Systolic tremor

Introduction 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.

Cause

1. Systolic tremor in the second intercostal space on the right sternum, common in aortic stenosis.

2. Systolic tremor in the second intercostal space on the left sternal border, common in pulmonary stenosis.

3. Systolic tremor in the 3-4 intercostal space of the left sternal border, common ventricular septal defect.

4. Systolic tremor in the apical region, common in severe mitral regurgitation.

an examination

First, medical history

The patient's medical history should be asked in detail. For example, the age of tremor and the accompanying symptoms are found for the first time. Symptoms such as palpitations and acute fever appear in early years are the main points of diagnosis of congenital heart disease. Aortic stenosis and mitral stenosis are mostly rheumatic. Patients generally have an onset age of 20-40 years old, and may have irregular fever and a history of arthritis. If the elderly find tremor, there is no clear history of heart disease, and the stenosis caused by calcification of the aortic valve should be considered.

Second, physical examination

Patients with congenital heart disease may have stunted growth, short stature, and special characteristics of the hair group. Patients with rheumatic valvular disease may have joint redness and swelling. Patients with patent ductus arteriosus may have water pulse noise. Peripheral vascular signs such as capillary pulsations, all diseases can hear pathological murmurs in the corresponding parts.

Differential diagnosis

Differential diagnosis of systolic tremor:

Systolic murmur is the most common murmur in the clinic. It can be functional or organic, and it is more common in function. It is one of the heart murmurs. Heart murmur refers to the abnormal sound produced by the vibration of the wall, valve or blood vessel wall caused by turbulence in the heart or blood vessels during heart contraction or extra heart sounds. When the mitral regurgitation is incomplete, During left ventricular systole, blood flows back from the left ventricle to the left atrium and produces murmurs, and the resulting systolic murmur is transmitted to the left iliac crest. Anything that increases the pressure gradient between the left ventricle and the left atrium during systole The factors can be enhanced by noise. When inhaling, the pressure in the thoracic cavity decreases (less than atmospheric pressure), the blood volume of the right ventricle pumped into the pulmonary circulation increases, the left ventricular filling volume also decreases, and is affected by the chest pressure, in the systolic phase. The pressure gradient in the left room of the room will decrease relatively, the amount of reflux will be relatively reduced, and the noise will be weakened. When exhaling, the chest pressure will increase (greater than atmospheric pressure), the blood volume of the right ventricle pumped into the pulmonary circulation will increase, and the left ventricular filling volume will also increase. Increased, and affected by chest pressure, the pressure gradient in the left ventricle of the left ventricle will increase relatively during the systole, the amount of reflux will increase, and the noise will increase.

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