Symptom >> Internal Medicine >> Cardiology

Systolic early click

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction One of the manifestations of abnormal heart sounds, a sudden sounding in the mitral auscultation area.

Cause

Cause

Mitral regurgitation is incomplete.

Examine

an examination

Related inspection

Doppler echocardiogram electrocardiogram

The clinical diagnosis is mainly based on the typical systolic murmur of the apical region and the left atrium and left ventricle enlargement. Echocardiography can confirm the diagnosis.

Clinical manifestation

(a) symptoms

Normally, symptoms from initial rheumatic carditis to significant mitral regurgitation can be as long as 20 years; in the event of heart failure, progress is rapid. Mild mitral regurgitation may have no obvious symptoms or only mild discomfort. Common symptoms of severe mitral regurgitation are: labor dyspnea, fatigue, sitting breathing, etc., and activity tolerance is significantly reduced. Hemoptysis and embolism are less common. In the case of advanced right heart failure, there may be hepatic congestion, tenderness, edema of the ankle, pleural effusion or ascites. Acute left heart failure or pulmonary edema can occur very quickly.

(two) signs

1. Cardiac auscultation in the apical region will be squeezing during the systolic period, the loudness is above 3/6, more to the left sputum, weakened when inhaling, the hourly tone is high in the return flow, and the murmur is thicker in the valve thickening. When the anterior lobe is dominant, the murmur is transmitted to the left or the left scapula; the posterior lobe is the main lesion, and the murmur is transmitted to the bottom of the heart. May be associated with systolic tremor. The first heart sound in the apical area is weakened or masked by noise. As the left ventricular ejection period is shortened, the aortic valve is closed in advance, causing the second heart sound to split. Severe mitral regurgitation may result in a low-pitched third heart sound. Smear and mitral valve opening revealed a mitral stenosis, but not mitral regurgitation. In patients with severe mitral regurgitation, due to the large amount of blood in the diastolic phase, the relative mitral stenosis is caused, so the apical area can be heard and low-key, short-term diastolic middle murmur. In pulmonary hypertension, the second heart sound in the pulmonary valve area is hyperthyroidism.

2. Other signs Arterial blood pressure is normal and the pulse is fine. The heart boundary expands to the left, and the apical region now touches the localized systolic lift-like pulsation, indicating left ventricular hypertrophy and enlargement. Pulmonary hypertension and right heart failure may have jugular vein engorgement, enlarged liver, and lower extremity edema.

Diagnosis

Differential diagnosis

Differential diagnosis of early contraction of the contraction:

(A) relative mitral regurgitation: can occur in hypertensive heart disease, a variety of causes of aortic regurgitation or myocarditis, dilated cardiomyopathy, anemia heart disease. As the left ventricle or mitral annulus is significantly enlarged, the mitral valve is relatively closed and the apical systolic murmur occurs.

(B) Functional apical systolic murmur: About half of normal children and adolescents can hear systolic murmur in the anterior region, loudness is 1 to 2/6, short, soft, not concealing the first heart sound, unintentional The expansion of the room and ventricles. It can also be seen in high-powered circulation states such as fever, anemia, and hyperthyroidism. After the cause is eliminated, the noise disappears.

(C) ventricular septal defect: can be heard in the third to fourth intercostal ribs of the sternal and rough systolic murmur, often accompanied by systolic tremor, murmur to the apical region conduction, apical beats are lifted. Electrocardiogram and X-ray examination showed an increase in left and right ventricles. Echocardiography showed a continuous interruption of the ventricular septum, and echocardiography confirmed the presence of left-to-right shunt at the level of the ventricle.

(4) Tricuspid regurgitation: The lower end of the left sternal border is scented with a localized squeaky squeaky squeak. When inhaling, the murmur is enhanced by the increase in blood volume, and the exhalation is weakened. When the pulmonary hypertension is high, the second heart sound of the pulmonary valve is hyperthyroidism, and the v-wave of the jugular vein is enlarged. There may be liver pulsation and swelling. Electrocardiogram and X-ray examination showed right ventricular hypertrophy. Echocardiography can confirm the diagnosis.

(5) Aortic stenosis: a loud and rough systolic murmur can be heard in the aortic valve area or apical area of the heart, which is transmitted to the neck with systolic tremor. There may be an early contraction of the contraction, and the apex of the apex is lifted. Electrocardiogram and X-ray examination showed left ventricular hypertrophy and enlargement. Echocardiography can confirm the diagnosis.