Physical methods of research of heart

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In General inspection primarily determine the position of the patient. In severe heart failure patients are in a half-sitting position. Pay attention to the color of the skin and visible mucous membranes, which in heart disease may be bluish (see Cyanosis). Often discover swelling. For edema associated with heart disease, characterized by the appearance of them in the evening on symmetric parts of the body and move when you change the position of the patient (for example, in the supine position swelling are located in the lumbar-sacral area, sitting - on legs). Pay attention to the shape of the fingers and nails; his fingers in the shape of a drum sticks and nails in the form of hour glasses are for persistent septic endocarditis, congenital heart disease and other
When viewed from the heart sometimes discover the swelling of the chest in the heart, called a heart hump. He is a sudden increase in heart, especially if this increase came at a young age.
Note the changes in the location apex beat (rhythmic pulsations in the apex of the heart). In healthy lean people it is located in the fifth intercostal space, medially from left srednesrochnoi line.
When the left ventricle hypertrophy area of terminal impulse is increased, it shifts to the left. With the increase of the right ventricle appears ripple in podlojecna area. Shake extensive area of the chest, caused primarily by an enlarged right ventricle, and covering the chest and the epigastric region, called the cardiac impulse.
Then examine the neck vessels. Swelling and throbbing neck veins characteristic of the tricuspid valve insufficiency (see heart Defects) and the weakening of the right ventricle. The pulsation of the carotid arteries see at insufficiency of the aortic valve. Sometimes note the pulsation of the liver (with the lack of tricuspid valve).
Method palpation determine the properties apex beat. When the left ventricle hypertrophy it increases, becomes higher. In normal, at a palpation in other areas of the heart no ripple or jitter is not noted. Heart disease can be detected by palpation shake the chest wall in a limited area (the so-called cat purring). Shake in the apex of the heart that appear during diastole, typical for mitral stenosis (see heart Defects); shaking over the aorta arising during systole,is to narrow mouth of the aorta. By palpation explore the peripheral vessels, which in pathological conditions are tight and winding, and define the properties of arterial pulse (see).

Fig. 1. The normal bounds of the relative (it is specified by path) and absolute (shaded) cardiac dullness. Fig. 2. The projection of the heart valves to the chest and point their best listening (indicated with a cross): 1 - the aortic valve, 2 - valve pulmonary trunk; 3-mitral valve; 4 - tricuspid valve.

Percussion allows you to define the boundaries of the heart (its size and configuration of the heart. Percutere set the boundaries of that part of the heart, which is covered with a light (of relative dullness of heart), and the part of the heart, which is directly adjacent to the chest (absolute dullness of heart). Over the relative dullness of heart is determined by the dullness of percussion sound, and above absolute dullness of heart - blunt percussion. The border of relative dullness (Fig. 1) corresponding to the true dimensions of the heart. The right border of the heart is formed mainly by the right atrium, left - the left ventricle, the upper cone of the pulmonary trunk and left atrial appendage. When defining the boundaries of the heart are the most distant from the median line of point heart of the circuit. In norm the most remote point of the right of the path of the heart is located in the IV intercostal space on 1 sm to the right from the right edge of a breast bone, left path of the heart - in the fifth intercostal space on 0,5-1 cm inwards from the left srednesrochnoi line. The upper border of the heart in norm lies in the third intercostal space on the left okolovrusno line.
When determining the size of the heart usually find the diameter of the heart. To do this, measure the shortest distance from the point of the right heart of the path up to the median line and found the point of the left heart circuit to the same line. The sum of these distances is the diameter of the heart, equal to 11.5-13 see
To determine the configuration hearts find additional border-right heart circuit in the third intercostal space, left in the third and fourth intercostal space and connect the found point to the right of the sternum and left. In II intercostal space percutere determine the width of a vascular bundle, in which the norm is equal to 4-5 see
The boundaries of the heart and its configuration change in diseases of the heart and its displacements in diseases of the chest cavity (pleura, lungs and other). The increase of the boundaries of the heart to the right is usually caused by expansion of the right atrium and the right ventricle (disease bi - and tri-leaflet heart valve, some congenital heart diseases, pulmonary heart and others). The increase in heart borders left and down is caused by the increase of the left ventricle (in aortic heart diseases, arterial hypertension, cardiosclerosis). The increase in border heart up appears with the increase of the left atrium and the expansion cone pulmonary trunk (often with mitral stenosis). The increase of heart boundaries in all directions occurs as a result of increase of all its departments (when combined heart disease, myocarditis), as well as the accumulation of fluid in the pericardium cavity.