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Auscultation of hearts

Consistently to describe the characteristic of tones and noise accordingly valves of heart.

Cardiac rhythm: rhythmical, arrhythmic (ectopic beats, atrial fibrillation etc.).

Heart apex of (cardiac apex) (mitral valve (bicuspid, left atrioventricular) sounds: clear, are muffled, deaf; first sound: quiet, amplified, clapping, splitting, reduplication, «the opening snap»; both sounds are reduplicate; III tone in protodiastole, opening snap of mitral stenosis, mid-systolic clicks associated with mitral valve prolapse, (quail rhythm), and the sounds associated with mechanical prosthetic heart valves; triple rhythm (gallop rhythm) — presystolic, protodiastolic, mesodiastolic (summation); pendulum rhythm or embryocardia; murmur — systolic, presystolic, middiastolic.

Zone of the tricuspid valve (Base of the xiphoid process or to the left): systolic, middiastolic murmur, their amplification at a breathing (symptom Korvalo).

Aortic valve (second right intercostal space): reduplication of the first sound «the opening snap», ejection clicks arising in the aorta, the second sound — is amplified (accent), reduplicated, splitting, quiet; murmur — systolic, protodiastolic (early protodiastolic).

Pulmonary valve (second intercostal space to the left of the sternum): reduplication of the first sound («the opening snap»), ejection clicks arising in the aorta, second sound — is amplified (accent) - reduplicated, splitting, quiet; noise — systolic, continuous ("machinery", tearing of fabric).

Under indications — auscultation in additional points (Botkin-Erb’s point (to the left of the sternum at the third and fourth costosternal articulation)).

At presence of endocardiac murmurs is necessary to determine: phase its character (systolic, presystolic, protodiastolic, mesodiastolic etc.), epicentre (localization of a maximum), radiation, individual features (intensity (loudness) — just audible, quiet, moderatory loud, loud, very loud, audible without stethoscope; the relation to I, to II tone; duration — during what part of a systole (holosystolic (pansystolic), early systolic, midsystolic, late systolic) or diastole (holodiastolic (pandiastolic), early diastolic (protodiastolic), middiastolic (mesodiastolic, delayed diastolic), presystolic (atrial systolic)), or both of them – continuous (artieriovenosus) murmur; the configuration (increasing, decreasing etc.) decrescendo, crescendo, crescendo-decrescendo, plateau; quality (timbre) — soft, flow, musical, rough, scratchy, squeaker, harsh, rumbling, mewing, saw-like etc.; amplification at a breathing, in position on left or on the right side, after physical activity, the Valsalva Manoeuvre etc.).

Exocardiac murmurs: pericardial friction — epicentre, extent, loudness, amplification at an exhalation or inhalation; pleuropericardial sound, localization.

Research of vessels

Inspection: abnormal pulsaton: carotid pulsation («carotid dancing»), temporal, subclavian, humeral, cubital, crimpiness.

 



Palpation. Pulse on radial artery: pulse rate per minute, rhythm (rhythmic (regular), arrhythmic (irregular) — extrasystolic arrhythmia — sporadic bigeminal, trigeminy, quadrigeminy, fibrillation, etc.; deficiency of pulse (Jackson's symptom)), volume (full (pulsus plenus), decreases (pulsus vacuus)), size (large-volume (pulsus magnus) or high pulse (pulsus altus), small (pulsus parvus), thready (pulsus filiformis); uniformis (equal (pulsus aequalis), unequal (pulsus inaequalis), alternating (pulsus alternans)); similarity on both hands (identical (equally) various filling), pressure (hard (high tension), mollis), character (quick (pulsus celer or salience), quick and high (pulsus celer et altus)), slow (pulsus tardus), slow and small (pulsus tardus et parvus)); dicrotic (pulsus dicroticus); paradoxical (pulsus paradoxus); properties of an arterial wall (soft, elastic, hard). The arterial blood pressure in brachial artery: systolic (maximal), diastolic (minimal), pulse pressure (sphygmic), millimeters of mercury column.

Pulsation (volume) of other arteries: carotid, subclavian, brachial, femoral, popliteal, arteries of feet (satisfactory, full, absent — on the right, on the left). Capillary (Quincke's) pulse.

Auscultation: carotid, subclavian, abdominal aorta, renal, iliac, femoral arteries (systolic, continuous murmur, doubled tone (Traube’s doubled tone), Vinogradov-Duroziez doubled tone). Swelling of cervical veins, venous pulsation: negative (atrial), positive (ventricular); «nun’s murmur» (on jugular vein);

Venous collateral, varicose veins.

 




Date: 2015-01-02; view: 908


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