Auscultation of the heart in children and adults
Two centuries have passed since then, as the French doctor Rene Laennec created the first device to listen to the patient's heart — a stethoscope. A year later the auscultation of the heart was practiced by doctors. Appeared benefits of mastering the technique.
Modern doctors are of a sufficiently serious diagnostic facilities, based on precise and sensitive devices. But still from a novice doctor requires the ability to independently apply basic methods and make a preliminary diagnosis based on their own senses.
Medical students study methods of approach to the patient, learning to treat individual symptoms and their significance in pathology. This course is called propaedeutics. It is a preclinical opportunity to study a minimal examination of the person and ways of interpretation of the results.
What methods should be taken by the doctor
Narrow medical specialization does not preclude General training of treating doctor. A standard set of knowledge and skills of novice doctors must include:
- a personal examination of the patient;
- palpation — palpation of dense body region to determine the consistency of size; the pulse, the heart — to determine the shock wave force of the cardiac impulse;
- percussion — definition of the boundaries of stupidity on the character of the sound obtained by tapping a finger over the bodies having different densities;
- auscultation — auscultation of the standard points of the body located above the zones closest to the movement of the liquid inside the hollow bodies from the velocity and the obstacle depends on the noise.
Consider the possible results of application of methods of propedeutics in the diagnosis of cardiac pathology.
Perception of sound signal is broken for subjective reasons:
- fatigue doctor;
- in the elderly.
This is a serious disadvantage. The patient have to listen again examined lying down, standing, after squats. Currently, in place of the stethoscope stethoscopes are prepared with the function of amplifying the audio signal and filter noise. Such auscultation will be more objective and reliable.
However, this does not absolve the doctor of responsibility for the accumulation of experience in recognition of heart sounds and murmurs.
A standard technique for auscultation of heart
The technique of listening to heart is simple, but requires compliance with certain sequence. Doctors learn the sequence of actions from his student years and do it without hesitation.
The procedure starts with the proposals for the patient to remove outer clothing. With abundant chest hair hairs moisten with water or cream. The point of listening to a selected minimumthe distance between the study area and the head of the stethoscope. The standard provides for 5 points as a mandatory set, but in pathology it is possible to use and other.
Before listening to each point of the doctor "command": "Take a deep breath, exhale everything and hold your breath!" On the exhale, shrinking air space of the lung tissue and the heart "closer" to the chest. Therefore, the sound will be more clear and strong.
The same effect is expected from the listening position on the left side. To enhance the intensity sometimes offer naturalise or do some sit-UPS.
As formed, the tones, the interpretation of deviations from the norm
Necessarily in each point of listening to two interrelated impact. It tones the heart. They are all healthy. Less able to listen to the third and even the fourth tone.
The first tone is called systolic, it consists of several components:
- the work of the Atria;
- muscle — caused by the fluctuations of tense muscles of the ventricles;
- valve — is the main component, is formed by the oscillating flaps of the atrioventricular valves;
- vascular — includes the wall of the aorta and pulmonary artery and valve apparatus.
The character of the sound can be considered:
- deaf — hypertrophy of left ventricle, myocarditis, cardiosclerosis, dystrophic changes;
- quiet, velvet — myocardial infarction;
- weak, as if coming from a distance — at exudative pleurisy, emphysema, a significant thickness of the chest wall;
- loud, banging — in neurosis, thyrotoxicosis, stenosis of the left atrioventricular holes, anemia, high fever, arrythmia;
- forked — during the blockade of bundle branch block, hyperthyroidism, aneurysm in the apex of the heart, degeneration of the myocardium.
The second tone is formed at the beginning of diastole, is called the collapse of the semilunar valves of the pulmonary artery and aorta. In a healthy person, he focused on the aorta. In cases of "pulmonary heart disease" hypertension in the pulmonary — pulmonary artery.
In atherosclerotic lesions of the aorta, vascular dilation the second tone rings and resonates. The split observed in aortic aneurysm and mitral stenosis.