小節的醫學筆記

如同心臟跳動的聲音會反映出特定疾病，脈博跳動的軌跡，也會反應出特定的心臟疾病。常見的觸診動脈有 Carotid artery、Brachial artery、Radial artery、Femoral artery、Popliteal artery、Dosalis pedis artery、Posterior tibial artery 這 7 條（更正確來說，兩側的動脈都要觸診，比較兩側差異，所以是 14條)。最容易摸的就是 Radial artery，所以我們摸摸看 Radial artery，從脈搏做理學檢查。

觸診 Radial artery 的方法：

考題觀摩

Which statement is wrong about the statement of paradoxical pulse? 
(A)The pulse may be detected by a palpable decreased pulse’s amplitude  
(B)Systolic pressure decreased by more than 10mmHg during inspiration 
(C)It may be found in cardiac tamponade 
(D)It may be found in left ventricular systolic failure 

解析

paradoxical pulse可能出現在Cardiac tampnade(C)，Constrictive pericarditis, COPD。
呼吸會影響脈搏，可能在吸氣時候 (Decrease afterload) 造成血壓下降10 mmHg(B)，此時的 pulse amplitude 也會下降(A)。
LV systolic failure 可能出現 S3 gallop，脈搏是 Pulsus alternans (交替脈)。
故答案選 (D)。

考題觀摩

Which statement is wrong about the jugular venous waveform?
(A) a wave is meaning of right atrial contraction 
(B) x descent is meaning of a combination of atrial relaxation and the downward displacement of the tricuspid valve during right ventricle systole 
(C) v wave is meaning of the pressure rises due to continuing venous return to the atrium 
(D) y descent is meaning of the rapid phase of atrial filling

解析

答案是(D)，(D)選項應該是y descent is meaning of the rapid phase of "VENTRICULAR" filling。

考題觀摩

When you observe elevated jugular venous pressure, what kind of disease is unlikely? 
(A) Severe TR (B) Septic shock (C) Constrictive pericarditis (D) Right ventricular failure

解析

JVP升高代表PA、RV、RA高壓，可能是PHT, PR, PS, TR, TS, MS, RVF, constrictive pericarditis, cor pulmonale。只有(B)septic shock不符合。

參考資料

1. 心臟理學檢查