Inofungidzirwa nguva yekuverenga: 7 Mineti
Zviri Mukati
(A) ve (B) Mienzaniso miviri yeauscultation uye kurekodha nedhijitari stethoscope; katsi dzaibatwa dzakamira kana kuti dzakagara patafura yebvunzo. Katsi dzaiitwa dzakamira kana kuti dzakagara patafura yebvunzo.
(C) Phonocardiographic trace uye ECG yakawanikwa neDS mukati ine yakajairika auscultation uye isina chirwere chemoyo pane echocardiography.
(D) Phonocardiographic trace uye ECG inowanikwa neDS mukati ine systolic kugunun'una.
(E) Phonocardiographic trace uye ECG yakawanikwa neDS mukati ine gallop sound.
Auscultation inofanira kuitwa sei mumakati?
Kunyatsoongorora kugunun'una kwemoyo mumakati parasternal auscultation, kushandiswa kwemidziyo kwakaringana ve ruzivo Mumamiriro ezvinhu apo kugunun'una kunoonekwa, kuongororwa kwakadzama kwehutano hwemurwere uye basa remwoyo kunokosha.
Kugunun'una kwemoyo mumakati kunonyanya kuoma kunyatsoongorora kupfuura imbwa. Izvi zvinodaro nekuti katsi dzine akasiyana chipfuva anatomy, uye kugunun'una kunowanzo kuve kwakapfava uye kwakajeka. Mwoyo unogunun'una mumakati kazhinji padivi pe sternum (parasternal) inonzwika zvakajeka.
Mazano eKuongorora Kugunun'una Kwemoyo muKatsi
1. Kuteerera Nzvimbo:
Kugunun'una kunonzwika kutenderera sternum mumakati, kureva, parasternal Inonzwika zvakanyanya kubva munzvimbo yevharuvhu uko kugunun'una kunobva. Izvi zvinoita kuti zvive nyore kuongorora nzvimbo yevharuvhu panotangira kugunun'una.
2. Pediatric Stethoscope Kushandisa:
Paunenge uchiita auscultation mumakati stethoscope yevana ine nzvimbo duku yemusoro Kushandisa stethoscope kwakakosha pakunzwa kurira kwemoyo uye kugunun'una zvakajeka. Yakajairwa stethoscope inogona kuita kuti zviome kuteerera munzvimbo chaidzo munzvimbo diki yembabvu.
3. Chiitiko Chinodiwa:
Kunyatsoona kuti ndeipi valve yemwoyo iri kukonzera kugunun'una kunoda ruzivo rwakakura uye kunzwa. Mukati, kupa kugunun'una kuvharuvhu kunogoneka neruzivo rwenzvimbo dzeanatomical uye kwakakodzera stethoscope kuiswa.
Ndeapi marudzi akajairika ekugunun'una anoonekwa panguva ye auscultation mumakati?
Congenital mwoyo zvirwere mumakati (semuenzaniso, VSD kana PDA), kunyanya maviri akawana systolic mwoyo inogunun'una Aya mamiriro maviri anoverengera angangoita 98% yekugunun'una kwemoyo kunoonekwa mumakati:
1. SAM (Systolic Anterior Motion)
2. DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
SAM (Systolic Anterior Motion)
• tsananguroMitral valve stenosis inzvimbo iyo iyo anterior leaflet ye mitral valve inotora nzvimbo isina kururama panguva yekubuda kweropa kubva kuruboshwe rworuboshwe, ichivhara chikamu chekuruboshwe ventricular outflow tract (LVOT).
• Mechanism: Yakabatana ne hypertrophic cardiomyopathy (HCM) uye inowanzokonzerwa nekukora kwemadziro eruboshwe ventricular. SAM inogona kukonzera mitral regurgitation (kudzokera shure kweropa kuburikidza ne mitral valve), kubudisa systolic kugunun'una nekudengenyeka kweropa.
DR VOTO (Dynamic Right Ventricular Outflow Tract Obstruction)
• tsananguro: Iko kuderera kwesimba rekurudyi ventricular outflow turakiti (RVOT).
• Mechanism: Inowanzobatanidzwa nekushungurudzika, kuwedzera kwemwoyo, kana ventricular hypertrophy. Izvi zvinokonzeresa nyonganyonga sezvo ropa richiyerera richibva kumhepo yekurudyi richienda kune pulmonary artery, richiburitsa systolic kugunun'una.
Localization Dambudziko uye Diagnostic Inodiwa
Nehurombo, SAM naDR VOTO vanogunun'una haikwanise kunyatsosiyaniswa maererano nenzvimboMamiriro ese ari maviri anowanzo kunzwika munzvimbo dzakafanana uye mhedzisiro yekuongororwa haigone kuitwa neauscultation chete.
Naizvozvo, Cardiac ultrasonography (echocardiography) mumakati ese ane moyo kugunun'una Echocardiography yakakosha pakuona kwakabva kugunun'una, kuongorora zvirwere zviri pasi seHCM, nekugadzira chirongwa chekurapa.
mugumisiro
• SAM ve DR VOTO, inoverengera vazhinji (98%) ye systolic mwoyo inogunun'una mumakati.
• Uku kugunun'una hakugoni kunyatsosiyaniswa nekutaura chete.
• Mukati dzine chero kugunun'una kwemoyo kwakaonekwa, echocardiography zvinodiwa pakuongororwa uye kurapwa.
• Sezvo mamiriro ezvinhu aya anowanzova chiratidzo chechirwere chemwoyo chakakomba, kuongororwa kwepakutanga uye kutevera kunokosha.
Chii chinonzi Systolic Anterior Motion (SAM) muKatsi?
SAM (Systolic Anterior Motion) inoitika apo septal mitral valve leaflet inofamba ichienda kuruboshwe ventricular outflow turakiti (LVOT) panguva yesystole. Izvi zvakanyanya hypertrophic cardiomyopathy (HCM) Iyo inoonekwa mumamiriro ekunze uye inoguma nekukobvura kweabnormal ventricular musculature.
Mechanism
1. Kuchinja Kwenzvimbo muPapillary Muscles uye Mitral Valve
• Kukora kwetsandanyama yeruboshwe, kuchinja kwechinzvimbo chepillary muscles inotungamira ku.
• Mitral valve mapepa, Chordae Tendinae Iyo yakabatana kune papillary tsandanyama kuburikidza ne papillary tsandanyama. Sezvo tsandanyama dzepapillary dzichichinja nzvimbo, matsamba emitral valve anochinjawo nzvimbo.
2. Kufambisa kweMitral Valve Mapepeti kupinda Kuruboshwe Ventricular Outflow Tract
• Mitral valve mapepa panguva yesystole Left ventricular outflow turakiti (LVOT) Kunyanya, iyo septal (anterior) mitral leaflet inovharira chikamu chekuruboshwe ventricular kubuda turakiti.
3. Dynamism-Inoenderana Subaortic Stenosis uye Mitral Regurgitation
• Uku kuchinja kwechinzvimbo kunoitika panguva yesystole. a dynamic subaortic stenosis anosika.
• Panguva imwecheteyo, kubuda kweropa kunoitika kubva kumitral valve kusvika kuruboshwe rweatrium, iyo mitral regurgitation (inotsanangurwa se mitral insufficiency).
Clinical Zvakawanikwa uye Dynamic Kugunun'una
• SAM, kazhinji kukwira kwemoyo (tachycardia) zvinova pachena.
• Apo kushaya kwemwoyo kunononoka (somuenzaniso, nemishonga), kugunun'una kune simba kunogona kupera kana kuderera musimba.
• Kugunun'una kazhinji munzvimbo yeruboshwe parasternal inonzwika zvakanyanya.
Clinical Kukosha
• SAM, hypertrophic cardiomyopathy (HCM) Iyo yakabatana zvakanyanya uye uye inowanzo kuwanikwa mumakati ane HCM.
• Mamiriro ezvinhu aya ese ari maviri kuruboshwe ventricular outflow turakiti kuvharika naizvozvowo mitral insufficiency Kana ikasarapwa, inogona kukonzera kufambira mberi kwematambudziko emwoyo.
• Kusimba kwekugunun'una kwemoyo kunogona kusiyana zvichienderana nekurova kwemoyo. Naizvozvo, echocardiography inofanirwa kuongorora shanduko ine simba mumakati ane anofungidzirwa SAM.
SAMHCM chinhu chakakosha chemoyo chinokanganisa kuruboshwe ventricular outflow tract uye inosanganiswa neHCM. Muzviitiko zveSAM zvakaonekwa mumakati, zvakakosha kumisikidza kuongororwa kwakaringana uye chirongwa chekurapa. cardiac ultrasonography (echocardiography) Izvi zvinofanira kuitwa. Kugunun'una kunogona kuve kwakanyanya kutaurwa pahupamhi hwemoyo uye kunyangarika nemitengo yakaderera, saka kutarisisa shanduko ine simba kwakakosha. Kurapa kwakanangana nekugadzirisa iri pasi peHCM uye kuderedza zviratidzo.
DR VOTO, chii chinonzi dynamic right ventricular outflow turakiti kuvharira?
DR VOTOChirwere chemoyo chinokonzerwa nekuderera kwesimba rekurudyi ventricular outflow turakiti. Chimiro ichi chinowanzo zvakanaka kunoonekwa sekugunun'una uye kunowanzoitwa chete kukwira kwemoyo (tachycardia) zvinonzwika.
Mechanism
1. Kuwedzera Kufamba kweKurudyi Ventricular Yemahara Wall
• DR VOTO inoitika semugumisiro wekufamba kwakanyanyisa kwerudyi ventricular free wall.
• Uku kufamba kwakanyanyisa kunokonzera kudzvinyirira kweiyo yakarurama ventricular outflow tract uye kuderera kwechinguva (dynamic stenosis).
2. Kuyerera kweRopa Rinobvongodza
• Ropa rinoyerera richibva ku ventricle yekurudyi richienda ku pulmonary artery rinokonzeresa nyonganyonga mune yakamanikana yekubuda turakiti, iyo kugunun'una kwe systolic inonzwika se.
Clinical Kukosha
• Kugunun'una Kwakanaka:DR VOTO, kazhinji zvisingaenderane nechirwere chemoyo Kugunun'una kwakanaka.
• Hukama neHCM: Muzviitiko zvisingawanzoitiki hypertrophic cardiomyopathy (HCM) Inogona kubatanidzwa nezvirwere zvemoyo zvakadai. Zvisinei, kushamwaridzana uku hakuwanzoitiki.
• Hukama neSystem Zvirwere:DR VOTO, mune dzimwe nguva kupererwa neropa kana kuti inogonawo kuonekwa nedzimwe zvirwere zve systemic. Nokudaro, zvakakosha kuongorora mamiriro ezvinhu e-systemic.
Dynamic Kugunun'una uye Kuongororwa
• High Heart Rate Kukosha:DR VOTO kugunun'una kunowanzoonekwa nekurova kwemoyo kwakanyanya uye kunogona kupera kana kurova kwemoyo kwadzokera kune zvakajairika.
• EchocardiographyKusimbisa kurudyi ventricular kubuda turakiti kutetepa uye yakawandisa yemahara madziro kufamba echocardiography inofanira kushandiswa.
DR VOTOIyo inowanzo iine benign mamiriro uye haikonzeri chero matambudziko akakosha ekiriniki mumakati mazhinji. Zvisinei, hypertrophic cardiomyopathy, kupererwa neropa Zvakakosha kuongorora chikonzero chinokonzera mumakati nekugunun'una nokuti, kunyange zvisingawanzoitiki, zvinogona kusanganiswa nezvimwe zvirwere zvehurongwa. Sekugunun'una kune simba, kusimba kweDR VOTO kunogona kusiyana zvichienderana nekurova kwemoyo uye kungangoda yakadzama echocardiographic evaluation.
Zvimwe Zvinyorwa Zvaunogona Kufarira
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