Cardiac: na farko (systolic), na biyu (diastolic) - kullum da kuma Pathology

Da farko phonendoscopes aka folded tube zanen gado ko m bamboo da sandunansu, kuma da yawa likitoci amfani kawai nasu ji. Amma duk suka so su ji abin da aka faruwa a ciki da jikin mutum, musamman a lokacin da ta je irin wannan muhimmanci jiki kamar zuciya.

Zuciya sauti - sauti da cewa ana samar a cikin aiwatar da rage tsokar bango. Yadda aka saba, da lafiya da mutum yana da wani biyu-sautin, wanda zai iya a tare da ƙarin sauti dangane da abin da irin pathological aiwatar tasowa. A likita a wani sana'a dole ne su iya ji wadannan sauti da kuma fassara su.

cardiac sake zagayowar

The zuciya beats a mita na daga sittin zuwa tamanin lashe minti daya. Wannan, ba shakka, da talakawan darajar, amma casa'in cikin dari na mutanen da a duniya fall karkashin shi, wanda ke nufin za ka iya dauke shi a matsayin na kullum. Kowane harbi kunshi biyu m aka gyara: systole da diastole. Systolic zuciya sauti, bi da bi, ne zuwa kashi atrial da kuma na ramin zuciya. By lokacin yana daukan 0.8 seconds, amma zuciya yana da lokaci zuwa mu'ãmalar da kuma shakata.

systole

Kamar yadda aka ambata a sama, da biyu aka gyara su ne da hannu. Da farko, akwai atrial systole: ganuwar da kwangila, jini a karkashin matsin shiga ventricles, bawuloli da shutters Gasa. A da sauti na rufe da bawuloli da kuma ji a cikin stethoscope. Wannan duka aiwatar daukan 0.1 seconds.

Sa'an nan ya zo da na ramin zuciya systole, wanda shi ne mai yawa fiye da hadaddun aiki fiye da shi ne yanayin da atria. Don fara, mun lura cewa aiwatar daukan sau uku daina - 0.33 seconds.

Da farko lokacin - da irin ƙarfin lantarki na ventricles. Yana hada lokaci asynchronous da Yanar gizo contractions. Yana duk farawa da gaskiya cewa eclectic bugun jini farfagandar tare da myocardium, ya yi murna da mutum tsoka zaruruwa da kuma sa su su spontaneously mu'ãmalar. Saboda wannan, shi ne canza siffar da zuciya. Saboda da atrioventricular bawuloli an rufe tam, da kara matsa lamba. To, akwai wani karfi ƙanƙancewa na ventricles, da kuma jini shiga lakã ko na huhu jijiya. Wadannan biyu bulan dauki 0,08 seconds da kuma 0.25 seconds suka rage a cikin jini shiga cikin babban tasoshin.

diastole

A nan, kuma, shi ne, ba haka sauki kamar yadda ta iya ze farko duba. Na ramin zuciya shakatawa yana 0,37 seconds da kuma daukan wuri a matakai uku:

1. Protodiastolic: bayan da jini bar zuciya, matsa lamba a cikin kogo an rage da kuma bawul, abu don manyan tasoshin, an rufe.
2. Yanar gizo shakatawa: shakata da tsokoki ci gaba, da matsa lamba da dama kara da hada kai tare da atrial. Daga wannan atrioventricular bawuloli bude, da kuma jini daga atria ga ventricles da dama.
3. Cika da ventricles: matsin dan tudu tare da m cika da ƙananan ɗakunan ajiya na zuciya. Lokacin da matsa lamba da aka farke, da jini ya kwarara a hankali slows saukar sa'an nan ya tsaya.

A sake zagayowar aka sa'an nan maimaita sake, da suka fara da systole. Its duration ne ko da yaushe guda, amma diastole za a iya taqaitaccen ko tsawo dangane da zuciya rate.

Ginshikai na samuwar Na sautin

Kamar yadda m kamar yadda na iya sauti, 1 sautin na zuciya kunshi hudu aka gyara:

1. Bawul - shi ne abu zuwa sauti ilimi. A gaskiya, wannan canji atrioventricular bawul leaflets a karshen na ramin zuciya systole.
2. Muscle - oscillatory motsi na ventricles a lokacin ƙanƙancewa.
3. Jijiyoyin bugun gini - mikewa da babban jirgin ruwa da ganuwar a lokacin da jini da dama.
4. Atrial - atrial systole. Wannan nan da nan farkon farko farar.

Ginshikai na samuwar II sautin kuma ƙarin sautunan

Saboda haka, 2 sautin zuciya ya hada biyu kawai aka gyara: a bawul da jijiyoyin bugun gini. Farko - wannan ne sauti da cewa ya zo daga jinin lashe a bawul arts da kuma huhu akwati a wani lokaci a lokacin da suke har yanzu rufe. Na biyu, shi yana da jijiyoyin bugun gini bangaren - wani yunkuri na manyan tasoshin ganuwar, a lokacin da ta bude yatsun da aka bude a karshe.

Bayan da biyu manyan, duk da haka rarrabe sautunan 3 da 4.

Uku sautin - wani canji na na ramin zuciya myocardium a lokacin diastole, a lokacin da jini gudana passively a cikin wani yanki na low matsa lamba.

Fourth sautin bayyana a karshen systole da ake dangantawa da karshen ga fitar jini daga atria.

Halayyar Na sautin

Cardiac dogara ne a kan al'amurra da dama, duka biyu intra- da extracardiac. 1 sonority sautin dogara a kan haƙiƙa jihar na myocardium. Saboda haka, a farkon girma da aka bayar da m ƙulli daga cikin zuciya bawuloli da kuma kudi a da ventricles an rage. Dauke sakandare fasali kamar bude yatsun yawa daga atrioventricular bawuloli kazalika da matsayin su, a cikin zuciya kogo.

Shi ne mafi kyau don sauraron farko zuciya sauti a saman shi - a cikin 4-5 intercostal sarari bar na sternum. Don ƙarin m kula wajibi ne don feat. Irfan daga cikin kirji a cikin wannan yankin da kuma a fili ayyana iyakokin cardiac dullness.

Halayyar farar II

Abin da ya saurare shi, shi wajibi ne don sa kararrawa stethoscope kan zuciya tushe. Wannan batu ne dan kadan da dama daga cikin xiphoid tsari na sternum.

A girma da kuma tsabta daga cikin biyu sautin ne ma dogara a kan yadda tam da bawuloli an rufe, amma yanzu semilunar. Bugu da kari, gudun aikinsu, da aka rufe da free iyakar da oscillation rinjayar da sake kunnawa sauti. Kuma ƙarin Properties ne da yawa daga duk Tsarin da hannu a cikin samuwar sautin, kazalika da matsayi na bawuloli a lokacin da fitar jini daga zuciya.

Dokokin auscultation na zuciya sauti

The sauti na zuciya shi ne mai yiwuwa mafi calming a duniya, bayan da fari amo. Masana kimiyya sun hypothesized cewa shi ne ya yaro ya ji a utero. Amma domin ya gane lalacewar da zuciya, kamar su ji yadda beats, shi ne bai isa ba.

Da farko tsunduma a auscultation bukatar a shiru da kuma wurin dumi. A matsayi na wani mutum ya dogara da abin da irin bawul kana bukatar ka saurare da lura. Wannan na iya zama matsayin kwance a kan hagu gefe, tsaye, amma tare da gaba karkata gidaje a gefen dama, da sauransu. D.

A haƙuri ya zama m da m numfashi, da kuma bisa ga likita ta request rike ka numfashi. Domin fahimtar inda systole da diastole inda likita ya kamata a layi daya tare da sauraron tausa carotid jijiya bugun jini wadda tayi daidai da kwanakin gaba ɗaya tare da systolic lokaci.

The domin na zuciya auscultation

Bayan wani na farko da dalilin da cikakkar da kuma zumunta cardiac dullness likita jin zuciya sauti. Ya fara, a matsayin mai mulkin, tare da saman jiki. To akwai da mitral bawul ne audible. Sa'an nan matsawa zuwa bawuloli daga cikin manyan jijiyoyi. Farko ga aortic - a karo na biyu intercostal sarari to da dama daga cikin sternum, sa'an nan zuwa ga huhu jijiya - a wannan matakin, kawai zuwa hagu.

A karo na hudu batu domin sauraro - wannan shi ne tushe na zuciya. An located a gindi daga cikin xiphoid tsari, amma za a iya canja zuwa gefe. Saboda haka da cewa likita ya kamata a duba abin da nau'i na zuciya da kuma lantarki axis a daidai saurare tricuspid bawul.

Ƙididdigar auscultation a Botkin-Erba. Za ka iya ji da aortic bawul. Shi ne a karo na hudu intercostal sarari a hagu na sternum.

ƙarin sautunan

zuciya sauti ne ba ko da yaushe tuna rhythmic akafi. Wani lokaci, mafi sau da yawa fiye da zai zama kyawawa, yana daukan m siffofin. Wasu daga cikin wadannan likitoci sun koya su gane kawai ta saurãre. Wadannan sun hada da:

- Danna mitral bawul. Ya za a iya ji a kusa da koli na zuciya, shi ake dangantawa da kwayoyin canje-canje na bawul leaflets da kuma bayyana ne kawai a lokacin da ya samu zuciya lahani.

- Systolic click. Wani irin mitral bawul. A wannan yanayin, shi bude yatsun an rufe tam, kamar yadda idan ya jũya daga cikin a lokacin systole.

- Perekardton. Found lokacin da m pericarditis. Hade da matsanancin dilation na ventricles saboda kafa a ciki da abin tsayawarta line.

- The kari na quail. Akwai mitral stenosis, bayyananne kayan haɓɓaka aiki na farko sautin, biyu sautin girmamawa a kan na huhu jijiya da kuma mitral bawul click.

- gallop. Dalilin da ya faru shi ne don rage tsokar sautin, ta bayyana a kan bango tachycardia.

Extracardiac sa karawa da attenuation sautunan

The zuciya beats a cikin jiki domin rayuwa, ba tare da karya da kuma holidays. Saboda haka, a lokacin da shi sa fita, da daukar sauti daga cikin ayyukansa bayyana extraneous. A dalilan da wannan iya ko dai kai tsaye nasaba da lalata da zuciya, kuma kada ku dogara ne a kan shi.

sautunan taimakawa wajen} arfafa:

- cachexia, anorexia, bakin ciki da kirji bango.

- huhu atelectasis ko sãshensa.

- busa a cikin na baya mediastinum, motsa sauƙi.

- infiltration na ƙananan lobes daga cikin huhu.

- bullae a cikin huhu.

A weakening na zuciya sauti:

- wuce kima nauyi.

- da ci gaban da tsokoki daga cikin kirji bango.

- subcutaneous emphysema.

- gaban ruwa a cikin thoracic kogo.

- exudative pericarditis.

Intracardiac dalilai domin karfafa da kuma weakening na zuciya sautunan

Cardiac bayyanannu, rhythmic a lokacin da mutum yake a sauran ko a lokacin barci. Idan aka koma, misali, ya hau matakala zuwa ofis likita, shi zai iya sa a zuciya sauti karawa. Har ila yau, hanzari na zuciya rate za a iya lalacewa ta hanyar anemia, endocrine cututtuka, da dai sauransu.

Kurãme zuciya sauti aka saurari tare da samu zuciya cututtuka, kamar mitral ko aortic stenosis, insufficiency na bawuloli. Taimakonsa da ya zo da aortic stenosis a sassan da suke kusa da zuciyarsa: da hawa na baka, da na sauko part. Muffled zuciya sautina hade tare da karin tsokar taro, kazalika da kumburi cututtuka na zuciya tsoka, manyan ga degeneration ko sclerosis.

zuciya Murmurs

Bayan launuka, likita zai iya ji wasu sauti, da ake kira amo. Suna kafa daga haukan kogi na jini ya kwarara, wanda ya wuce ta rami na zuciya. Yadda aka saba, da suka kada ta kasance. Duk sautuna za a iya raba kwayoyin da aikin.

1. Organic bayyana a lokacin da sashin jiki ilimin Halittar Jiki faruwa, babu ja canje-canje a cikin bawul tsarin.
2. Aikin amo hade tare da mai illa jijiya wadata ko ikon papillary tsokoki, ya karu zuciya kudi da kuma jini ya kwarara kudi, wani karu a danko.

Noises iya bi zuciya sauti, kuma zai iya zama mai zaman kanta da su. Wani lokaci pleural gogayya a kumburi cututtuka ne superimposed a zuciya, sa'an nan kuma za ku tambayi mãsu haƙuri rike da ya numfashi da kuma jingina a gaba sake rike auscultation. Wannan sauki m iya taimaka kauce wa kuskure. Yawanci, a lokacin da sauraron da amo na pathological Gwada domin sanin a cikin abin da lokaci na cardiac sake zagayowar da suka faru, wuri mafi kyau a sami da kuma tattara sauraron amo halaye: ƙarfi, duration da shugabanci.

Properties amo

Timbre da dama iri amo:

- taushi ko hurawa (yawanci ba a hade tare da Pathology, sau da yawa a cikin yara).

- m, scraping kuma sawing.

- music.

Domin da duration bambanta:

- takaice.

- dogon.

By girma:

- shiru.

- m.

- ragewa.

- girma (musamman a takaita na hagu atrioventricular orifice).

- incrementally-ragewa.

Don canja ƙara a lokacin rubuta daya daga cikin bulan na cardiac aiki.

Height:

- high (a lokacin da aortic stenosis).

- low mita (mitral stenosis).

Akwai wasu janar alamu a cikin auscultation amo. Na farko, su saurari kyau ga wurare na bawuloli, saboda da Pathology na wanda suka samu. Abu na biyu, da amo haskakawa shugabanci na jini ya kwarara, ba da shi. Kuma uku, kamar yadda zuciya ke sauti, mahaukaci sautuna mafi kyau ji inda zuciya ba a rufe tare da wani haske, kuma tam shigeba, ga kirji.

Systolic murmurs ne mafi alhẽri don sauraron a supine matsayi, saboda ya kwarara daga jini daga ventricles zama sauki da kuma sauri, da kuma diastolic - zaune, saboda a karkashin karfi na nauyi, da ruwa daga atria ga ventricles da dama da sauri.

Surutu za a iya bambanta bisa ga wuri, kuma da cardiac sake zagayowar lokaci. Idan amo a cikin wannan wuri ya bayyana a systole da diastole, shi yayi magana akan hada raunuka na bawul. Idan amo bayyana a systole a daya batu, da kuma a diastole - da sauran - shi ne riga mai hada asarar biyu bawuloli.