Nthawi yowerengera: 7 miniti
Zamkatimu
(A) ve (B) Zitsanzo ziwiri za auscultation ndi kujambula ndi digito stethoscope; amphaka ankasungidwa moimirira kapena kukhala patebulo loyeserera. Amphaka ankawaimirira kapena atakhala patebulo loyeserera.
(C) Phonocardiographic trace ndi ECG yopezedwa ndi DS mu mphaka wokhala ndi auscultation wamba komanso wopanda matenda amtima pa echocardiography.
(D) Phonocardiographic trace ndi ECG yopezedwa ndi DS mu mphaka wokhala ndi kung'ung'udza kwa systolic.
(E) Phonocardiographic trace ndi ECG yopezedwa ndi DS mu mphaka wokhala ndi phokoso lamphamvu.
Kodi auscultation iyenera kuchitidwa bwanji amphaka?
Kuwunika molondola kung'ung'udza kwa mtima mwa amphaka parasternal auscultation, kugwiritsa ntchito bwino zida ve zochitika Pamene kung'ung'udza kumapezeka, kufufuza mwatsatanetsatane za thanzi la wodwalayo ndi ntchito ya mtima ndizofunikira.
Kung'ung'udza kwamtima mwa amphaka kumakhala kovuta kwambiri kuyesa molondola kusiyana ndi agalu. Izi ndichifukwa choti amphaka ali ndi mawonekedwe a chifuwa chosiyana, ndipo kung'ung'udza nthawi zambiri kumakhala kofewa komanso kosawoneka bwino. Mtima kung'ung'udza amphaka nthawi zambiri kumbali ya sternum (parasternal) imamveka bwino kwambiri.
Maupangiri Owunika Kung'ung'udza kwa Mtima mwa Amphaka
1. Malo Omvera:
Kung'ung'udza kumamveka kuzungulira sternum mwa amphaka, ndiko kuti, parasternal Zimamveka bwino kuchokera kumalo a valve kumene kung'ung'udza kumayambira. Izi zimapangitsa kuti zikhale zosavuta kuyesa malo a valve kumene kung'ung'udza kumachokera.
2. Kugwiritsa Ntchito Ana Stethoscope:
Pamene kuchita auscultation amphaka stethoscope ya ana yokhala ndi mutu waung'ono Kugwiritsa ntchito stethoscope ndikofunikira kuti mumve phokoso la mtima ndikung'ung'udza momveka bwino. Stethoscope yokhazikika imatha kupangitsa kuti zikhale zovuta kumvetsera pamalo olondola mdera laling'ono la nthiti.
3. Chofunikira Chochitika:
Kudziwa bwino lomwe valve yamtima ikuyambitsa kung'ung'udza kumafuna chidziwitso chochuluka komanso chidwi. Mu amphaka, kunena kuti kung'ung'udza kwa valve ndi kotheka ndi chidziwitso cha malo a anatomical ndi malo oyenera a stethoscope.
Ndi mitundu iti yong'ung'udza yomwe imapezeka nthawi zambiri amphaka?
Matenda a mtima obadwa nawo amphaka (mwachitsanzo, VSD kapena PDA), makamaka kung'ung'udza kwa mtima wa systolic Zinthu ziwirizi zimapanga pafupifupi 98% ya kung'ung'udza kwa mtima komwe kumawonedwa mwa amphaka:
1. SAM (Systolic Anterior Motion)
2. DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
SAM (Systolic Anterior Motion)
• tanthauzoMitral valve stenosis ndi chikhalidwe chomwe kapepala kakang'ono ka mitral valve kamakhala kolakwika pamene magazi akutuluka kuchokera kumanzere kwa ventricle, kutsekereza pang'ono kumanzere kwa ventricular outflow thirakiti (LVOT).
• Njira: Zogwirizana ndi hypertrophic cardiomyopathy (HCM) ndipo nthawi zambiri zimachitika chifukwa chakukhuthala kwa khoma lamanzere la ventricular. SAM ingayambitse mitral regurgitation (kubwerera kwa magazi kudzera mu mitral valve), kutulutsa kung'ung'udza kwa systolic ndi kuthamanga kwa magazi.
DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
• tanthauzo: Ndikuchepa kwamphamvu kwa thirakiti lamanja la ventricular outflow (RVOT).
• Njira: Nthawi zambiri zimagwirizanitsidwa ndi kupsinjika maganizo, kuwonjezeka kwa mtima, kapena hypertrophy ya ventricular yoyenera. Izi zimabweretsa chipwirikiti pamene magazi amayenda kuchokera ku ventricle yoyenera kupita ku pulmonary artery, kutulutsa kung'ung'udza kwa systolic.
Vuto Lakumaloko ndi Kufuna Kuzindikira
Tsoka ilo, SAM ndi DR VOTO akung'ung'udza sizingasiyanitsidwe momveka bwino potengera kumasuliraMikhalidwe yonseyi imamveka m'malo ofanana ndipo chidziwitso chotsimikizika sichingapangidwe ndi auscultation yokha.
Chifukwa chake, Cardiac ultrasonography (echocardiography) mwa amphaka onse okhala ndi kung'ung'udza kwa mtima Echocardiography ndiyofunikira kwambiri pakuzindikira komwe kung'ung'udza, kuzindikira matenda omwe amayambitsa monga HCM, ndikupanga dongosolo lamankhwala.
chifukwa
• SAM ve DR VOTO, ndichifukwa chake ambiri (98%) a systolic mtima amang'ung'udza amphaka.
• Kung'ung'udza kumeneku sikungasiyanitsidwe molondola ndi auscultation yokha.
• Amphaka omwe ali ndi mtima uliwonse amang'ung'udza, echocardiography ndikofunikira kuti adziwe matenda ndi chithandizo.
• Popeza kuti mikhalidwe imeneyi nthawi zambiri imakhala chizindikiro cha matenda aakulu a mtima, kuzindikira msanga ndi kutsata ndizofunikira.
Kodi Systolic Anterior Motion (SAM) mu Amphaka ndi chiyani?
SAM (Systolic Anterior Motion) zimachitika pamene kapepala ka septal mitral valve kakupita kumanzere kwa ventricular outflow trakiti (LVOT) panthawi ya systole. Izi makamaka hypertrophic cardiomyopathy (HCM) Imawonedwa mu nkhani ya ndi zotsatira za kukhuthala kwachilendo kwa minyewa yakumanzere ya ventricular.
Njira
1. Kusintha kwa Position mu Minofu ya Papillary ndi Mitral Valve
• Kukula kwa minofu ya kumanzere kwa ventricular, kusintha kwa malo a minofu ya papillary amatsogolera ku.
• Mitral valve timapepala, Chordae Tendinae Zimagwirizanitsidwa ndi minofu ya papillary kudzera mu minofu ya papillary. Pamene minofu ya papillary imasintha malo, timapepala ta mitral valve timasinthanso malo.
2. Kusuntha Kwa Mapepala a Mitral Valve Kupita Kumanzere Kwa Ventricular Outflow Tract
• Mitral valve timapepala pa nthawi ya systole kumanzere kwa ventricular outflow thirakiti (LVOT) Makamaka, kapepala ka septal (anterior) mitral kumalepheretsa pang'ono kutuluka kwa thirakiti lamanzere.
3. Dynamism-Related Subaortic Stenosis ndi Mitral Regurgitation
• Kusintha kumeneku kumachitika panthawi ya systole. dynamic subaortic stenosis amalenga.
• Panthawi imodzimodziyo, kutuluka kwa magazi kumachitika kuchokera ku mitral valve kupita kumanzere kwa atrium, yomwe mitral regurgitation (kufotokozedwa ngati kusakwanira kwa mitral).
Zotsatira Zachipatala ndi Kung'ung'udza Kwamphamvu
• SAM, kawirikawiri kuthamanga kwa mtima (tachycardia) zimawonekera.
• Pamene kugunda kwa mtima kumachepetsedwa (mwachitsanzo, ndi mankhwala osokoneza bongo), kung'ung'udza kwamphamvu kumatha kutha kapena kuchepa kwambiri.
• Kung'ung'udza kawirikawiri kumanzere kwa parasternal dera zimamveka bwino.
Kufunika Kwachipatala
• SAM, hypertrophic cardiomyopathy (HCM) Zimagwirizana kwambiri ndi zomwe zimapezeka mwa amphaka omwe ali ndi HCM.
• Izi ndi zonse kumanzere kwa ventricular outflow thirakiti kutsekeka pa nthawi yomweyo kusakwanira kwa mitral Ngati sichitsatiridwa, imatha kuyambitsa zovuta zamtima.
• Kuchuluka kwa kung'ung'udza kwa mtima kumatha kusiyanasiyana malinga ndi kugunda kwa mtima. Chifukwa chake, echocardiography ndiyofunikira kuti muwone kusintha kwamphamvu kwa amphaka omwe akuganiziridwa kuti SAM.
SAMHCM ndi vuto lalikulu la mtima lomwe limakhudza kumanzere kwa ventricular outflow trakiti ndipo limagwirizanitsidwa ndi HCM. Ngati SAM yapezeka amphaka, ndikofunikira kukhazikitsa njira yolondola yodziwira matenda ndi chithandizo. ultrasound ya mtima (echocardiography) Izi zichitike. Kung'ung'udza kumatha kumveka bwino pakugunda kwamtima komanso kutha pang'onopang'ono, kotero kuyang'anira kusintha kwamphamvu ndikofunikira. Cholinga cha chithandizo ndikuwongolera HCM ndikuchepetsa zizindikiro.
DR VOTO, kodi kutsekeka kwa thirakiti lakumanja kwa ventricular yakumanja ndi chiyani?
DR VOTOndi vuto la mtima lomwe limabwera chifukwa cha kuchepa kwamphamvu kwa thirakiti lamanja la ventricular outflow. Izi nthawi zambiri zimakhala zabwino kumatengedwa ngati kung'ung'udza ndipo nthawi zambiri kumakhala kokha kuthamanga kwa mtima (tachycardia) zomveka.
Njira
1. Kusuntha Kwambiri Kwa Khoma Laulere Lamanja la Ventricular
• DR VOTO imachitika chifukwa cha kusuntha kwachilendo kwa khoma lopanda ventricular lamanja.
• Kuyenda mopitirira muyesoku kumayambitsa kupanikizana kwa njira yoyenera ya ventricular outflow ndi kuchepa kwakanthawi (dynamic stenosis).
2. Kuthamanga kwa Magazi Osokonezeka
• Magazi othamanga kuchokera ku ventricle yoyenera kupita ku pulmonary artery amachititsa chipwirikiti mu njira yopapatiza yotuluka, yomwe kung'ung'udza kwa systolic imamveka ngati.
Kufunika Kwachipatala
• Kudandaula Kwabwino:DR VOTO, nthawi zambiri zosagwirizana ndi matenda amtima Ndi kung'ung'udza kwabwino.
• Zogwirizana ndi HCM: Nthawi zina hypertrophic cardiomyopathy (HCM) Zitha kukhala zogwirizana ndi matenda amtima monga. Komabe, mayanjano awa nthawi zambiri amakhala osowa.
• Ubale ndi Matenda a Systemic:DR VOTO, nthawi zina kuchepa kwa magazi m'thupi kapena zitha kuwonekanso ndi matenda ena amthupi. Chifukwa chake, ndikofunikira kuwunika momwe zilili zadongosolo.
Kung'ung'udza Kwamphamvu ndi Kuzindikira
• Kufunika kwa Mtima Wapamwamba:DR VOTO kung'ung'udza nthawi zambiri kumawonekera pakagunda kwambiri ndipo kumatha kugunda kwa mtima kuyambiranso.
• EchocardiographyKutsimikizira kulondola kwamitsempha yamagazi kutuluka thirakiti kuchepera komanso kusuntha kwaulere kwa khoma echocardiography ziyenera kugwiritsidwa ntchito.
DR VOTONthawi zambiri zimakhala zabwino ndipo sizimayambitsa vuto lililonse mwa amphaka ambiri. Komabe, hypertrophic cardiomyopathy, kuchepa kwa magazi m'thupi Ndikofunika kufufuza zomwe zimayambitsa amphaka ndi kung'ung'udza chifukwa, ngakhale kuti ndizosowa, zimatha kugwirizanitsidwa ndi matenda ena a m'thupi. Monga kung'ung'udza kwamphamvu, mphamvu ya DR VOTO imatha kusiyanasiyana malinga ndi kugunda kwa mtima ndipo kungafunike kuwunika kwatsatanetsatane kwa echocardiographic.
Nkhani Zina Zomwe Mungakonde nazo
"Zomwe sizili m'malingaliro sizingakhale m'malingaliro."
John Locke
