Diastolic tremor

Introduction The tremor is a small sense of vibration felt by the palm of the palpation, similar to the respiratory tremor that is felt in the throat of the cat, also known as cat asthma. The mechanism of tremor is the same as that of murmur. It is caused by blood flowing through a narrow caliber or in an abnormal direction to form a vortex, causing vibration of the valve, blood vessel wall or heart chamber wall to the chest wall. In general, tremor is seen in some congenital cardiovascular diseases and stenotic valvular lesions, and in the case of valve regurgitation, there is less tremor, and tremor can be reached only when the atrioventricular valve is severely closed. In addition to the tremors produced by the right heart (tricuspid and pulmonary valves), tremors are more easily accessible after deep exhalation.

Cause

The most common cause of the disease is mitral stenosis, which is caused by diastolic tremor in the apical region. There is also a tricuspid stenosis, which can also be seen in the bottom of the heart and diastolic tremor. 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. In general, tremor is seen in some congenital cardiovascular diseases and stenotic valvular lesions, and in the case of valve regurgitation, there is less tremor, and tremor can be reached only when the atrioventricular valve is severely closed. In addition to the tremors produced by the right heart (tricuspid and pulmonary valves), tremors are more easily accessible after deep exhalation. Clinically, when the tremor is touched, the heart can be considered to have organic lesions. Those who have palpation have tremors, and most of them can hear loud noises. However, usually palpation is sensitive to low frequency vibrations, while auscultation is sensitive to high frequency vibrations. For some low-pitched diastolic murmurs (such as mitral stenosis), the noise is not loud or almost inaudible, and auscultation is not sensitive enough. However, tremors are still visible when palpation, and attention needs to be paid.

an examination

Related inspection

Chest flat chest MRI chest CT examination chest perspective chest B super

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, 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.

Physical examination: patients with congenital heart disease may have dysplasia, short stature, fevery clubbing, etc.; patients with rheumatic valvular disease may have joint redness and swelling; patients with patent ductus arteriosus may have water pulse. All diseases of peripheral vascular signs such as capillary pulsation can hear pathological murmurs in the corresponding parts.

Differential diagnosis

Clinically often associated with the Falo triplet. Fallot triad is a congenital pulmonary stenosis with a patent foramen ovale or secondary atrial septal defect, with a syndrome of right ventricular hypertrophy. In cyanotic congenital heart disease, the incidence rate is second only to the Faro quadruple syndrome, the incidence rate of females is higher than that of males, and the age distribution is below 20 years old. Due to pulmonary stenosis, right ventricular and right atrial pressure is significantly increased, causing right-to-left shunt, clinical occurrence of cyanosis; right atrial pressure is lower than left atrial pressure, hemodynamic changes are left to right Diversion, no clinical convulsions. The main clinical symptoms are palpitations, shortness of breath, and fatigue after activity. Most patients have cyanosis. In severe cases, paralysis may occur, followed by upper respiratory tract infection, dizziness, fainting, and poor development. Heart failure may occur in patients with advanced disease. Therefore, the diagnosis is clear and should be treated with active and early surgery.

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