in misdiagnosis
2012-3-22 21
THE NORMAL BLOOD
PRESSURE
JNC-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
2012-3-22 22
ABNORMAL BLOOD PRESSURE
Hypertension
Hypotension
Significant difference in two upper
extremities
Significant difference in upper and
lower extremities
Abnormality in pulse pressure
2012-3-22 23
ELEVATION OF BLOOD
PRESSURE
Endocrine causes
Renal causes
Essential hypertension
2012-3-22 24
LOW BLOOD PRESSURE
Decrease in cardiac output, acute
myocardial infarction,pericarditis with
effusion,heart failure,following
hemorrhage
Decrease in peripheral risistence,
septicemia,acute adenal insufficiency,
drug intoxications
2012-3-22 25
SIGNIFICANT DIFFERENCE IN
THE UPPER EXTREMITIES
Aortic aneurysm
Obstruction of the innominate artery
(thromboangiitis obliterans,etc)
2012-3-22 26
SIGNIFICANT DIFFERENCE IN
THE UPPER AND LOWER
EXTREMITIES
Most common in coarctation of the aorta
-Elevated systolic pressure in the arms
and a lower systolic pressure in the legs
2012-3-22 27
ABNORMALITY IN PULSE
PRESSURE
Pulse pressure increased,
atherosclerosis of the aorta,
hyperthyroidism,aortic valve
regurgitation,arteriovenou fistula,etc
Pulse pressure decreased:aortic
stenosis,mitral stenosis,heart failure
and massive pericardial effusion
2012-3-22 28
AUSCULTATION OF BLOOD
VESSELS- vein
Venous hum over the jungular vein in
cases of marked anemia and
hyperthyroidism
Loud murmers heard over dilated vein
in liver cirrhosis
2012-3-22 29
AUSCULTATION OF BLOOD
VESSELS -arteries
Normal artery sound
Pistol–shot sound
Duroziez’s sound
Pathological sound,including systolic
and continuous murmer
2012-3-22 30
PISTOL-SHOT SOUND
In aortic insufficiency,a loud first sound
(pistol-shot sound) may be heard over
the femoral arteries without exerting
pressure
2012-3-22 31
DUROZIEZ’S SIGN
On pressing the stethoscope firmly over
the femoral artery in aortic insufficiency,
this double intermittent murmur may be
heard
