Heart tremor

Introduction Cardiac tremor is a kind of subtle tremor that touches the root of the palm, which is similar to the cat's wheezing. It is also called "cat asthma" and is one of the characteristics of organic heart disease. No matter where the tremor is found, it indicates that there is severe stenosis or arteriovenous shunt in the site, and the normal heart will not tremble. Therefore, the appearance of tremor has important clinical significance, and is more common in some congenital heart diseases and heart valve stenosis. Under normal circumstances, the heavier the valve stenosis, the faster the blood flow velocity, the greater the pressure difference, the stronger the tremor, but the tremor will weaken or even disappear when the valve is too narrow.

Cause

(a) systolic tremor

1. Aortic stenosis.

2. Pulmonary stenosis.

3, ventricular septal defect.

4. Fallot triad.

5, the permanent room is shared.

(two) diastolic tremor

1, mitral stenosis.

2, tricuspid stenosis.

(3) Continuous tremor

1. Aortic catheter is not closed.

2, the main pulmonary artery septal defect.

mechanism

Tremor is the turbulent flow generated by the flow of blood through a narrow valve orifice or abnormal passage to a wider area, causing vibrations in the valve, heart wall or blood vessel wall to pass to the chest wall. The intensity of tremor is related to the degree of stenosis, blood flow velocity, and the magnitude of the pressure difference between the two chambers of the heart. Under normal circumstances, the heavier the valve stenosis, the faster the blood flow velocity, the greater the pressure difference, the stronger the tremor, but the tremor will weaken or even disappear when the valve is too narrow.

an examination

Related inspection

Cardiopulmonary exercise test (CPET) apolipoprotein A-I (ApoA-I) platelet aggregation test (PAgT) lipoprotein a (Lp-a) serum globulin (G, GL0)

First, medical history

The patient's medical history should be asked in detail, such as the age at which tremor was first discovered and the accompanying symptoms. Symptoms such as palpitations and shortness of breath appear in early years are the main points of diagnosis of congenital heart disease; aortic stenosis and mitral stenosis are mostly rheumatic, and the general onset age is 20-40 years old, and there may be irregular fever and arthritis. Medical history; if the elderly find tremor, and there is no clear history of heart disease, the stenosis caused by calcification of the aortic valve should be considered.

Second, physical examination

Congenital heart disease patients may have dysplasia, short stature, hairpin special indicators; rheumatic valvular disease patients may have joint swelling, deformation; patients with patent ductus arteriosus may have water pulse, traffic, hair Peripheral vascular signs such as vascular beats. Pathological murmurs can be heard in all areas of the disease.

Third, laboratory inspection

Rheumatic valvular heart disease in the rheumatic activity period may have increased ESR, positive C-reactive protein, anti-streptolysin "O" positive changes, etc., can aid diagnosis.

Fourth, equipment inspection

The diagnosis of echocardiography is of the most value. In patients with valvular heart disease, the nature and severity of the lesion can be found in the corresponding valve. The location of the lesion can be found in patients with congenital heart disease. Combined with X-ray and electrocardiogram, the diagnosis is not difficult to establish.

Differential diagnosis

Systolic tremor is a small sense of vibration felt by the palm of the hand during palpation, similar to the respiratory tremor that is felt in the cat's throat, also known as cat asthma. The mechanism of tremor is the same as that of the hybrid. The blood flows through the narrow caliber or in the direction of the abnormality to form a vortex, which causes the valve, the blood vessel wall or the wall of the heart cavity to vibrate to the chest wall. After the tremor, the location and source (valve, large vessel or septal defect) should be determined first, and then the phase (systolic, diastolic or continuous) in the cardiac cycle should be determined. Finally, the clinical significance is analyzed. Congenital heart disease patients may have stunted short hair and special indicators. Patients with rheumatic valvular disease may have joint redness and swelling. Patients with patent ductus arteriosus may have water pulse noise. All diseases of peripheral vascular signs such as capillary pulsation can hear pathological murmurs in the corresponding parts.

Diastolic tremor: The most common cause of clinical mitral stenosis, diastolic tremor in the apical region caused by mitral stenosis. There is also a tricuspid stenosis, which can also be seen in the bottom of the heart and diastolic tremor. The patient's medical history should be asked in detail, such as the age at which tremor was first discovered and the accompanying symptoms. Symptoms such as palpitations, shortness of breath, and fever appear in the early years are the main points of diagnosis of congenital heart disease; mitral stenosis is mostly rheumatic, and the general onset age of patients is around 20-40 years old. There may be irregular fever and a history of arthritis; if the elderly find tremor, and there is no clear history of heart disease, the stenosis caused by calcification of the aortic valve should be considered.

Ventricular fibrillation (referred to as ventricular fibrillation) is one of the common causes of sudden cardiac arrest. The ventricle delivers continuous, rapid, and even excitement more than 240 times per minute, called ventricular flutter. If the excitement of ventricular release is rapid and irregular, it is called ventricular fibrillation (ventricular fibrillation). The frequency of ventricular fibrillation can be between 250 and 600 beats per minute. The causes of ventricular fibrillation are both cardiogenic and non-cardiac. Common causes of cardiogenic ventricular fibrillation are coronary heart disease, especially acute myocardial ischemia; common causes of non-cardiac ventricular fibrillation are anesthesia and surgical accidents, severe electrolyte and acid-base imbalance, electric shock, drowning, and drug poisoning or allergies. Wait.

Voice tremor: When the examiner touches the voice of the examinee, the sound waves rise from the throat, and the vibrations that resonate along the trachea, bronchi, and alveoli to the chest wall are enhanced.

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