Oge agụpụtara echere: 7 Nkeji
Ọdịnaya
(A) ve (B) Ihe atụ abụọ nke auscultation na ndekọ na stethoscope dijitalụ; a na-ejide nwamba n'ọnọdụ guzoro ma ọ bụ nọdụ ọdụ na tebụl nyocha. A na-ejide nwamba n'ọnọdụ guzoro ma ọ bụ ọdụ na tebụl nyocha.
(C) phonocardiographic trace na ECG nwetara site na DS na pusi nwere auscultation nkịtị na enweghị ọrịa obi na echocardiography.
(D) phonocardiographic trace na ECG nwetara site na DS n'ime nwamba nwere ntamu systolic.
(E) phonocardiographic trace na ECG nwetara site na DS na pusi nwere ụda gallop.
Kedu ka esi eme auscultation na nwamba?
Iji nyochaa nke ọma ntamu obi na nwamba parasternal auscultation, eji akụrụngwa eme ihe ziri ezi ve ahụmahụ N'ọnọdụ ebe achọpụtara ntamu, nyocha zuru ezu nke ahụike n'ozuzu onye ọrịa na ọrụ obi dị mkpa.
Ntamu obi na nwamba na-esi ike ịmata nke ọma karịa nkịta. Nke a bụ n'ihi na nwamba nwere ọdịdị obi dị iche iche, ntamu na-adịkarị nro ma na-adịkwa nro karị. Ntamu obi na nwamba na-abụkarị n'akụkụ sternum (parasternal) a na-anụ nke ọma karị.
Ndụmọdụ maka inyocha ntamu obi na nwamba
1. Ọkwa Ntị:
A na-anụ ụda ntamu gburugburu sternum na nwamba, ya bụ, parasternal A na-anụ ya nke ọma site na mpaghara valvụ ebe ntamu si malite. Nke a na-eme ka ọ dịkwuo mfe ịlele mpaghara valvụ ebe ntamu si malite.
2. Stethoscope ụmụaka eji:
Mgbe ị na-eme auscultation na nwamba stethoscope ụmụaka nwere obere mpaghara isi Iji stethoscope dị mkpa maka ịnụ ụda obi na ntamu nke ọma. Stethoscope ọkọlọtọ nwere ike ime ka ọ sie ike ige ntị n'ebe ziri ezi na mpaghara obere ọgịrịga.
3. Ahụmahụ chọrọ:
Ịchọpụta kpọmkwem valvụ obi nke na-akpata ntamu ahụ chọrọ ahụmahụ dị ukwuu na nghọta. Na nwamba, ikwu ntamu na valvụ ga-ekwe omume site n'ịmata ebe anatomical na ntinye stethoscope kwesịrị ekwesị.
Kedu ụdị ntamu a na-ahụkarị n'oge auscultation na nwamba?
Ọrịa obi a mụrụ na nwamba (dịka ọmụmaatụ, VSD ma ọ bụ PDA), karịsịa abụọ enwetara systolic ntamu obi Ọnọdụ abụọ a bụ ihe dịka 98% nke ntamu obi a na-ahụ na nwamba:
1. SAM (Systolic Anterior Motion)
2. DR VOTO (Mgbochi ikuku ventricular nke aka nri na-agbanwe agbanwe)
SAM (Systolic Anterior Motion)
• definitionMitral valve stenosis bụ ọnọdụ nke mpempe akwụkwọ mpempe akwụkwọ nke mitral mitral na-ewere ọnọdụ na-ezighi ezi n'oge ọbara na-apụta site na ventricle aka ekpe, na-egbochi akụkụ nke akụkụ aka ekpe nke ventricular outflow tract (LVOT).
• Mechanism: Ejikọtara ya na hypertrophic cardiomyopathy (HCM) ma na-esite na njupụta nke mgbidi ventricular aka ekpe. SAM nwere ike ime ka mitral regurgitation (nkwụghachi nke ọbara site na valvụ mitral), na-emepụta ntamu systolic nke nwere ọgba aghara ọbara.
DR VOTO (Mgbochi ikuku ventricular nke aka nri na-agbanwe agbanwe)
• definition: Ọ bụ mbelata nke traktị ventricular outflow traktị aka nri (RVOT).
• Mechanism: A na-ejikọta ya na nrụgide, mmụba obi, ma ọ bụ hypertrophy ventricular ziri ezi. Nke a na-ebute ọgba aghara ka ọbara na-esi na ventricle aka nri gaa na akwara akpa ume, na-emepụta ntamu systolic.
Nsogbu nhazi mpaghara na mkpa nchọpụta
O di nwute, SAM na DR VOTO na-atamu ntamu enweghị ike ịwapụta nke ọma n'ihe gbasara mpagharaA na-anụkarị ọnọdụ abụọ ahụ n'akụkụ ndị yiri ya na enweghị ike ịme nchọpụta doro anya site na auscultation naanị.
N'ihi na, Ultrasonography nke obi (echocardiography) na nwamba niile nwere ntamu obi Echocardiography dị oké mkpa maka ịchọpụta isi iyi ntamu, ịchọpụta ọrịa ndị dị ka HCM, na ịmepụta atụmatụ ọgwụgwọ.
N'ihi
• Sam ve DR VOTO, na-akpata ihe ka n'ọnụ ọgụgụ (98%) nke obi systolic ntamu na nwamba.
• Enweghị ike ịwapụta ntamu ndị a n'ụzọ ziri ezi site na auscultation naanị.
• Na nwamba nwere ntamu obi ọ bụla achọpụtara, echocardiography dị mkpa maka nyocha na ọgwụgwọ.
• Ebe ọ bụ na ọnọdụ ndị a na-abụkarị ihe mgbaàmà nke ọrịa obi siri ike, nchọpụta mmalite na nleba anya dị mkpa.
Kedu ihe bụ Systolic Anterior Motion (SAM) na nwamba?
Sam (Systolic Anterior Motion) na-eme mgbe mpempe akwụkwọ mpempe akwụkwọ septal mitral valve na-aga n'ihu traktị ventricular outflow traktị (LVOT) n'oge systole. Nke a bụ karịsịa hypertrophic cardiomyopathy (HCM) A na-ahụ ya na ọnọdụ nke na-esite na mgbochi na-adịghị mma nke musculature ventricular aka ekpe.
Mechanism
1. Mgbanwe ọnọdụ na akwara Papillary na Mitral Valve
• Ịba ụba nke akwara ventricular aka ekpe, mgbanwe na ọnọdụ nke akwara papillary na-eduga na.
• Akwụkwọ ntanye valvụ mitral, Chordae Tendinae Ejikọtara ya na mọzụlụ papillary site na mọzụlụ papillary. Ka akwara papillary na-agbanwe ọnọdụ, mpempe akwụkwọ valvụ mitral na-agbanwekwa ọnọdụ.
2. Ntugharị nke mpempe akwụkwọ Mitral Valve n'ime traktị ọpụpụ ventricular aka ekpe
• Akwụkwọ mpempe akwụkwọ Mitral valve n'oge systole traktị ọpụpụ ventricular aka ekpe (LVOT) Karịsịa, mpempe akwụkwọ mitral septal (n'ihu) na-egbochi akụkụ nke akụkụ akụkụ ventricular aka ekpe.
3. Dynamism metụtara Subaortic Stenosis na Mitral Regurgitation
• Mgbanwe ọnọdụ a na-eme n'oge systole. a dynamic subaortic stenosis na-emepụta.
• N'otu oge ahụ, ntanye ọbara na-apụta site na mitral valve na atrium aka ekpe, nke mitral regurgitation (akọwapụtara dị ka mitral insufficiency).
Nchọpụta ụlọọgwụ na ntamu dị egwu
• SAM, na-emekarị oke obi (tachycardia) na-apụta ìhè.
• Mgbe ọnụ ọgụgụ obi na-ebelata (dịka ọmụmaatụ, site na ọgwụ mgbochi), ntamu na-agbanwe agbanwe nwere ike ịla n'iyi ma ọ bụ ibelata n'ike.
• ntamu na-emekarị na mpaghara parasternal ekpe a na-anụ nke ọma.
Mkpa ụlọ ọgwụ
• SAM, hypertrophic cardiomyopathy (HCM) Ejikọtara ya na ya bụ ihe a na-ahụkarị na nwamba nwere HCM.
• Ọnọdụ a bụ ma mgbochi ventricular outflow traktị aka ekpe n'otu oge ahụ mitral insufficiency Ọ bụrụ na a naghị agwọ ya, ọ nwere ike ibute nsogbu obi na-aga n'ihu.
• Ike nke ntamu obi nwere ike ịdịgasị iche dabere na ọnụọgụ obi. Ya mere, echocardiography dị mkpa iji chọpụta mgbanwe dị ike na nwamba nwere SAM a na-enyo enyo.
SamHCM bụ ọnọdụ obi dị ịrịba ama nke na-emetụta traktị mpụta ventricular aka ekpe ma jikọtara ya na HCM. N'ihe gbasara SAM achọpụtara na nwamba, ọ dị mkpa iji guzobe usoro nyocha na ọgwụgwọ ziri ezi. ultrasonography nke obi (echocardiography) Ekwesịrị ime nke a. ntamu nwere ike ịpụta karịa na ọnụ ọgụgụ obi dị elu ma na-apụ n'anya na ọnụ ọgụgụ dị ala, ya mere nlekota maka mgbanwe mgbanwe dị mkpa. Ezubere ọgwụgwọ bụ ijikwa HCM dị n'okpuru yana ibelata mgbaàmà.
DR VOTO, kedu ihe bụ mgbochi mgbochi ikuku ventricular ziri ezi?
DR VOTObụ ọnọdụ obi obi na-esite na mbelata dị ike nke traktị ventricular outflow ziri ezi. Ọnọdụ a na-abụkarị adịghị mma a na-ewere dị ka ntamu ma na-abụkarị naanị oke obi (tachycardia) nụrụ.
Mechanism
1. Mbugharị oke nke mgbidi ventricular efu ziri ezi
• DR VOTO na-apụta n'ihi mmegharị oke oke nke mgbidi ventricular aka nri.
• Mmegharị a gabigara ókè na-ebute mkpakọ nke traktị na-apụ apụ nke ventricular aka nri yana mbelata nwa oge (stenosis ike).
2. Mgbagwoju anya Ọbara
• Ọbara na-esi na ventricle aka nri na-erute na akwara pulmonary na-emepụta ọgba aghara na traktị ahụ na-asọpụta warara, nke ntamu systolic a na-anụ dị ka.
Mkpa ụlọ ọgwụ
• A Benign ntamu:DR VOTO, n'ọtụtụ oge enweghị njikọ na ọrịa obi Ọ bụ ntamu na-adịghị mma.
• Mmekọrịta ya na HCM: Na obere oge hypertrophic cardiomyopathy (HCM) Enwere ike jikọta ya na ọrịa obi dịka. Agbanyeghị, mkpakọrịta a na-adịkarị ụkọ.
• Mmekọrịta ya na Ọrịa Sistemu:DR VOTO, n'ọnọdụ ụfọdụ anaemia ma ọ bụ nwekwara ike ịhụ ya na ọrịa ndị ọzọ nke sistem. Ya mere, ọ dị mkpa iji nyochaa ọnọdụ usoro dị n'okpuru.
Ntumu di omimi na nchọpụta
• Mkpa ọ̀tụ̀tụ̀ obi dị elu: DR VOTO ntamu na-apụtakarị ìhè n'ọ̀tụ̀tụ̀ obi dị elu ma nwee ike ịpụ n'anya mgbe ọ̀tụ̀tụ̀ obi obi laghachiri n'ụzọ nkịtị.
• echocardiographyIji kwado ụzọ mpụta ventricular aka nri na-ebelata na mmegharị mgbidi n'efu echocardiography kwesịrị iji.
DR VOTOỌ bụ n'ozuzu ọnọdụ adịghị mma na ọ dịghị akpata nsogbu ọ bụla dị ịrịba ama ụlọ ọgwụ n'ọtụtụ nwamba. Agbanyeghị, hypertrophic cardiomyopathy, anaemia Ọ dị mkpa iji nyochaa ihe kpatara ya na nwamba nwere ntamu n'ihi na, ọ bụ ezie na ọ dị ụkọ, ọ nwere ike jikọta ya na ọrịa ndị ọzọ nke usoro. Dịka ntamu siri ike, ike nke DR VOTO nwere ike ịdịgasị iche dabere na ọnụọgụ obi ma nwee ike ịchọ nyocha echocardiographic zuru ezu.
Akụkọ ndị ọzọ nwere ike ịmasị gị
"Ihe na-abụghị n'echiche enweghị ike ịbụ n'uche."
John Locke
