Manaʻo manawa heluhelu: 7 minuke
Nā ʻikepili i loko
(A) ve (B) ʻElua laʻana o ka auscultation a me ka hoʻopaʻa ʻana me kahi stethoscope kikohoʻe; paʻa ʻia nā pōpoki ma kahi kū a noho paha ma luna o ka papa hoʻokolokolo. Hoʻopaʻa ʻia nā pōpoki ma kahi kūlana kū a noho paha ma luna o ka papa hoʻokolokolo.
(C) Ponocardiographic trace a me ECG i loaʻa e DS i loko o kahi pōpoki me ka auscultation maʻamau a ʻaʻohe maʻi puʻuwai ma ka echocardiography.
(D) Ponocardiographic trace a me ECG i loaʻa e DS i loko o kahi pōpoki me ka ʻōhumu systolic.
(E) Ponocardiographic trace a me ECG i loaʻa e DS i loko o kahi pōpoki me ke kani gallop.
Pehea e hana ʻia ai ka auscultation i nā pōpoki?
No ka loiloi pono ʻana i nā ʻōhumu o ka naʻau i nā pōpoki auscultation parasternal, hoʻohana pono i nā mea hana ve ʻike I nā hihia i ʻike ʻia ka ʻōhumu, pono ka nānā ʻana i nā kikoʻī o ke olakino a me ka hana puʻuwai o ka mea maʻi.
ʻOi aku ka paʻakikī o ka ʻōhumu o ka naʻau i nā pōpoki ma mua o nā ʻīlio. No ka mea he ʻokoʻa ka ʻanatomy umauma o nā pōpoki, a ʻoi aku ka palupalu a me ka maʻalahi o ka ʻōhumu. ʻO ka ʻōhumu puʻuwai i nā pōpoki he pinepine ma ka ʻaoʻao o ka sternum (parasternal) lohe maopopo loa ia.
Manaʻo kōkua no ka loiloi ʻana i nā ʻōhumu o ka naʻau i nā pōpoki
1. Kūlana Hoʻolohe:
Lohe ʻia nā leo ʻōhumu a puni ka sternum i nā pōpoki, ʻo ia hoʻi, parasternal ʻOi aku ka maikaʻi o ka lohe ʻia mai ka ʻāpana valve kahi i puka mai ai ka ʻōhumu. He mea maʻalahi kēia i ka nānā ʻana i ka wahi valve kahi i puka mai ai ka ʻōhumu.
2. Hoʻohana Stethoscope Pediatric:
Ke hana auscultation i nā pōpoki he stethoscope pediatric me kahi wahi poʻo liʻiliʻi He mea nui ka hoʻohana ʻana i kahi stethoscope no ka lohe ʻana i ke kani o ka naʻau a me ka ʻōhumu. Hiki i ka stethoscope ma'amau ke pa'akikī i ka ho'olohe 'ana ma nā wahi kūpono o ka iwi iwi li'ili'i.
3. Koi ʻike:
ʻO ka hoʻoholo pololei ʻana i ka puʻuwai puʻuwai e kumu ai ka ʻōhumu e pono ai ka ʻike nui a me ka naʻau. I loko o nā pōpoki, hiki ke hoʻohui ʻia ka ʻōhumu i ka valve me ka ʻike o nā wahi anatomical a me kahi kau stethoscope kūpono.
He aha nā ʻano ʻōhumu maʻamau i ʻike ʻia i ka wā auscultation i nā pōpoki?
ʻO nā maʻi puʻuwai hānau i nā pōpoki (e.g., VSD ai ole ia, PDA), ʻoi aku ʻelua mau ʻōhumu puʻuwai systolic i loaʻa ʻO kēia mau kūlana ʻelua e pili ana i ka 98% o nā ʻōhumu puʻuwai i ʻike ʻia i nā pōpoki:
1. SAM (Systolic Anterior Motion)
2. DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
SAM (Systolic Anterior Motion)
• ka wehewehenaʻO ka stenosis valve Mitral kahi kūlana i kū hewa ʻole ai ka lau mua o ka valve mitral i ka wā o ke kahe ʻana o ke koko mai ka ventricle hema, e ālai ana i ka ʻāpana ventricular outflow tract (LVOT).
• Mechanism: Pili me ka hypertrophic cardiomyopathy (HCM) a ma muli o ka mānoanoa o ka paia ventricular hema. Hiki i ka SAM ke hoʻoulu i ka mitral regurgitation (ka hoʻihoʻi ʻana o ke koko ma o ka valve mitral), e hana ana i ka ʻōhumu systolic me ke kahe ʻana o ke koko.
DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
• ka wehewehena: He hōʻemi ikaika ia o ka ʻaoʻao kahe o ka ventricular akau (RVOT).
• Mechanism: Hoʻopili pinepine ia me ke kaumaha, ka piʻi ʻana o ka puʻuwai, a i ʻole ka hypertrophy ventricular akau. Hoʻokumu kēia i ka haunaele i ke kahe ʻana o ke koko mai ka ventricle ʻākau a i ke aʻa pulmonary, e hana ana i kahi ʻōhumu systolic.
Pilikia Localization a me Diagnostic Pono
ʻO ka mea pōʻino, ʻōhumu ʻo SAM lāua ʻo DR VOTO ʻAʻole hiki ke hoʻokaʻawale ʻia ma ke ʻano o ka localizationLohe mau ʻia nā kūlana ʻelua ma nā wahi like a ʻaʻole hiki ke hana ʻia kahi hōʻailona ma ka auscultation wale nō.
No laila, ʻO ka ultrasonography cardiac (echocardiography) i nā pōpoki āpau me ka ʻōhumu puʻuwai He mea koʻikoʻi ka Echocardiography no ka hoʻoholo ʻana i ke kumu o ka ʻōhumu, ka ʻike ʻana i nā maʻi i lalo e like me HCM, a me ka hoʻomohala ʻana i kahi hoʻolālā lapaʻau.
hopena
• Sam ve KAUKA VOTO, no ka hapa nui (98%) o nā ʻōhumu puʻuwai systolic i nā pōpoki.
• ʻAʻole hiki ke hoʻokaʻawale pololei ʻia kēia mau ʻōhumu ma o ka auscultation wale nō.
• I loko o nā pōpoki me ka ʻōhumu puʻuwai i ʻike ʻia, echocardiography pono no ka maʻi a me ka mālama ʻana.
• Ma muli o kēia mau maʻi he hōʻailona maʻamau ia o nā maʻi maʻi puʻuwai koʻikoʻi, he mea nui ka ʻike mua a me ka hahai ʻana.
He aha ka Systolic Anterior Motion (SAM) i nā pōpoki?
Sam (Systolic Anterior Motion) i ka wā e neʻe ai ka lau septal mitral valve i ka ʻāpana ventricular outflow tract (LVOT) hema i ka wā systole. ʻOi aku kēia ka maʻi maʻi maʻi hypertrophic (HCM) ʻIke ʻia ia ma ka pōʻaiapili a me nā hopena mai ka mānoanoa ʻokoʻa o ka musculature ventricular hema.
Mechanism
1. Nā Hoʻololi Kūlana i nā ʻiʻo Papillary a me Mitral Valve
• ka mānoanoa o ka ʻiʻo ventricular hema, he hoʻololi i ke kūlana o nā ʻiʻo papillary alakai i.
• Nā lau o ka valve Mitral, Chordae Tendinae Hoʻopili ʻia i nā ʻiʻo papillary ma o nā ʻiʻo papillary. I ka hoʻololi ʻana o nā ʻiʻo papillary i ke kūlana, hoʻololi pū ʻia nā lau o ka valve mitral.
2. ʻO ka neʻe ʻana o nā lau o ka Mitral Valve i ka Left Ventricular Outflow Tract
• Nā lau o ka valve Mitral i ka wā systole ʻāpana kahe puka ʻana o ka ventricular hema (LVOT) ʻO ka mea nui, ʻo ka septal (mua) mitral leaflet ke keakea ʻana i ka ʻaoʻao o waho ventricular hema.
3. ʻO ka Dynamism-Related Subaortic Stenosis a me ka Mitral Regurgitation
• Hoʻololi kēia kūlana i ka wā systole. he stenosis subaortic ikaika hana.
• I ka manawa like, hiki mai ke kahe koko mai ka pahu mitral a i ka atrium hema, kahi mitral regurgitation (i wehewehe ʻia ʻo ka lawa ʻole o ka mitral).
Nā ʻImi Lapaʻau a me Dynamic Murmur
• SAM, maʻa mau ka nui o ka puʻuwai (tachycardia) lilo i mea maopopo.
• Ke hoʻolohi ka puʻuwai (e laʻa me nā mea hoʻomaha), hiki ke nalo a emi paha ka ʻōhumu ikaika.
• Ohumu maa mau ma ka ʻāpana parasternal hema lohe maikaʻi ʻia.
ʻO ke koʻikoʻi o ke kino
• SAM, ka maʻi maʻi maʻi hypertrophic (HCM) Hoʻopili pili ia a he ʻike maʻamau i nā pōpoki me HCM.
• ʻO kēia kūlana ʻelua ʻākeʻakeʻa ʻana o ka ʻāpana ventricular outflow hema i ka manawa like lawa ole mitral Inā haʻalele ʻole ʻia, hiki ke alakaʻi i nā pilikia cardiovascular holomua.
• Hiki ke ʻokoʻa ka ikaika o ka ʻōhumu o ka naʻau ma muli o ka piʻi ʻana o ka naʻau. No laila, pono ka echocardiography e loiloi i nā loli ikaika i nā pōpoki me ka SAM i manaʻo ʻia.
SamʻO ka HCM kahi maʻi puʻuwai koʻikoʻi e pili ana i ka ʻaoʻao o waho ventricular hema a pili pū me HCM. I nā hihia o SAM i ʻike ʻia i loko o nā pōpoki, pono e hoʻokumu i kahi hōʻailona kūpono a me ka hoʻolālā lapaʻau. ʻO ka ultrasound cardiac (echocardiography) Pono e hana ʻia kēia. Hiki ke ʻike ʻia ka ʻōhumu ma ka puʻuwai kiʻekiʻe a nalowale i nā haʻahaʻa haʻahaʻa, no laila he mea nui ka nānā ʻana i nā loli ikaika. Hoʻohana ʻia ka lāʻau lapaʻau i ka mālama ʻana i ka HCM kumu a me ka hoʻēmi ʻana i nā hōʻailona.
DR VOTO, he aha ke ʻano obstruction o ka ʻāʻī ʻana o ka ʻāʻī o waho ventricular akau?
KAUKA VOTOHe maʻi naʻau ia ma muli o ka hōʻemi ikaika ʻana o ka ʻāpana kahe o ka ventricular akau. ʻO kēia kūlana maʻamau maikaʻi ua manaoia he ohumu a he pinepine wale ka nui o ka puʻuwai (tachycardia) lohe ʻia.
Mechanism
1. ʻO ka neʻe ʻana o ka pā ʻokoʻa ventricular akau
• Loaʻa ʻo DR VOTO ma muli o ka hoʻoneʻe ʻana o ka paia ʻokoʻa ventricular ʻākau.
• 'O ka ne'e nui 'ana ke kumu o ka pa'i 'ana o ka 'ao'ao puka o ka ventricular akau a me ka haiki no ka manawa (dynamic stenosis).
2. Kahe Koko Huhu
• Ke kahe ana ke koko mai ka ventricle akau a i ke a'a pulmonary e hooulu ana i ka haunaele ma ke ala haiki iwaho. he ʻōhumu systolic lohe ia e like me.
ʻO ke koʻikoʻi o ke kino
• He Ohumu Benign:DR VOTO, ma ka hapanui o na hihia pili ole i ka ma'i puuwai He ʻōhumu maikaʻi.
• Pili me HCM: Ma na hihia kakaikahi ka maʻi maʻi maʻi hypertrophic (HCM) Hiki ke pili me nā maʻi puʻuwai e like me. Eia naʻe, kakaikahi kēia hui.
• Pili me nā maʻi maʻi:DR VOTO, ma kekahi mau hihia anemia a i ʻole e ʻike pū ʻia me nā maʻi ʻē aʻe. No laila, he mea nui e loiloi i kahi kūlana systemic underlying.
ʻO ka ʻōhumu ʻino a me ka ʻike
• ʻO ke koʻikoʻi o ka puʻuwai kiʻekiʻe: ʻIke pinepine ʻia nā ʻōhumu o DR VOTO i ka piʻi ʻana o ka naʻau a e nalowale paha ke hoʻi ka puʻuwai i ka maʻamau.
• echocardiographyNo ka hōʻoia ʻana i ka hoʻokaʻawale ʻana o ka ʻāpana ventricular akau a me ka neʻe ʻana o ka paia manuahi echocardiography pono e hoohanaia.
KAUKA VOTOHe maʻi maʻamau ia a ʻaʻole kumu i nā pilikia koʻikoʻi i ka hapa nui o nā pōpoki. Eia naʻe, hypertrophic cardiomyopathy, anemia He mea nui ka loiloi i ke kumu kumu o nā pōpoki me ka ʻōhumu no ka mea, ʻoiai kakaʻikahi, hiki ke pili pū me nā maʻi ʻē aʻe. Ma ke ʻano he ʻōhumu ikaika, hiki ke ʻokoʻa ka ikaika o kahi DR VOTO ma muli o ka puʻuwai puʻuwai a makemake paha i ka loiloi echocardiographic kikoʻī.
Nā ʻatikala ʻē aʻe āu e makemake ai
"ʻO ka mea ʻaʻole i loko o ka manaʻo ʻaʻole hiki i ka noʻonoʻo."
John Locke
