Continuous machine noise

Introduction A continuous machine-like loud murmur in the second intercostal space on the left sternal border, accompanied by continuous tremor, often indicates the presence of patent ductus arteriosus. The clinical manifestations of patent ductus arteriosus mainly depend on the amount of blood flow from the aorta to the pulmonary artery and whether secondary pulmonary hypertension is produced and to what extent. Light can have no obvious symptoms, and severe heart failure can occur. Common symptoms are nausea, shortness of breath, fatigue, fatigue, and prone to respiratory infections and growth retardation.

Cause

Patent ductus arteriosus is a more common congenital cardiovascular malformation. Normally, 10-15 hours after birth, the arterial catheter begins to functionally close, 2 months to 1 year after birth, and most of them are closed. If the patient is still occluded after 1 year of age, the patent ductus arteriosus is not closed.

an examination

Related inspection

Cardiovascular electrocardiogram

There is a loud and rough continuous machine-like murmur in the second intercostal space on the left side of the sternum. It can be transmitted to the neck and back, and can touch the tremor. The second sound of the pulmonary valve area is enhanced. If the flow rate is large, the pulse pressure is widened. Water rushing veins, femoral artery gunshots and other peripheral vascular signs. Need to further do echocardiography. X-ray. ECG. Even through cardiac catheterization and cardiovascular angiography and other examinations can be diagnosed.

When the patent ductus arteriosus is closed, the pulmonary artery receives blood from both the right ventricle and the aorta, increasing blood flow to the pulmonary circulation, increasing blood flow to the left atrium and left ventricle, and increasing left ventricular diastolic load, leading to left atrium and left. The ventricle is enlarged. As the aortic blood is divided into the pulmonary artery, the peripheral arterial diastolic pressure decreases and the pulse pressure is widened. A large number of left-to-right shunts cause pulmonary hypertension. At the beginning, it is a dynamic high pressure, followed by thickening of the pulmonary arteriolar wall. Hardening, leading to obstructive pulmonary hypertension, increased right ventricular burden, right ventricular hypertrophy, and even failure, when the pulmonary artery pressure exceeds the aorta, the pulmonary blood flows back into the aorta, producing a two-way or right-to-left shunt.

Differential diagnosis

Differential diagnosis of continuous machine-like noise:

1, wind-like murmur: common in the mitral valve area and pulmonary valve area, generally high-profile.

2, and the wind-like noise: often a functional murmur; typical rough hairy systolic murmur, often suggesting mitral regurgitation.

3, the murmur is low-key: apical period diastolic rumbling murmur is a feature of mitral stenosis.

4, gas-like murmur: seen in the aortic valve area, the characteristics of aortic valve insufficiency.

5, the sound of noise is high-profile: the noise of musical nature, mostly due to valve perforation, papillary muscle or chordae rupture formation, seen in infective endocarditis, melanin heart disease.

6, vocal: is a special systolic music murmur, raised and pointed, like a certain bird song, common such as gull sound, can be seen in rheumatic heart valve disease.

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