Cardiac: ka mua (systolic), i ka lua o ka (diastolic) - kūmau a me ka pathology

First phonendoscopes Ua pelupelu ia Tube a lahilahi paha puhaʻohe ka laau, a me na mea he nui na kumu hana wale lākou iho lohe. Akā, makemake iho la lakou a pau, e hoolohe mea i hele ma loko o ka kanaka kino, o ka oi aku ka wā e hele mai i ka ia he nui kino e like me ka naau.

Heart kani - mea kani-i i hua mai i loko o ke kaʻina hana o ka hoemi myocardial paia. Maʻamau, he ola i ke kanaka i ka mau-leo, a hiki e ukali ma nā mea kani-ke kaumaha ma muli i ke ano o pathological kaʻina e hoʻomōhala ai. e hiki ke lohe i kēia mau leo a me ke ano o ia ke kahuna lapaau e pono i loko o kekahi hana kūikawā pono.

cardiac pōʻaiapuni

Ka Pauma i ke alapine (frequency) o mai kanaono a hiki i kanawalu kui iho oe a no minuke. Keia, o ka papa, i ka awelika cia, akā, kanaiwa pakeneka o na kanaka ma ka Honua haule ana ma lalo o ia, a 'o ia hoʻi' oe hiki ke lawe ia e like me ke kūmau. ua pana mai kēlā me kēia he o mau ka mea i hahai ana ka mea mamuli o kekahi eiiiiiaiou: systole a me ka diastole. Systolic naau kani, ma ka huli, ua maheleia i atrial a me ka ventricular. Ma ka manawa e ai 0,8 kekona, akā, me ka naʻau, he manawa e aelike a hoʻonānea.

systole

I haiia ae maluna,, na eiiiiiaiou elua e hoʻomau ana. Initially, he mea atrial systole: na paia o ko lākou mau palapala, ke koko ma lalo o ka puʻuwai komo na ventricles, kiwikā a me shutters slam. Ka mea, ua i ke kaniʻana o ka panina o ka nohona kiwikā, a lohe i loko o ka stethoscope. Kēia holoʻokoʻa kaʻina ai 0,1 kekona.

A laila, hiki mai ka ventricular systole, a mea he nui oi luna 'ana ma mua o ka ka hihia a me ka atria. E hoʻomaka, ua e hoailona oukou i ka kaʻina i ekolu mau manawa hou - 0,33 kekona.

First wā - ke anakahi uila o nā ventricles. Ua nā pae asynchronous a me isometric contractions. Ua pau hoomaka me ka mea i ka lāʻau ikiʻai wale eclectic hoʻopulapula ma ka myocardium, oia excites ke kanaka Muscle olona, a me ke kumu no ia e spontaneously aelike. No ka mea, o keia, ka mea, ua hoʻololi i ke kinona o ka naau. Aie i ka mea atrioventricular kiwikā i hoopili paa, mahuahua ka'aloʻahiʻa. A laila, he mea he ikaika contraction o na ventricles, a me ke koko komo i ka aorta a pulmonary artery. Kēia mau kūlana lawe 0.08 kekona, a 0,25 kekona i koe i loko o ke koko komo na moku nui.

diastole

Here, pū, ia mea,ʻaʻole no ka mea e like me ka mea i ikea ma mua kilohi. Ventricular hoʻomaha mau 0,37 kekona, a lawe wahi i loko o ekolu kahua o ka hoʻonaʻauao.

1. Protodiastolic: ma hope o ke koko haʻalele i ka naau, puʻe i loko o kona lua ua hoemi, a me ka nohona kiwikā, e alakai i na moku nui, ua paa.
2. Isometric hoʻomaha: hoʻonānea na nāʻiʻo mau, me ka manaʻo koikoi e hina hou aku, a ua kūponoʻia me ka atrial. Mai keia atrioventricular kiwikā e hamama ana, a me ke koko mai ka atria a hiki i ka ventricles, e hina ia.
3. Ka hoopiha ana i na ventricles: ka'aloʻahiʻaʻano piʻina ma ka loli hoopiha i ka lalo keena o ka naau. I ka wā o ka'aloʻahiʻa ua equalized, i ke koko i nā 'aʻole hoʻi i lalo, a laila aɃe.

Ka pōʻaiapuni Ua laila hou hou, e hoʻomaka ana me ka systole. Kona lōʻihi like 'ole mea mau i ka ia, akā, i ka diastole hiki e hoopokole ole hooloihiia ke kaumaha ma muli o ka naʻau kōmi.

Keʻano papa hana o ka ho okumu ana o I leo

Like Kupanaha me ka mea e kani, 1 leo o ka naau ninoieo o eha eiiiiiaiou:

1. Kiwikā - ka mea, ua alakai ana i ka leo hoʻonaʻauao 'ana. I mea, keia fluctuation atrioventricular kiwikā leaflets ma ka hopena o ka ventricular systole.
2. Muscle - oscillatory noi o na ventricles i contraction.
3. Vascular - kona i ka papa kuhikuhiE moku pā i kekahi manawa, i ka wa o ko lakou koko, e hina ia.
4. Atrial - atrial systole. Kēia koke hoʻomaka o ke kukulu mua.

Keʻano papa hana o ka ho okumu II leo a me nā nanahe

No laila, 2 leo naʻau kikowaena elua wale eiiiiiaiou: he nohona kiwikā a me ka vascular. Mua - keia mea i ka leo i hele mai, mai na kui iho oe a ke koko i loko o ka nohona kiwikā mea noʻeau, a me ka pulmonary kumu i kekahi manawa, i ka wa a lakou e nō paa. ʻO ka lua, ka mea i he vascular ke keʻena - ka holo o ka nui moku pā, ka wā e wehe i ka puapua ma hope.

Ma waho o ka nui, akā, hoomaopopo nanahe elua 3 a me 4.

Ekolu leo - he fluctuation o ventricular myocardium i diastole, ka wā koko kahe passively i loko o ka wahi o ka haʻahaʻa puʻe.

Ha o ka kamaʻilio ikeia ma ka pau ana o systole, a ua pili i ka hopena o ka expulsion o ke koko mai ka atria.

Ano I leo

Cardiac hilinaʻi ma na mea he nui aʻe, nā intra- a me ka extracardiac. 1 sonority kamaʻilio hilinaʻi nui ma luna o ka Pahuhopu moku'āina o ka myocardium. Pela, i loko o ka buke mua ua hoʻolako 'ia e pilipaa panina o ka naau kiwikā a me ka lākiō o ma i na ventricles i hoemiia. Noonoo kiʻekiʻe helehelena e like me puapua nuʻa o atrioventricular kiwikā e like me kā lākouʻoihana i loko o ka naʻau lua.

E aho nō e hoʻolohe i ka mea mua naau kani ma luna o ka mea - i loko o ka 4-5 intercostal makahiki i koe o ka sternum. No ka hou pololei kūlike pono e percussion o ka pahu i loko o kēia wahi, a no ka maopopo hoakaka i ka palena o cardiac dullness.

Ano nui II

He aha e hoolohe ia ia, ia mea e pono ke kau i ka bele stethoscope ma luna o ka naʻau kumu. Kēia wahi mea iki i ka pono o ka xiphoid kaʻina hana o ka sternum.

mea no hoi e kaukaʻi ma pehea paa i ka nohona kiwikā i hoopili, wale e semilunar i ka buke a me ka mōakaaka o ka lua o ka leo. Eia hou, i ka mämä holo o ko lākou mau hana, i ka panina, a me ka noa welau o ka oscillation e loli ai i ka hōʻike hou kani. A me nā waiwai i ka pa apŘ o na hale a pau 'ole i loko o ke kahua o ka leo, e like me ke kulana o ka nohona kiwikā i ka expulsion o ke koko mai o ka naau.

Na rula auscultation o ka naau kani

Ke kani ana o ka naau, oia paha ka loa calming i loko o ke ao nei, ma hope o ka keʻokeʻo leo. ʻepekema, ua wänana i ia mea, ua i kona keiki lohe i ka utero. Akā, ma ka mea e huai ae poino ana i ka naau, pono e lohe pehea e mokomoko ana, ia mea,ʻaʻole lawa.

Kuhikuhi komo i loko o auscultation pono o ka noho malie a me ka pumehana wahi. Ke oweliweli o ke kanaka hilinaʻi nui ma luna o ka 'ano o ka nohona kiwikā' oe pono e hoolohe hou akahele. Kēia paha ia i ka oihana o ka moe ana ma konaʻaoʻao hema, hoʻopapakū, akā, me lākou i hāliu mai i ko hale ma kaʻaoʻao'ākau, a no laila, ma luna o. D.

Ke hoomanawanui E e pohihihi a me ka pāpaʻu hanu, a me ka like me ke kauka o ka noi e hoopaa i kou hanu. I mea e maopopo pono ai ma ka systole a me ka diastole kahi i ke kahuna lapaau e ia laua me ka hoʻolohe, e palpate i ka carotid artery ka lāʻau ikiʻai a coincides loa me ka systolic pae.

Ke kauoha ana o ka naau auscultation

Ma hope o ka ka mua paa o ka loa a me ka pili cardiac dullness Kauka, oia ke hoolohe i ka naʻau kani. Ua hoʻomaka, e like me ka rula, a me ka luna kino. Well ma laila ka mitral kiwikā mea audible. A laila, neʻe i ka nohona kiwikā o na arteries nui. Mua i ka aortic - i loko o ka lua o ka intercostal makahiki ma ka akau o ka sternum, laila, a hiki i ka pulmonary artery - ma ka ia pae, pono i ka hema.

I ka ha o ka wahi no ka Papa Hana - keia mea i ke kumu o ka naau. Ua Ua Aia ma ke kumu o ka xiphoid kaʻina hana, akā, hiki ke 'oni iki a hiki i kaʻaoʻao. No laila, i ke kauka e kaha i ke ano o ka naau, a me ka pou (axis) e pololei hoolohe tricuspid kiwikā.

Polopelema auscultation ma Botkin-Erba. 'Oe ke lohe i ka aortic kiwikā. Ua mea i loko o ka ha o ka intercostal makahiki ma ka hema o ka sternum.

Additional nanahe

naau kani mea e mau loa ana me ka nani a rhythmic clicks. I kekahi manawa, oi pinepine ma mua o makemake e pono, ka mea, ai bizarre 'ano apau loa. Kekahi o kēia mau kauka i aʻoʻia, e hōʻike i pono ma ka lohe. Mau nā:

- Kaomi i ka mitral kiwikā. He hiki ke lohe kokoke i ka apex o ka naau, ka mea, ua pili ia me ke aloha loli o ka nohona kiwikā leaflets a me ka mea akaka wale i ka wa a ka lilo naau mā.

- Systolic kaomi. Kekahiʻano o mitral kiwikā. Ma keia hihia, ia puapua i hoopili paa, me he mea huli maloko mai i systole.

- Perekardton. Loaʻa ka wā o ka lina pericarditis. Pili me ka excessive dilation o na ventricles aie i hanaʻia i loko o ka wahi laina.

- Ka pāpana o sēlū. Aia mitral stenosis, akaka holomua o ka leo mua, lua o ka leo kākauʻana ma luna o ka pulmonary artery, a me ka mitral kiwikā kaomi.

- holo māmā. Ke kumu no kona hanana mea e ho'ēmi i myocardial leo, eia kahi mea akaka ma ka kāʻei kua tachycardia.

Extracardiac ke kumu no amplification a me ka attenuation nanahe

Ka naau mokomoko ana i loko o ke kino no ke ola, me ka mai hemo mai a me ka aiiia. A, i ka wa ia i kekahi mai, me ka ana aʻelaʻo ia kani ana o kana mau hana a ikeia extraneous. Nā kumu no kēia hiki e kekahi pololei ua hoʻopili i ka pōʻino i ka naʻau, a me ka mai mai hilinai aku ma luna o laila.

nanahe he hoʻonui i ka hooikaika ana:

- cachexia, anorexia, wiwi umauma pa;

- pulmonary atelectasis a hapa paha;

- haanou ana i loko o ka posterior mediastinum, neʻe eaaei;

- infiltration o ka lalo lobes o na maʻiʻaʻai;

- bullae i loko o ka ia maʻiʻaʻai.

Ka mea hoʻonāwaliwali maoli nō o ka naʻau kani:

- excessive ke kaupaona;

- i ka hooulu ana o na nāʻiʻo o ka pahu pa;

- subcutaneous emphysema;

- i ke alo o ka loli ma ka thoracic lua;

- exudative pericarditis.

Intracardiac kumu no ka hoʻoikaika 'ana i a me ka mea hoʻonāwaliwali maoli nō o ka naʻau nanahe

Cardiac akaka, rhythmic wā i ke kanaka mea ma maha paha i ka hiamoe. Inā ka mea, Ua hoʻoneʻe, no kekahi laʻana, pii aku la ia i ka anuu i ka kauka i ka oihana, e hiki i ka naau kani amplification. Nō hoʻi, hoʻonui o ka naau kōmi i ke kena ae la ma ka anaemia, endocrine maʻi, etc.

Kuli naau kani ua hoolohe me ka loaa ana ka naau maʻi, e like me mitral a aortic stenosis, insufficiency o ka nohona kiwikā. Kona na makana lawe aortic stenosis i ka oihana e e kokoke ana i kona naau: no ka pii aku kekahi hapa o ka piʻo, i ka iho mahele. Muffled naʻau kani pili me ka loa myocardial nui, e like me hoʻoʻino maʻi o ka naau Muscle, e alakai ana i ka degeneration paha sclerosis.

naau ohumu mai ai me

Ma waho kala, i ke kauka ke lohe nā mea kani-, no laila-kahea leo. Ka mea i hana mai i ka turbulence o ke koko, a hele ma ka lua o ka naau. Maʻamau, ka mea e ole e. All kani hiki ke maheleia i loko o ke aloha a me ka iaea ooieoeiiaeuiiai.

1. Ke aloha hou ka wā o ka hui, anatomical i hoʻomaka ai, irreversible hou i loko o ka nohona kiwikā nenoaiu.
2. Iaea ooieoeiiaeuiiai halulu pili me kaʻole nā aʻalolo lako a me ka mana papillary nāʻiʻo, mahuahua naʻau uku a me ke koko kahe ana, he emi i loko o kona (viscosity).

Ino e pili ana i ka naau mea kani-, a hiki e kuokoa no ia. I kekahi manawa, pleural kū'ē i ka hoʻoʻino mai ua superimposed ma luna o ka naʻau, a laila 'oe i ke noi i ka hoʻomanawanui, e hoopaa i kona hanu, a hilinaʻi hookahi manawa hou aku e hoopaa auscultation. Ua noʻonoʻo 'ana i kūpono ke kōkua pale hewa. Nō kāu, i ka wa e hoolohe ai i ka halulu o ka pathological hoao mai la lakou e hooholo ma a pae o ka cardiac kalapona ka mea, ana, o ka wahi maikai e ae, e imi, a ohi i hoolohe kani ano: ikaika, lōʻihi like 'ole a me ka ao ao.

ka waiwai a noise

Timbre i kekahi mauʻano o ka walaau.

- pahee a puhi (IeAUPIIe, IAa IO ole pili me ka pathology, pinepine i loko o nā keiki);

- ino, hamoʻia me ka i oloʻia;

- mele.

No ka mea lōʻihi like ike okoa ia.

- pōkole;

- loa;

By ka leo:

- mālie;

- nui;

- ka hōʻemiʻana;

- e ulu ana (oi loa ma ka hou o ka hema atrioventricular orifice);

- incrementally-ka hōʻemiʻana.

E hoʻololi i ka buke kākau i kekahi o nā kūlana o cardiac haʻawina.

ke kiekie:

- kiʻekiʻe (wā aortic stenosis);

- haahaa alapine (frequency) (mitral stenosis).

Aia nō kekahi mau kumu hoohalike i loko o ka auscultation leo. Mua, ka mea hoʻolohe pono i na wahi o ka nohona kiwikā, aie i ka pathology o i ka mea i hana. Ka lua, o ka halulu houʻia ala e hiki aku o ke koko,ʻaʻole e kū'ē iā ia. A me ke kolu, me ka naau kani, e pono lohe'āno'ē leo kahi ua ole uhiia i ka naau a me ka malamalama a me ka paa i adherent i ka pahu.

Systolic ohumu mai ai me ka maikaʻi, e hoolohe mai i loko o ka supine kulana, no ka mea, i ke kahe o ke koko mai ka ventricles lilo uuku a me ka wikiwiki, a me ka diastolic - e noho ana, no ka mea, ma lalo o ka ikaika o ka umekaumaha, i ka wai, mai ka atria a hiki i ka ventricles hina wikiwiki.

Noise hiki e differentiated e like me kā lākou wahi, a me ka cardiac kalapona pae. Inā ka leo i loko o ka ia wahi i ke systole a me ka diastole, ka mea, olelo no ka hoʻohui pūʻia lesions o ka nohona kiwikā. Inā walaau ikeia ma ka systole ma kekahi wahi, a ma diastole - ka 'ē aʻe - ia mea mua i hoʻohui pūʻia lilo o ka elua kiwikā.