心脏听诊要点(英文).docVIP

Heart murmurs 1.Valve area and anatomic position: 2.S1:closing of mitral valve and tricuspid valve onset of systole Systole: draining of ventricles S2:closing of pulmonary artery valve and aortic valve: onset of diastole Diastole: filling of ventricles 3. How to describe a murmur? ?Timing(most important) ?Intensity(important) ?Shape ?Pitch ?Location(important) ?Radiation ?Dynamic Auscultation (changes with maneuvers) 5. Basic murmurs Systolic Systolic ejection murmurs Aortic stenosis(a narrow outflow for left ventricle) systolic, crescendo-decrescendo, high pitched murmur located at the aortic listening post radiates to the carotid arteries. As AS worsens, the murmur peaks later in systole. ? paradoxical split S2 heart sound (if the S2 is audible). ? In severe AS, the S2 heart sound is almost absent ? systolic murmur at aortic post, pathological murmur is more common, which is caused by Valvular aortic stenosis comparative aortic stenosis is caused by Aortic atherosclerosis, hypertension. The sound is Mild, no thrills, radiate along the right edge of sternum, A2 accentuated. Pulmonic stenosis much less common than aortic stenosis (except in pediatrics) Systolic murmur at pulmonic post functional Child, adolescent: Mild, low pitch, local below 2/6 , supine Hypertrophic Obstructive Cardiomyopathy: similar to that of AS. heard best at the left lower sternal border. Maneuvers are crucial to distinguish HOCM from AS. Any maneuver that decreases LV volume will worsen the obstruction thus increasing the murmur. The opposite is also true. Pansystolic murmurs Mitral/tricuspid regurgitation ?The murmur of MR is a holosystolic, uniform, high pitched murmur heard best at the mitral listening post (apex) radiating to the axilla. ? three different holosystolic: MR, TR, and VSD. ?The intensity of the murmur does not change with respiration (helps to distinguish from TR). ? often the S1 and S2 sounds is overwhelmed by the