Physical methods of research of heart

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At auscultation first listen individual heart valves: mitral - at the apex of the heart, aorta valve - in II intercostal space to the right of the sternum, the pulmonary valve-stem - in II intercostal space to the left of the sternum and tricuspid valve at the base of the xiphoid process of the sternum (Fig. 2). Heart listen in Botkin - Erba (attachment III - IV ribs to the breastbone to the left), where frequently detected noise associated with the defeat of the aortic valve. If auscultation of these five points detected deviation from the norm, you need to carefully listen to the entire area of the heart.
OK auscultation of the heart are heard two tones. The first tone is produced during the beats of the heart at the reduction of cardiac muscle and the collapse of the atrioventricular valves; the second tone occurs during diastole with the collapse of the flaps of the valve of aorta and the pulmonary trunk. Tones separated by pauses between the first and second colours pause shorter than between the second and first. Sometimes during diastole able to listen to additional third and fourth heart sounds generated during ventricular filling with blood. Young thin subjects of the third and fourth colours may listens and healthy heart, older people are usually indicate myocardial damage (see Gallop rhythm).
The sonorous tones of the heart depends on the state of the heart, and the state organs and tissues surrounding the heart. The sonorous tones of the heart decreases with the weakening of the myocardium, when the accumulation of fluid in the pericardium cavity, emphysema and other Colours become more vocal on increased heart (physical and nervous tension, diffuse toxic goiter and other). Sometimes changing the sound only one tone. So, the first tone at the top is weakened by failure of the mitral valve, valve of aorta, increases - in mitral stenosis. The second tone over the aorta and pulmonary trunk increases in cases where increased pressure in these vessels. If the pressure in the aorta second tone increases above the aortic valve (the focus of the second tone of the aorta). If the pressure in the pulmonary artery emphasis of the second tone is determined on the pulmonary valve stem. Sometimes there is a dichotomy or splitting tones, often associated with the timing of the systole right and left ventricles or timing of the collapse of the valves valve of aorta and the pulmonary trunk.
In pathological processes can receive a heart murmur (rarely they can be healthy). Pathologic heart murmurs arise either when narrowing of the valve opening, or at the deformation of the heart valves, which, closing not provide a complete circuit of the hole. There are a systolic murmur (see) and see diastolic murmur (see) depending on the appearance of noise in systole or diastole.
Systolic murmur occurs when failure bivalve and tricuspid valves, when narrowing of the aortic and pulmonary trunk and other
see Diastolic murmur - when narrowing atrioventricular holes, failure of the valves, the aorta and the pulmonary trunk and other
If the pericarditis (see) you can hear the noise pericardial friction. Noises that are not associated with heart disease, sometimes arise in the decrease of blood viscosity and increase the speed of blood flow (in case of anemia, diffuse toxic goiter). After auscultation of the heart listen to the blood vessels, especially the neck, over which sometimes find noises (e.g. systolic murmur over the carotid artery narrowing of the aortic, the noise of the jugular veins in case of anemia).
Blood pressure is determined by the method of sphygmomanometry (see). Normal blood pressure in the brachial artery in people aged 20-40 the average is 120/70 mm RT. Art. (see Blood pressure).