Manaʻo manawa heluhelu: 8 minuke
Nā ʻikepili i loko
Madhero88, CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, ma o Wikimedia Commons
He aha ka gallop rhythm, kahi āu e lohe ai i ke kani puʻuwai hou?
ʻO ke kani ʻana o Gallop, me ka puuwai mua (S1) a me ka lua (S2). kani puʻuwai ʻekolu (S3) a i ʻole ʻehā (S4). I kēia hihia, ma waho aʻe o ka puʻuwai "lub-dub" maʻamau, lohe ʻia nā kani puʻuwai me kahi leo hou e like me "lub-dub-ta" a i ʻole "ta-lub-dub." ʻO kēia ka mea maʻamau kahi ʻike pathological a hōʻike i nā abnormalities i ka hoʻopiha ventricular.
Pono e lohe ʻia nā kani puʻuwai i nā manawa maʻamau a me ka ikaika like. I loko o kahi holoholona olakino, lohe ʻia nā leo S1 a me S2 me ka maopopo a me ke kaulike. Piʻi ka ikaika o ke kani o ka puʻuwai i kēlā me kēia kuʻi. pono e likeEia naʻe, i kekahi mau hihia, hiki ke loli i ka ikaika o ke kani.
Nā kumu o nā kani nawaliwali
Inā kani ka puʻuwai inā lohe nawaliwali (muffled), pili pinepine kēia me nā kumu penei:
• MomonaʻO ka hoʻonui ʻia ʻana o ka ʻiʻo momona ma ka ʻāpana o ka umauma he mea paʻakikī ke lohe ʻana i nā kani puʻuwai.
• ʻO ka hōʻiliʻili wai i loko o ka lua o ka umauma (Pericardial effusion or Pleural effusion): ʻO ka loaʻa ʻana o ka wai i loko o ka pericardium a i ʻole ka lua o ka umauma e pale ai i ka lawe ʻana i ke kani i waho.
• Ka nui o ka intrathoracicʻO ka loaʻa ʻana o nā maʻi maʻi a i ʻole ka nui o ka umauma e hoʻemi i ka ikaika o nā kani puʻuwai.
Nā kumu o ka hoʻololi ʻana i ka ikaika o nā kani puʻuwai
Inā piʻi ka ikaika o ke kani ʻana o ka puʻuwai i kēlā me kēia kuʻi inā hoʻololi, keia kulana maa mau a arrhythmia I ka arrhythmias, no ka mea ʻaʻole maʻamau ka puʻuwai o ka puʻuwai, ʻokoʻa paha ka ikaika o nā leo mai kekahi kuʻi a i kekahi. ʻo kahi laʻana:
• ʻO ka fibrillation atrial (AF)Ma muli o ka hoʻopaʻapaʻa ʻole ʻana a me ka wikiwiki o ka ventricular, hiki ke kani ke kani i ka puʻuwai hoʻokahi a palupalu i kekahi.
• ʻO nā paʻakikī ventricular premature (PVC)Ke puka mai ka kuʻi mua ʻana mai ka ventricle me ka ʻokiʻoki maʻamau, maule ka leo i lohe ʻia i kēia kuʻi mua ʻana.
Ke hopena, gallop rhythm, maʻamau cardiomyopathy ve puʻuwai hāʻule He hōʻailona ia o nā maʻi e like me ke kani puʻuwai. ʻO ka maʻamau ka hoʻololi ʻana i ka ikaika o nā kani puʻuwai arrhythmia he hoailona. ʻO ka nāwaliwali o nā kani puʻuwai obesity, hoʻoheheʻe pericardial, pleural effusion ai ole ia, me ka nui intrathoracic Ma ia mau hihia, ma muli o nā ʻike auscultation, echocardiography ve EKG ʻO nā hoʻokolohua diagnostic kiʻekiʻe e like me nā mea e pono ai.
He aha nā kumu o ka ʻōhumu puʻuwai systolic?
ʻO Ceccomaster, CC BY-SA 3.0 https://creativecommons.org/licenses/by-sa/3.0, ma o Wikimedia Commons
Lohe ʻia nā ʻōhumu puʻuwai systolic i ka wā systole o ka puʻuwai. nā leo ʻano ʻēʻO kēia mau ʻōhumu maʻamau ma waena o ka puʻuwai mua (S1) a me ka lua (S2). puka mai a pau me ke kani puuwai lua (S2)Lohe ʻia kēia mau ʻōhumu ma muli o ke kahe ʻana o ke koko a hiki ke pili i nā kumu like ʻole ma muli o ke kumu o kēia haunaele.
ʻO nā kumu nui o ka ʻōhumu o ka naʻau systolic
1. ʻAʻole lawa ʻole ka pahu AV (Mitral a me Tricuspid Valve Insufficiency)
• MechanismHoʻopili nā ʻūhā mitral a me tricuspid i ka wā o ka ʻoki ʻana o ka ventricular, e pale ana i ke kahe ʻana o ke koko i loko o ka atria. Eia nō naʻe, inā ʻaʻole paʻa loa kēia mau kiwi, kahe hou ke koko mai ka ventricles a i ka atria (regurgitation). ʻO kēia hoʻihoʻi haunaele, ʻōhumu systolic lohe ia e like me.
• Ka Wahi i Lohe ʻia ka ʻōhumu:
• Ka lawa ole o ka mitral: Lohe ia ma ka aoao hema, ma ka piko o ka puuwai (hopena o ka puuwai).
• ʻAʻole lawa ka tricuspid: Ua lohe maopopo loa ia ma ka aoao akau kokoke i ka sternum.
• ʻO ke koʻikoʻi o ke kino:
• ʻAʻole lawa ka valve Mitral (e laʻa, myxomatous mitral valve maʻi) ʻo ia kekahi o nā maʻi puʻuwai maʻamau i loaʻa i nā ʻīlio.
• Hoʻopili pinepine ʻia ka hoʻihoʻi ʻana o Tricuspid me ka puʻuwai ʻākau a me ʻaʻa ʻaʻa ʻokoʻa ve ascites (ka hoʻonui ʻana o ka wai i loko o ka ʻōpū o ka ʻōpū) Hiki ke hōʻike iā ia iho me nā hōʻailona e like me.
2. Stenosis (Narrowing) o ka Aortic and Pulmonary Valves
• MechanismHāmama nā ʻūhā aortic a me ka pulmonary i ka wā o ka hoʻokaʻawale ʻana o ka ventricular, e ʻae ana i ke koko e hele mai nā ventricles a i ke aorta a me ka pulmonary artery. Ina keia mau kiwi hōʻeha kino Inā loaʻa, paʻakikī ka hele ʻana mai ka ventricle a hiki i ke aʻa a kahe ke koko me ka haunaele. ʻO kēia haunaele ʻōhumu systolic lohe ia e like me.
• Ka Wahi i Lohe ʻia ka ʻōhumu:
• I ka stenosis aortic: Ma ka hema, ʻāina basal (mahele luna o ka puʻuwai) lohe ʻia.
• ʻO ka maʻi pulmonary stenosis: Lohe ʻia ma ka ʻaoʻao hema, ma ka ʻāpana basal o ka puʻuwai, akā kokoke i ka sternum.
• ʻO ke koʻikoʻi o ke kino:
• ʻO ka stenosis aorticHe mea maʻamau ia i nā ʻīlio ʻano nui (e laʻa, Boxer, Golden Retriever).
• ʻO ka maʻi pulmonary stenosisHe anomaly congenital a ʻike pinepine ʻia i nā ʻano me kahi predisposition genetic (eg, Beagle, Bulldog).
• ʻO nā ʻano ʻelua o ka stenosis ka mea e hana ai ka ventricle i ke kaomi ʻoi aku ka nui o ka pā ventricular hypertrophy (ke kumu mānoanoa).
3. Na ma'i puuwai kino
Hoʻopilikia kekahi mau maʻi puʻuwai hānau i ke kahe o ke koko, e hoʻoulu ai i ke kahe ʻana a no laila ʻōhumu systolic ʻO nā kumu maʻamau o ka congenital:
• ʻO ka hewa o ka Septal Ventricular (VSD)
• MechanismʻO ka VSD he puka ma ka septum (pā) ma waena o nā ventricle ʻākau a hema. Holo ke koko mai ka ventricle hema kiʻekiʻe a i ka ventricle ʻākau haʻahaʻa. ʻO kēia kahe ʻino ʻōhumu systolic lohe ia e like me.
• Ka Wahi i Lohe ʻia ka ʻōhumu: Lohe maopopo ia ma ka aoao akau o ka sternum.
• ʻO ke koʻikoʻi o ke kinoʻO ka VSD kahi kīnā hānau e hiki ai ke hōʻeha i ka naʻau, ma muli o ka nui o ka defect septal. ʻO nā hemahema liʻiliʻi ka mea maʻamau i ka ʻōhumu nui, ʻoiai ʻo nā mea nui e hāmau.
• Tetralogy of Fallot
• MechanismʻO Tetralogy of Fallot kahi maʻi puʻuwai congenital paʻakikī i loaʻa i nā anomalies ʻehā:
1. ʻO ka maʻi pulmonary stenosis (ka maʻi ʻaʻaʻa pulmonary stenosis)
2. ʻO ka hypertrophy ventricular akau
3. ʻO ka hemahema septal ventricular (VSD)
4. ʻO ka dextraposition aortic (ma kahi o ka aorta mai ka ventricle akau)
• Ka Wahi i Lohe ʻia ka ʻōhumu: Maʻamau ma ka aoao hema o ka sternum lohe ia.
• ʻO ke koʻikoʻi o ke kino: Tetralogy of Fallot, maʻamau ʻōlelo uliuli (cyanosis) ve hooikaika kino ʻO kēia maʻi he maʻi kīnā koʻikoʻi e pono ai ke hoʻoponopono ʻokiʻoki.
No ka hōʻuluʻulu ʻana i nā ʻōhumu systolic:
E ʻike i ka ʻaoʻao no ka mea kākau, CC BY 4.0 https://creativecommons.org/licenses/by/4.0, ma o Wikimedia Commons
1. ʻAʻole lawa ka Mitral Valve
• Mechanism: Kahe hope o ke koko mai ka ventricle hema a i ka atrium hema
• Kahi o ka Murmur: ʻApex hema (ma lalo o ka puʻuwai)
• Nā ʻike hōʻike kinoʻO ke kuʻi, hoʻoikaika kino ʻole, pōkole o ka hanu
2. ʻAʻole lawa ʻole nā valve Tricuspid
• Mechanism: Kahe hope o ke koko mai ka ventricle akau a i ka atrium akau
• Kahi o ka Murmur: ʻĀkau ʻākau (lalo o ka puʻuwai)
• Nā ʻike hōʻike kino: ʻO ka hoʻohaʻahaʻa ʻana o ka ʻāʻī ʻo Jugular, ascites (hui wai i loko o ka ʻōpū o ka ʻōpū), pōkole o ka hanu.
3. Aortic Stenosis
• Mechanism: ʻO ke kahe ʻana o ke koko mai ka ventricle hema a i ke aorta
• Kahi o ka Murmur: Māhele basal hema (mahele luna o ka puʻuwai)
• Nā ʻike hōʻike kinoHoʻomaʻamaʻa ʻole, maule, hema ventricular hypertrophy (mānoanoa)
4. ʻAiʻi ʻAiʻi o ka Pulmonary
• Mechanism: ʻO ke kahe ʻana o ke koko mai ka ventricle ʻākau a i ke aʻaʻa pulmonary
• Kahi o ka Murmur: Māhele basal hema (ma luna o ka puʻuwai, kokoke i ka sternum)
• Nā ʻike hōʻike kinoHoʻomaʻamaʻa ʻole, maule, hypertrophy ventricular akau (mānoanoa)
5. ʻAʻole ʻo Ventricular Septal Defect (VSD)
• Mechanism: Ka hele ana o ke koko mai ka ventricle hema a i ka ventricle akau
• Kahi o ka Murmur: Ka aoao akau o ka sternum
• Nā ʻike hōʻike kinoHiki ke ʻano like ʻole ka ʻōhumu ʻana ma muli o ka nui o ka lua
6. Tetralogy of Fallot
• MechanismʻO ka pulmonary stenosis kahi hui o ventricular septal defect (VSD), ventricular hypertrophy akau, a me aortic dextroposition (malposition of the aorta).
• Kahi o ka Murmur: Ma ka aoao hema o ka sternum
• Nā ʻike hōʻike kinoCyanosis (ʻeleʻele uliuli), hoʻomaʻamaʻa ʻole, maule (syncope)
ʻO nā ʻōhumu systolic nā leo ʻē aʻe i lohe ʻia i ka wā o ka ʻoki ʻana o ka puʻuwai (ma waena o S1 a me S2). ʻO kēia mau ʻōhumu ʻaʻole lawa ka mitral a me ka tricuspid valve, aortic a me ka pulmonary stenosis ai ole ia, nā maʻi puʻuwai hānau (VSD, Tetralogy of Fallot) Lohe ʻia kēlā me kēia ma nā wahi auscultatory like ʻole a pili pū me nā hōʻailona lapaʻau like ʻole.
No laila, i nā holoholona me ka'ōhumu systolic, pono e loiloiʻia ka ikaika, kahi, a me ka lōʻihi o ka'ōhumu. Hāʻawi kēia mau ʻike i nā hōʻailona koʻikoʻi e hoʻoholo ai i ke kumu o ka ʻōhumu. No ka hoʻokumu ʻana i kahi hōʻailona hōʻoia a me ka protocol lapaʻau, echocardiography ve EKG ʻO nā mea hana diagnostic kiʻekiʻe e like me ka pono e hoʻohana.
Nā ʻatikala ʻē aʻe āu e makemake ai
"ʻO ka ʻike ʻana i kāu mea i ʻike a ʻike ʻole ai ʻo ia ka ʻike maoli."
Confucius
