Ixesha lokufunda eliqikelelweyo: 7 mzuzu
Table of Contents
(A) ve (B) Imizekelo emibini ye-auscultation kunye nokurekhoda nge-stethoscope yedijithali; iikati zazibekwe kwindawo yokuma okanye yokuhlala phezu kwetafile yeemviwo. Iikati zazibekwe zime okanye zihleli phezu kwetafile yeemviwo.
(C) I-Phonocardiographic trace kunye ne-ECG efunyenwe yi-DS kwikati ene-auscultation eqhelekileyo kwaye akukho sifo senhliziyo kwi-echocardiography.
(D) I-Phonocardiographic trace kunye ne-ECG efunyenwe yi-DS kwikati ene-systolic murmur.
(E) I-Phonocardiographic trace kunye ne-ECG efunyenwe yi-DS kwikati enesandi sokuhamba.
I-auscultation kufuneka yenziwe njani kwiikati?
Ukuvavanya ngokuchanekileyo ukumbombozela kwentliziyo kwiikati i-parasternal auscultation, ukusetyenziswa kwezixhobo ezichanekileyo ve amava Kwiimeko apho ukumbombozela kufunyenwe, uviwo olungakumbi lwempilo yesigulane kunye nomsebenzi wenhliziyo kubalulekile.
Ukumbombozela kwentliziyo kwiikati kunzima kakhulu ukuvavanya ngokuchanekileyo kunezinja. Oku kungenxa yokuba iikati zinesifuba esahlukileyo, kwaye ukumbombozela kuhlala kuthambile kwaye kunobuqili. Ukumbombozela kwentliziyo kwiikati kuhlala kunjalo kwicala le-sternum (i-parasternal) iviwa ngokucacileyo ngakumbi.
Iingcebiso zokuvavanya ukumbombozela kwentliziyo kwiikati
1. Isikhundla Sokuphulaphula:
Izandi zokumbombozela zivakala kwi-sternum kwiikati, oko kukuthi, parasternal Ivakala ngcono kwindawo yevalve apho umbombozo usuka khona. Oku kwenza kube lula ukuvavanya indawo yesivalo apho umbombozo usuka khona.
2. Ukusetyenziswa kweStethoscope yabantwana:
Xa usenza auscultation kwiikati i-stethoscope yabantwana enentloko encinci Ukusebenzisa i-stethoscope kubalulekile ekuveni izandi zentliziyo kunye nokumbombozela ngokucacileyo. I-stethoscope esemgangathweni inokwenza kube nzima ukumamela kwiindawo ezichanekileyo kwindawo ye-rib cage encinci.
3. Imfuneko yamava:
Ukumisela ngokuchanekileyo ukuba yeyiphi ivalve yentliziyo ebangela ukumbombozela kufuna amava kunye novakalelo. Kwiikati, ukubonakalisa ukumbombozela kwivalve kunokwenzeka ngolwazi lweendawo ze-anatomical kunye nokubekwa kwe-stethoscope ngokufanelekileyo.
Ziziphi ezona ntlobo zixhaphakileyo zokumbombozela ezifunyenwe ngexesha le-auscultation kwiikati?
Izifo zentliziyo ezizalwayo kwiikati (umzekelo, VOD okanye PDA), ngakumbi ezimbini ezifunyenwe kwintliziyo ye-systolic Ezi meko zimbini zenza malunga ne-98% yokumbombozela kwentliziyo ebonwa kwiikati:
1. SAM (Systolic Anterior Motion)
2. I-DR VOTO (i-Dynamic Right Ventricular Outflow Tract Abstruction)
SAM (Systolic Anterior Motion)
• definitionI-Mitral valve stenosis yimeko apho i-leaflet yangaphambili yevalve ye-mitral ithatha indawo engafanelekanga ngexesha lokuphuma kwegazi kwi-ventricle yasekhohlo, ngokuyinxenye ithintele i-left ventricular outflow tract (LVOT).
• Inkqubo: Inxulunyaniswa ne-hypertrophic cardiomyopathy (HCM) kwaye ngokuqhelekileyo ibangelwa ukuqiniswa kodonga lwe-ventricular yasekhohlo. I-SAM inokubangela i-mitral regurgitation (i-backflow yegazi nge-valve ye-mitral), ukuvelisa ukumbombozela kwe-systolic kunye nokuhamba kwegazi okuphazamisayo.
I-DR VOTO (i-Dynamic Right Ventricular Outflow Tract Abstruction)
• definition: Kukucutha okuguquguqukayo kwendlela yokuphuma kwe-ventricular yasekunene (RVOT).
• Inkqubo: Idla ngokunxulunyaniswa noxinzelelo, ukubetha kwentliziyo okwandisiweyo, okanye i-right ventricular hypertrophy. Oku kudala isiphithiphithi njengoko igazi liphuma kwi-ventricle elungileyo ukuya kumthambo we-pulmonary, ukuvelisa ukumbombozela kwe-systolic.
Ingxaki yendawo kunye nesidingo sokuxilonga
Ngelishwa, u-SAM kunye no-DR VOTO bayambombozela ayinako ukwahlulwa ngokucacileyo ngokwemiqathango yendawoZombini iimeko zivame ukuva kwiindawo ezifanayo kwaye ukuxilongwa okuqinisekileyo akunakwenziwa nge-auscultation yodwa.
Kuba, I-Cardiac ultrasonography (i-echocardiography) kuzo zonke iikati ezinokukhala kwentliziyo I-Echocardiography ibalulekile ekumiseleni umthombo wokumbombozela, ukufumanisa izifo ezisisiseko ezifana neHCM, kunye nokuphuhlisa isicwangciso sonyango.
ngenxa
• SAM ve DR IVOTO, akhawunti uninzi (98%) yeentliziyo ze-systolic zimbombozela kwiikati.
• Ezi zimbombozo azinakwahlulwa ngokuchanekileyo ngokuthetha nje kuphela.
• Kwiikati ezinako nakuphi na ukumbombozela kwentliziyo kufunyenwe, i-echocardiography iyimfuneko kuxilongo kunye nonyango.
• Kuba ezi meko zidla ngokuba luphawu lwesifo sentliziyo esimandundu, ukuxilongwa kwangoko kunye nokulandelela kubalulekile.
Yintoni iSystolic Anterior Motion (SAM) kwiikati?
SAM (I-Systolic Anterior Motion) yenzeka xa i-leaflet yevalve ye-mitral ye-septal isiya ngakwi-left ventricular outflow tract (LVOT) ngexesha le-systole. Oku ngokukodwa hypertrophic cardiomyopathy (HCM) Ibonakala kumxholo kunye neziphumo zokutyeba okungaqhelekanga kwe-left ventricular musculature.
Inkqubo
1. Utshintsho lweSimo kwi-Papillary Muscles kunye ne-Mitral Valve
• Ukujiya kwesihlunu se-ventricular yasekhohlo, utshintsho kwindawo yemisipha ye-papillary iqhubela kwi.
• Amaphecana evalve yeMitral, Chordae Tendinae Idityaniswe kwimisipha ye-papillary ngokusebenzisa imisipha ye-papillary. Njengoko imisipha ye-papillary itshintsha indawo, amaphecana e-mitral valve nawo atshintsha indawo.
2. Ukushukunyiswa kwamaPhepha eValve yeMitral ukuya kwiPhecana lokuPhuma kweVentricular yasekhohlo
• Amaphecana evalve yeMitral ngexesha le-systole i-left ventricular outflow tract (LVOT) Ngokukodwa, i-septal (yangaphambili) i-mitral leaflet ithintela ngokuyinxenye i-ventricular outflow tract.
3. I-Dynamism eNxulumene ne-Subaortic Stenosis kunye ne-Mitral Regurgitation
• Olu tshintsho lwendawo lwenzeka ngexesha le-systole. ukuqina kwe-subaortic stenosis iyadala.
• Ngelo xesha, ukuvuza kwegazi kwenzeka kwi-valve ye-mitral ukuya kwi-atrium yasekhohlo, leyo ukubuyisela i-mitral (kuchazwa njenge-mitral insufficiency).
Iziphumo zeklinikhi kunye nokumbombozela okunamandla
• SAM, ngokwesiqhelo izinga eliphezulu lentliziyo (tachycardia) kuyacaca.
• Xa ukubetha kwentliziyo kuncitshiswa (umzekelo, ngokuthomalalisa), ukumbombozela okuguquguqukayo kunokunyamalala okanye kunciphe ngamandla.
• Ukumbombozela ngokuqhelekileyo kummandla wasekhohlo parasternal iviwa ngcono.
Ukubaluleka kweklinikhi
• SAM, hypertrophic cardiomyopathy (HCM) Idityaniswa ngokusondeleyo kwaye iyinto eqhelekileyo kwiikati ezineHCM.
• Le meko zombini uthintelo lwendlela yokuphuma kwe-ventricular ekhohlo ngokunjalo ukusilela kwe-mitral Ukuba ayiphathwa, kunokukhokelela kwiingxaki ze-cardiovascular progressive.
• Ubunzulu bokumbombozela kwentliziyo bunokwahluka ngokuxhomekeke ekubetheni kwentliziyo. Ke ngoko, i-echocardiography iyimfuneko ukuvavanya utshintsho oluguquguqukayo kwiikati ezine-SAM ekrokrelekayo.
SAMI-HCM yimeko ebalulekileyo yentliziyo echaphazela i-ventricular outflow tract kwaye ihambelana neHCM. Kwiimeko ze-SAM ezifunyenwe kwiikati, kubalulekile ukuseka ukuxilongwa ngokuchanekileyo kunye nesicwangciso sonyango. I-ultrasound yentliziyo (i-echocardiography) Oku kufuneka kwenziwe. Ukumbombozela kunokuvakala ngakumbi kumazinga aphezulu entliziyo kwaye inyamalale ngamaqondo aphantsi, ngoko ke ukubeka esweni utshintsho oluguquguqukayo kubalulekile. Unyango lujolise ekulawuleni i-HCM ephantsi kunye nokunciphisa iimpawu.
DR VOTO, yintoni isithintelo sepheshana lokuphuma kwe-ventricular yasekunene?
DR IVOTOyimeko yentliziyo ebangelwa ukucutha okuguquguqukayo kwendlela yokuphuma kwe-ventricular yasekunene. Le meko iqhelekile nobubele kuthathwa njengokumbombozela kwaye kudla ngokubakho kuphela izinga eliphezulu lentliziyo (tachycardia) evakalayo.
Inkqubo
1. Intshukumo egqithisileyo yodonga lwaMahala lweVentricular
• I-DR VOTO yenzeka ngenxa yentshukumo engaqhelekanga ngokugqithisileyo yodonga olungena ventricular yasekunene.
• Oku kunyakaza okugqithisileyo kubangela ukunyanzeliswa kwe-right ventricular outflow tract kunye nokunciphisa okwethutyana (dynamic stenosis).
2. Ukuqukuqela kweGazi eliMqhushululu
• Igazi elimpompoza ukusuka kwi-ventricle yasekunene ukuya kwi-pulmonary artery lenza isiphithiphithi kwindlela ephumayo emxinwa, ethi ukumbombozela kwe-systolic ivakala njenge.
Ukubaluleka kweklinikhi
• Ukumbombozela Okulungileyo:DR VOTO, kwiimeko ezininzi ezinganxulumananga nesifo sentliziyo Kukumbombozela okulungileyo.
• Ubudlelwane neHCM: Kwiimeko ezinqabileyo hypertrophic cardiomyopathy (HCM) Isenokunxulunyaniswa nezifo zentliziyo ezifana. Nangona kunjalo, olu nxulumano lunqabile ngokubanzi.
• Ubudlelwane kunye neZifo zeNkqubo:DR VOTO, kwezinye iimeko ianemia okanye inokubonwa nezinye izifo zesistim. Ngoko ke, kubalulekile ukuvavanya imeko yenkqubo ephantsi.
Ukumbombozela okunamandla kunye nokuxilongwa
• High Heart Rate UkubalulekaUkumbombozela kweDR VOTO kudla ngokubonakala kumazinga aphezulu entliziyo kwaye kunokunyamalala xa izinga lokubetha kwentliziyo libuyela kwesiqhelo.
• I-EchocardiographyUkuqinisekisa ukuphuma kwe-ventricular yasekunene ukucutha kunye nokuhamba kodonga lwasimahla i-echocardiography kufuneka isetyenziswe.
DR IVOTONgokuqhelekileyo yimeko enobungozi kwaye ayibangeli naziphi na iingxaki ezibalulekileyo zeklinikhi kwiikati ezininzi. Nangona kunjalo, hypertrophic cardiomyopathy, ianemia Kubalulekile ukuvavanya isizathu esisisiseko kwiikati ngokukhononda kuba, nangona kunqabile, kunokudibaniswa nezinye izifo zesistim. Njengokumbombozela okuguquguqukayo, ubunzulu be-DR VOTO bunokwahluka ngokuxhomekeke kwizinga lentliziyo kwaye kunokufuna uvavanyo oluneenkcukacha lwe-echocardiographic.
Amanye amanqaku onokuthi ube nonomdla kuwo
"Into engekhoyo kwiingqondo ayinakuba sengqondweni."
UJohn Locke
