Cardiac: wokutanga (systolic), wechipiri (diastolic) - wokuyera uye zvokurwara

phonendoscopes okutanga akapeta chubhu machira kana mhango yemishenjere tsotso, uye vanachiremba vakawanda vanoshandisa chete pachavo kunzwa kwavo. Asi ivo vose vaida kunzwa zvaiitika mukati muviri, kunyanya kana totaura zvakadaro muviri chinokosha somoyo.

Mwoyo rinonzwika - ruzha kuti anobudiswa mubishi kuderedza rusvingo myocardial. Kazhinji, munhu ane utano hwakanaka ane mbiri-matauriro, izvo angaperekedzwa okuwedzera ruzha zvichienderana worudzii pathological kwacho hwapedyo. Chiremba chero dzakagadzirirwa vanofanira kukwanisa kunzwa ruzha izvi uye kuhududzira.

cardiac kutenderera

Mwoyo anorova panguva kakawanda anorova kubva makumi matanhatu kusvika makumi masere paminiti. Izvi Chokwadi, paavhareji kukosha, asi makumi mapfumbamwe kubva muzana vanhu panyika kuwa pasi payo, izvo zvinoreva unogona kutora chaiwo. Mumwe bara ine mbiri anotevedzana zvinoriumba: systole uye diastole. Systolic mwoyo ruzha, akavapindurawo, rakakamurwa atrial uye ventricular. Pakazosvika nguva zvinotora 0,8 masekonzi, asi mwoyo une nguva kubata uye kuzorora.

systole

Sezvataurwa pamusoro apa, zvakamisa hurongwa maviri unobatanidzwa. Pakutanga, hapana atrial systole: masvingo chibvumirano dzavo, ropa pasi kumanikidza anopinda ventricles, mavharuvhu uye utorwe slam. Yakanga inzwi nokuvhara mavharuvhu akanzwa ari stethoscope. Izvi yose muitiro zvinoda 0.1 seconds.

Zvadaro wouya ventricular systole, chinova zvikuru kunzwisisa mashandiro kupfuura zvakaita atria. Chokutanga, tinoona kuti kwacho zvinoda katatu kwenguva - 0.33 seconds.

First nguva - the voltage of ventricles. Hunosanganisira danho asynchronous uye Isometric sunga. Zvakangotanga rinotanga pakuti eclectic kupomba propagates achifamba myocardium, iye excites munhu tsandanyama fibers uye chinoita kuti nomuzvarirwo kubata. Nokuda kwaizvozvi, zviri kuchinja chimiro mwoyo. Nokuda atrioventricular mavharuvhu dzakavharika zvakasimba, kuwedzera kumanikidza. Zvadaro pane marwadzo pakati ventricles simba, uye ropa anopinda yeropa kana pulmonary tsinga. maitikiro maviri aya kutora 0.08 masekonzi uye 0.25 nemasekonzi vakasara muropa anopinda chikuru midziyo.

diastole

Panowo, hazvina kudaro nyore sezvo zvingaita sokuti pakutanga kuaona. Ventricular kutandara rinovapo 0.37 masekonzi uye kunoitika mumatanho matatu:

1. Protodiastolic: pashure ropa akasiya mwoyo, kumanikidzwa waro mhango ipfupi uye vharuvhu, zvichitungamirira midziyo makuru, dzakavharika.
2. Isometric kutandara: kwenyama dzemuviri inopfuurira, kumanikidza anowira mberi uye dzichienderana atrial. Kubva ichi atrioventricular mavharuvhu akazaruka, uye ropa kubva atria kusvika ventricles rinokundwa.
3. Kuzadza ventricles: muedzo gradient achitevedza Urume anozadza rezasi Makamuri mwoyo. Kana nhamo iri equalized, ropa kubuda zvishoma nezvishoma DZEMUNHU DZINODZORA uye ipapo anomira.

The kutenderera ari ipapo akadzokorora zvakare, kutanga systole. Its chinguva nguva dzose chete, asi diastole inogona pfupi kana mazhinji zvichienderana kwemwoyo.

The mashandiro pamusoro inotungamirwa I matauriro

Sezvo chinoshamisa sezvo zvinganzwika, 1 mataurire mwoyo ine yenhengo zvina:

1. Valve - nayo inoenda dzidzo inzwi. Kutaura zvazviri, izvi kusiyana-siyana atrioventricular vharafu mapepa pakupera ventricular systole.
2. Muscle - oscillatory inofamba of ventricles panguva marwadzo.
3. Vascular - Munotatamura huru mudziyo masvingo panguva apo ropa ravo kumanikidzwa Falls.
4. Atrial - atrial systole. Izvi pakarepo pakutanga wokutanga nebhitumini.

The mashandiro pamusoro inotungamirwa II matauriro uye mamwe zvenzwi

Saka, 2 matauriro mwoyo kunosanganisira zviviri chete zvinoti: a vharafu uye vascular. First - ichi ruzha rinobva ropa anorova ari vharuvhu unyanzvi uye pulmonary hunde panguva vachiri kuvharwa. Chechipiri, ine vascular pakuderedza - sangano hari huru madziro, kana ichibhabhamisa akazarurwa pakupedzisira.

Kunze maviri makuru, asi kusiyanisa zvenzwi 3 uye 4.

inzwi Third - a kusiyana-siyana kwezvinhu ventricular myocardium panguva diastole, kana ropa runoyerera tinyerere ive nzvimbo yakaderera kumanikidzwa.

Matauriro chechina rinowanikwa pakupera systole uye chokuita pakuguma kudzingwa ropa kubva atria.

Mamirire I matauriro

Cardiac kuvimba zvinhu zvizhinji, zvose intra- uye extracardiac. 1 sonority mataurire kunobva chinangwa mamiriro myocardium. Saka, pakutanga vhoriyamu inopiwa vakabatisisa kuvhara mwoyo mavharuvhu uye mwero uko ventricles vari kuderedzwa. Vaiona yechipiri zvinhu zvakadai ichibhabhamisa arambe achirema kuti atrioventricular mavharuvhu uyewo nzvimbo yavo mumwoyo mhango.

Zvakanaka kuteerera wokutanga mwoyo kurira pamusoro payo - iri 4-5 intercostal nzvimbo wakasiya sternum. Kuti uwane yakarurama anoona zvakakodzera kuti percussion pechipfuva munzvimbo iyi uye kuti chidzore zvakajeka miganhu cardiac dullness.

Mamirire nenamo II

Chii kumuteerera, zvakakodzera kuisa bhero stethoscope pamusoro mwoyo nechimwe. iyi ndiyo zvishoma kurudyi xiphoid muitiro yacho sternum.

Vhoriyamu uye Kujeka wechipiri matauriro ndiyewo novimba sei zvakasimba kuti mavharuvhu dzakavharika, chete ikozvino semilunar. Mukuwedzera, kumhanya basa ravo, kuti unotsinzina vakasununguka kumugumo oscillation rinokanganisa playback inzwi. Uye mamwe ehupfumi ndiwo arambe achirema vose zvivako zvinobatanidzwa paumbwe matauriro, uyewo nzvimbo mavharuvhu panguva kudzingwa ropa kubva mumwoyo.

Mitemo auscultation mwoyo ruzha

zvimwe Kurira mwoyo kupfuura chinozorodza munyika, mushure chena ruzha. Masayendisiti hypothesized kuti akanga mwana wake anonzwa ari utero. Asi kuti rione kuvadza mwoyo, kungonzwa sei anorova, hazvina kukwana.

Zvikurukuru mubasa auscultation vanoda akanyarara uye kwoushamwari nzvimbo. The Makogon womunhu kunoenderana worudzii vharafu unofanira kuteerera vakachenjerera. Izvi zvinogona kuva nzvimbo norutivi rwake rworuboshwe, vertically, asi pamwe pokugara mberi kurerekera kurudyi, uye zvichingodaro. D.

Murwere anofanira kuva mashoma uye kudzika kufema, uye maererano chiremba chikumbiro kubata mweya wako. Kuti tinzwisise zvakajeka apo systole uye diastole apo chiremba inofanira kuenderana ne kuteerera palpate ari carotid tsinga kupomba rinobatana zvachose kufambidzana systolic chokutambudzika.

Hurongwa mwoyo auscultation

Pashure rokutanga Kutsunga kwakakwana uye hama cardiac dullness chiremba anoteerera mwoyo kurira. Rinotanga, sezvo mutemo, pamwe pamusoro muviri. Zvakanaka ipapo mitral vharuvhu iri anzwike. Zvadaro kufamba kuti mavharuvhu guru arteries. Yokutanga kutsemuka - yechipiri intercostal nzvimbo kurudyi sternum, zvadaro pulmonary tsinga - panguva iyoyo yakati sandara, chete kuruboshwe.

Wechina inokosha kuteerera - ndiwo mujinga mwoyo. Riri mujinga ari xiphoid kwacho, asi zvinogona zvava kurutivi. Saka kuti chiremba vanofanira kuongorora kuti chimiro mwoyo uye magetsi akabatana kuti zvakarurama kuteerera tricuspid vharafu.

Rounding auscultation pana Botkin-Erba. Unogona kunzwa mashoko kutsemuka vharuvhu. It ari intercostal chechina nzvimbo kuruboshwe yacho sternum.

Zvimwe zvenzwi

mwoyo wakagadzikana haisi nguva dzose anoyeuchidza mutinhimira the clicks. Dzimwe nguva, kakawanda kupfuura yaizova yakanaka, zvinoda noshamisa siyana. Vamwe vanachiremba izvi vakadzidza kuziva chete nokuteerera. Idzi dzinosanganisira:

- Baya mitral vharuvhu. Iye anogona kunzwika pedyo chakaderedzwa mutengo kwemoyo, inobatanidzwa Organic rokuchinja vharuvhu mapepa uye chete anooneka kana vawana mwoyo kuremara.

- Systolic watinya. Rumwe rudzi mitral vharafu. Muchiitiko chino, izvozvo ichibhabhamisa dzakavharika zvakasimba, sokunge akatendeuka mukati kubva panguva systole.

- Perekardton. Found apo namira pericarditis. Chokuita kunyanya dilation pamusoro ventricles yakafanira yakaumbwa mukati mooring mutsetse.

- The mutinhimira zvihuta. Pane mitral stenosis, pachena enhancement wokutanga matauriro, wechipiri inzwi Kumikidzo pulmonary tsinga uye mitral vharuvhu watinya.

- gallop. Chikonzero parinowanika ndiko kuderedza myocardial matauriro, zvinoita sokuti uri kumashure tachycardia.

Extracardiac anoita amplification uye attenuation zvenzwi

Mwoyo anorova mumuviri upenyu, pasina anoputsa uye mazororo. Saka, kana wakapfeka kunze, kuti chakayerwa kutinhira mabasa ake kuonekwa extraneous. Zvikonzero iyi kana anogona chokuita zvakananga kukuvadza mwoyo, uye regai kuvimba nayo.

zvenzwi zvinobatsira kusimbisa:

- cachexia, kudya mutete chipfuva rusvingo;

- pulmonary atelectasis kana chacho;

- kuzvimba ari posterior mediastinum, kufamba nyore;

- infiltration repasi lobes ari mumapapu;

- bullae mumapapu.

The kwakaderera mwoyo rinonzwika:

- kunyanya uremu;

- kukura tsandanyama pechipfuva rusvingo;

- subcutaneous emphysema;

- kuvapo mvura iri thoracal mhango;

- exudative pericarditis.

Intracardiac zvikonzero nokusimbaradza uye kwakaderera moyo zvenzwi

Cardiac yakajeka, mutinhimira kana munhu yozorora kana pakurara. Kana akanzwa Somuenzaniso, akakwira masitepisi kuhofisi yachiremba, zvinogona kukonzera mwoyo wakagadzikana amplification. Uyewo, kumhanyisa mumwoyo exchange anogona kukonzerwa kupererwa, kwemakemikari anobudiswa zvirwere, etc.

Matsi mwoyo ruzha iri Akateerera vawana mwoyo zvirwere, zvakadai mitral kana kutsemuka stenosis, insufficiency kuti mavharuvhu. mupiro wake kunounza kutsemuka stenosis mumadhipatimendi kuti vari pedyo nomwoyo wake; asi vachikwira chikamu chinhu chakakombama, kurova kworuoko chikamu. mwoyo Muffled Sounds chokuita rakawedzera myocardial gobvu, uyewo anogumbura zvirwere zvomwoyo tsandanyama, zvichiita kuti degeneration kana kuoma dzimwe nhengo dzomuviri.

mwoyo Inogunun'unira

Kunze mavara, chiremba anogona kunzwa mamwe ruzha, anonzi ruzha. Vari aumba kubva mhirizhonga ropa kuyerera, iyo inopfuura nomunyika mhango mwoyo. Kazhinji, havafaniri kuva. Ruzha All inogona rakakamurwa Organic uye dzichipfekeka.

1. Organic kuoneka apo nhengo anatomical kuitika, kusingarapiki kuchinja vharuvhu mugadziriro.
2. Functional ruzha chokuita havachanyatsogoni tsinga wedzerai kana simba papillary tsandanyama, vakawedzera kwemwoyo uye ropa riyerere zvazvingava, vasanyanye kwayo viscosity.

Ruzha muchiyamura mwoyo ruzha, uye unogona kuva yakazvimirira navo. Dzimwe nguva pleural kukweshera mu anogumbura zvirwere iri seari pamusoro mwoyo, uye ipapo unofanira kubvunza murwere kubata mweya wake uye vakazembera mberi kamwe zvakare kubata auscultation. Izvi Nzira nyore kunogona kubatsira kudzivisa zvikanganiso. Kazhinji, kana kuteerera inzwi pathological kuedza kuona umo chokutambudzika cardiac kutenderera zvaitika, yakanakisisa nzvimbo kuwana uye kuunganidza kuteerera ruzha unhu: simba, nguva uye kutungamirirwa.

ehupfumi ruzha

Timbre marudzi anoverengeka ruzha:

- nyoro kana vachiridza (kazhinji haana chokuita zvokurwara, kazhinji vana);

- kunaka, tichibvisa uye sawing;

- music.

Nokuti nguva musiyano

- pfupi;

- refu;

By vhorumu:

- kunyarara;

- guru;

- kudzikira;

- kukura (zvikurukuru aienda pamusoro kuruboshwe atrioventricular orifice);

- kuwedzerwa-kudzikira.

Kushandura bhuku rakanyorwa mukati mumwe maitikiro ose cardiac basa.

urefu:

- mukuru (kana kutsemuka stenosis);

- pasi kakawanda (mitral stenosis).

Pane dzimwe mapatani mukuru ari auscultation ruzha. Chokutanga, vakateerera zvakanaka nzvimbo mavharuvhu, nokuda zvokurwara iyo ivo dzakaumbwa. Chechipiri, ruzha zvichiratidza mirayiridzo ropa kuyerera, kwete pamusoro payo. Uye wechitatu, somoyo ichirira, kanganisika ruzha zvakanakisisa akanzwa apo mwoyo haina akafuka chiedza uye zvakasimba adherent kuti chipfuva.

Systolic ino- tsutsumwa nani kuteerera vari supine nzvimbo, nekuti aibuda ropa kubva ventricles kunova nyore uye dzichimhanya, uye diastolic - agere, nekuti pasi simba regiravhiti, nemvura kubva atria kusvika ventricles Falls nokukurumidza.

Ruzha zvinogona kusiyaniswa maererano nzvimbo dzavo uye cardiac kutenderera danho. Kana ruzha panzvimbo iri systole uye diastole, izvozvo inotaura maronda akabatana vharuvhu. Kana ruzha anooneka systole pane imwe nguva, uye diastole - mumwe - yatova kurasikirwa yaisanganisa kuti mavharuvhu maviri.