Auscultation of hearts

Consistently to describe the characteristic of tones and noise accordingly valves of heart.

Cardiac rhythm: rhythmical, arrhythmic (ectopic beats, atrial fibrillation etc.).

H eart apex of (cardiac apex) (mitral valve (bicuspid, left atrioventricular) sounds: clear, are muffled, deaf; first sound: quiet, amplified, clapping, splitting, reduplication, «the opening snap»; both sounds are reduplicate; III tone in protodiastole, opening snap of mitral stenosis, mid-systolic clicks associated with mitral valve prolapse, (quail rhythm), and the sounds associated with mechanical prosthetic heart valves; triple rhythm (gallop rhythm) — presystolic, protodiastolic, mesodiastolic (summation); pendulum rhythm or embryocardia; murmur — systolic, presystolic, middiastolic.

Zone of the tricuspid valve (Base of the xiphoid process or to the left): systolic, middiastolic murmur, their amplification at a breathing (symptom Korvalo).

Aortic valve (second right intercostal space): reduplication of the first sound «the opening snap», ejection clicks arising in the aorta, the second sound — is amplified (accent), reduplicated, splitting, quiet; murmur — systolic, protodiastolic (early protodiastolic).

Pulmonary valve (second intercostal space to the left of the sternum): reduplication of the first sound («the opening snap»), ejection clicks arising in the aorta, second sound — is amplified (accent) - reduplicated, splitting, quiet; noise — systolic, continuous ("machinery", tearing of fabric).

Under indications — auscultation in additional points (Botkin-Erb’s point (to the left of the sternum at the third and fourth costosternal articulation)).

At presence of endocardiac murmurs is necessary to determine:phase its character (systolic, presystolic, protodiastolic, mesodiastolic etc.),epicentre (localization of a maximum),radiation, individual features (intensity (loudness) — just audible, quiet, moderatory loud, loud, very loud, audible without stethoscope; the relation to I, to II tone; duration — during what part of a systole (holosystolic (pansystolic), early systolic, midsystolic, late systolic) or diastole (holodiastolic (pandiastolic), early diastolic (protodiastolic), middiastolic (mesodiastolic, delayed diastolic), presystolic (atrial systolic)), or both of them – continuous (artieriovenosus) murmur; the configuration (increasing, decreasing etc.) decrescendo, crescendo, crescendo-decrescendo, plateau; quality (timbre) — soft, flow, musical, rough, scratchy, squeaker, harsh, rumbling, mewing, saw-like etc.; amplification at a breathing, in position on left or on the right side, after physical activity, the Valsalva Manoeuvre etc.).

Exocardiac murmurs: pericardial friction — epicentre, extent, loudness, amplification at an exhalation or inhalation; pleuropericardial sound, localization.

Дата добавления: 2015-11-16