Isikhathi sokufunda esilinganiselwe: 7 iminithi
Uhlu Lokuphakathi
(A) ve (B) Izibonelo ezimbili ze-auscultation nokurekhoda nge-stethoscope yedijithali; amakati ayebekwe endaweni yokuma noma yokuhlala phezu kwetafula lokuhlola. Amakati ayebekwe emile noma ehlezi etafuleni lokuhlola.
(C) I-Phonocardiographic trace kanye ne-ECG etholwe i-DS ekati eline-auscultation evamile futhi asikho isifo senhliziyo ku-echocardiography.
(D) I-Phonocardiographic trace ne-ECG etholwe u-DS ekatini elinokububula kwe-systolic.
(E) I-Phonocardiographic trace kanye ne-ECG etholwe u-DS ekatini elinomsindo ogelezayo.
I-auscultation kufanele yenziwe kanjani emakati?
Ukuhlola ngokunembile ukububula kwenhliziyo emakati i-parasternal auscultation, ukusetshenziswa ngendlela efanele kwemishini ve isipiliyoni Ezimweni lapho kutholakala khona ukukhononda, ukuhlolwa okunemininingwane eminingi yempilo jikelele yesiguli kanye nokusebenza kwenhliziyo kubalulekile.
Ukububula kwenhliziyo emakati kunzima kakhulu ukukuhlola ngokunembile kunezinja. Lokhu kungenxa yokuthi amakati anesimo sesifuba esihlukile, futhi ukububula kuvame ukuthamba futhi kucashe kakhulu. Ukububula kwenhliziyo emakati kuvame ohlangothini lwe-sternum (parasternal) kuzwakala ngokucacile.
Amathiphu Okuhlola Ukububula Kwenhliziyo Emakatini
1. Isikhundla Sokulalela:
Imisindo yokububula izwakala eduze kwe-sternum emakati, okungukuthi, parasternal Kuzwakala kahle endaweni ye-valve lapho kuvela khona ukukhononda. Lokhu kwenza kube lula ukuhlola indawo ye-valve lapho ukububula kuvela khona.
2. Ukusetshenziswa kwe-Stethoscope yezingane:
Lapho wenza i-auscultation emakati i-stethoscope yezingane enendawo encane yekhanda Ukusebenzisa i-stethoscope kubalulekile ekuzweni imisindo yenhliziyo nokububula ngokucacile. I-stethoscope evamile ingenza kube nzima ukulalela ezindaweni ezifanele endaweni yezimbambo ezincane.
3. Isidingo Sokuzizwela:
Ukunquma ngokunembile ukuthi iyiphi i-valve yenhliziyo ebangela ukububula kudinga ulwazi olunzulu nokuzwela. Emakati, ukusho ukukhononda ku-valve kungenzeka ngolwazi lwezindawo ze-anatomical kanye nokubekwa kwe-stethoscope efanele.
Yiziphi izinhlobo ezivame kakhulu zokukhononda ezitholwe ngesikhathi se-auscultation emakati?
Izifo zenhliziyo ezizalwa nazo emakati (isb., VOD noma I-PDA), ikakhulukazi ukububula kwenhliziyo okutholwe okubili kwe-systolic Lezi zimo ezimbili zenza cishe u-98% wokububula kwenhliziyo okubonakala kumakati:
1. I-SAM (Systolic Anterior Motion)
2. I-DR VOTO (I-Dynamic Right Ventricular Outflow Tract Obstruction)
I-SAM (Systolic Anterior Motion)
• definitionI-Mitral valve stenosis yisimo lapho i-leaflet yangaphambili ye-mitral valve ithatha indawo engalungile ngesikhathi sokuphuma kwegazi kusuka ku-ventricle yesokunxele, ivimbela kancane i-left ventricular outflow tract (LVOT).
• Indlela: Ihambisana ne-hypertrophic cardiomyopathy (HCM) futhi ngokuvamile ebangelwa ukujiya kodonga lwe-ventricular yesokunxele. I-SAM ingabangela i-mitral regurgitation (ukugeleza kwegazi emuva nge-mitral valve), ikhiqize ukububula kwe-systolic ngokugeleza kwegazi okunezinxushunxushu.
I-DR VOTO (I-Dynamic Right Ventricular Outflow Tract Obstruction)
• definition: Kuwukuncipha okuguquguqukayo kwepheshana lokuphuma kwe-ventricular elingakwesokudla (RVOT).
• Indlela: Kuvame ukuhlotshaniswa nokucindezeleka, izinga lokushaya kwenhliziyo elikhulayo, noma i-hypertrophy ye-ventricular yangakwesokudla. Lokhu kudala isiphithiphithi njengoba igazi ligeleza lisuka ku-ventricle elungile liya emthanjeni wamaphaphu, likhiqize ukukhononda kwe-systolic.
Inkinga Yendawo Nesidingo Sokuxilonga
Ngeshwa, u-SAM kanye no-DR VOTO bayabubula ayikwazi ukuhlukaniswa ngokucacile mayelana nokwenza kwasendaweniZombili izimo zivame ukuzwakala ezindaweni ezifanayo futhi ukuxilongwa okuqondile akukwazi ukwenziwa nge-auscultation kuphela.
Ngoba, I-Cardiac ultrasonography (i-echocardiography) kuwo wonke amakati anobubula benhliziyo I-Echocardiography ibalulekile ekutholeni umthombo wokukhononda, ukuhlonza izifo eziwumsuka ezifana ne-HCM, nokwenza uhlelo lokwelapha.
yi
• SAM ve DR IVOTO, ibangela iningi (98%) lokububula kwenhliziyo ye-systolic emakati.
• Lokhu kukhononda akukwazi ukuhlukaniswa ngokunembile ngokuthi i-auscultation iyodwa.
• Emakatini ananoma yikuphi ukububula kwenhliziyo kutholiwe, i-echocardiography kuyadingeka ekuxilongweni nasekulashweni.
• Njengoba lezi zimo ngokuvamile ziyizimpawu ze-pathologies eyingozi yenhliziyo, ukuxilongwa kusenesikhathi kanye nokulandelela kubalulekile.
Iyini i-Systolic Anterior Motion (SAM) Emakatini?
SAM (I-Systolic Anterior Motion) yenzeka lapho ipheshana le-valve ye-mitral lihamba libheke ku-left ventricular outflow tract (LVOT) ngesikhathi se-systole. Lokhu ikakhulukazi i-hypertrophic cardiomyopathy (HCM) Kubonakala kumongo we-ventricular kanye nemiphumela yokuqina okungavamile kwemisipha ye-ventricular kwesokunxele.
Indlela
1. Izinguquko Zesikhundla Emisipha Papillary kanye Mitral Valve
• Ukuqina komsipha we-ventricular kwesokunxele, ushintsho esimweni semisipha ye-papillary kuholela ku.
• Amapheshana e-mitral valve, Chordae Tendinae Ixhunywe emisipha ye-papillary ngokusebenzisa imisipha ye-papillary. Njengoba imisipha ye-papillary ishintsha indawo, amapheshana e-mitral valve nawo ashintsha indawo.
2. Ukunyakaza kwamapheshana e-Mitral Valve ku-Left Ventricular Outflow Tract
• Amapheshana e-mitral valve ngesikhathi se-systole i-left ventricular outflow tract (LVOT) Ikakhulukazi, i-septal (yangaphambili) ipheshana le-mitral livimbela kancane i-ventricular outflow tract.
3. I-Subaortic Stenosis Ehlobene Ne-Dynamism kanye ne-Mitral Regurgitation
• Lokhu kushintsha kwendawo kwenzeka ngesikhathi se-systole. i-subaortic stenosis enamandla kudala.
• Ngesikhathi esifanayo, ukuvuza kwegazi kwenzeka kusuka ku-mitral valve kuya ku-atrium yangakwesobunxele, okuyinto ukuvuselelwa kwe-mitral (kuchazwa njengokushoda kwe-mitral).
Okutholakele Komtholampilo kanye Nokububula Okunamandla
• I-SAM, ngokuvamile izinga eliphezulu lenhliziyo (tachycardia) kuba sobala.
• Uma ukushaya kwenhliziyo kwehliswa (isibonelo, ngamaphilisi okubulala), ukuvungama okuguquguqukayo kungase kunyamalale noma kwehle ngamandla.
• Ukububula ngokuvamile esifundeni kwesokunxele parasternal kuzwakala kangcono.
Ukubaluleka Komtholampilo
• SAM, i-hypertrophic cardiomyopathy (HCM) Ihlotshaniswa eduze futhi iwukuthola okuvamile kumakati ane-HCM.
• Lesi simo yizo zombili ukuvinjelwa kwepheshana lokuphuma kwe-ventricular kwesokunxele ngesikhathi esifanayo ukungasebenzi kahle kwe-mitral Uma ingelashwa, ingaholela ezinkingeni eziqhubekayo zenhliziyo nemithambo yegazi.
• Amandla okububula kwenhliziyo angahluka kuye ngokushaya kwenhliziyo. Ngakho-ke, i-echocardiography iyadingeka ukuze kuhlolwe izinguquko eziguquguqukayo kumakati ane-SAM esolwayo.
SAMI-HCM yisimo esibalulekile senhliziyo esithinta i-ventricular outflow tract futhi ihlotshaniswa ne-HCM. Ezimweni ze-SAM ezitholwe emakati, kubalulekile ukusungula uhlelo olunembile lokuxilongwa kanye nokwelashwa. i-ultrasound yenhliziyo (i-echocardiography) Lokhu kufanele kwenziwe. Ukukhononda kungase kugqame kakhulu ngezinga eliphezulu lenhliziyo futhi kunyamalale ngamanani aphansi, ngakho ukuqapha izinguquko eziguquguqukayo kubalulekile. Ukwelashwa kuhloselwe ukuphatha i-HCM ewumsuka kanye nokunciphisa izimpawu.
DR VOTO, yini i-dynamic right ventricular outflow tract block?
DR IVOTOyisimo senhliziyo esibangelwa ukufinyela okuguquguqukayo kwepheshana lokuphuma kwe-ventricular elilungile. Lesi simo ngokuvamile abalungile kuthathwa njengokububula futhi kuvame ukuba kuphela izinga eliphezulu lenhliziyo (tachycardia) ezwakalayo.
Indlela
1. Ukunyakaza Okudlulele Kodonga Olukhululekile Lwe-Ventricular
• I-DR VOTO yenzeka ngenxa yokunyakaza okungavamile kodonga olukhululekile lwe-ventricular yesokudla.
• Lokhu kunyakaza ngokweqile kubangela ukucindezelwa kwe-ventricular outflow tract kanye nokuncipha kwesikhashana (i-dynamic stenosis).
2. Ukugeleza Kwegazi Okuyaluzayo
• Igazi eligeleza lisuka ku-ventricle kwesokudla liya emthanjeni wamaphaphu lidala isiphithiphithi emgudwini wokuphuma owumngcingo, ukububula kwe-systolic kuzwakala ngokuthi.
Ukubaluleka Komtholampilo
• Ukububula Okuhle:DR VOTO, ezimweni eziningi ezingahlobene nesifo senhliziyo Kungukububula okuhle.
• Ubudlelwano ne-HCM: Ezimweni ezingavamile i-hypertrophic cardiomyopathy (HCM) Kungase kuhlotshaniswe nezifo zenhliziyo ezifana. Nokho, lokhu kuhlobana ngokuvamile akuvamile.
• Ubudlelwano Nezifo Zesistimu:DR VOTO, kwezinye izimo i-anemia noma kungase kubonakale nezinye izifo zesistimu. Ngakho-ke, kubalulekile ukuhlola isimo sesistimu esicashile.
Ukububula Okunamandla Nokuxilongwa
• Isilinganiso Senhliziyo Ephakeme Ukubaluleka:DR VOTO ukububula ngokuvamile kubonakala ngezinga eliphezulu lenhliziyo futhi kungase kunyamalale lapho izinga lokushaya kwenhliziyo libuyela kokujwayelekile.
• I-EchocardiographyUkuqinisekisa ukuphuma kwe-ventricular kwesokudla ukuncipha kanye nokunyakaza kwamahhala odongeni i-echocardiography kufanele isetshenziswe.
DR IVOTONgokuvamile kuyisimo esibucayi futhi asibangeli izinkinga ezibalulekile emtholampilo kumakati amaningi. Nokho, i-hypertrophic cardiomyopathy, i-anemia Kubalulekile ukuhlola imbangela eyinhloko yamakati ngokukhononda ngoba, nakuba kungavamile, kungahlotshaniswa nezinye izifo zesistimu. Njengokukhononda okuguquguqukayo, ukushuba kwe-DR VOTO kungahluka kuye ngezinga lokushaya kwenhliziyo futhi kungase kudinge ukuhlolwa okunemininingwane kwe-echocardiographic.
Ezinye Izihloko Ongase Uzithande
"Okungekho emizweni akukwazi ukuba semqondweni."
UJohn Locke
