Loss of heart sounds and pulse

Introduction Heart sound and pulse disappearance are manifestations of ventricular fibrillation: pulse can not be touched, heart sound disappears, breathing stops after tens of seconds; skin, mucous membranes are blemishes or pale; some patients have short-term convulsions and incontinence; most patients have dilated pupils . Blood pressure (systolic blood pressure) is often below 60 mm Hg or signs of deterioration of the blood circulation are not detected.

Cause

The most common cause of heart sound and pulse loss is ECG instability, which may be related to the following factors:

1 Local coronary blood supply disorders caused by acute coronary syndrome: thrombosis and coronary spasm;

2 a series of pathophysiological changes caused by hypoxia: such as sympathetic excitation, anaerobic metabolism caused by the increase of a large number of metabolites such as lactic acid and myocardial cell metabolism abnormalities such as intracellular calcium ion, sodium ion overload accumulation and potassium ion loss;

3 The superoxide radical produced by reperfusion increased a lot, the cell membrane ion pump activity changed and the local electrophysiological disorder;

4 significant metabolic differences between ischemic myocardial tissue and non-ischemic myocardial tissue;

5 The basic state of the myocardium: In the past, chronic susceptibility states such as chronic myocardial injury, cardiac hypertrophy, hypokalemia, and long QT interval are more likely to cause fatal arrhythmias under the trigger of myocardial ischemia.

an examination

Related inspection

ECG dynamic electrocardiogram (Holter monitoring)

Clinical manifestations of ventricular fibrillation indicate that the patient has had a cardiac arrest, the main clinical manifestations are loss of consciousness; heart sounds and pulse disappear; breathing stops after tens of seconds; skin, mucous membranes are blemishes or pale; some patients have short convulsions and bowel movements Incontinence; most patients have dilated pupils.

Differential diagnosis

Low heart sound: It means that the heart rate is low. Low heart bluntness is not necessarily morbid. When the chest wall is thick, obesity, etc., the auscultation heart sound can be low and blunt. In some cases, it can also occur, such as pericardial effusion, heart failure, shock, etc.

When the chest wall is thick, obese, etc., auscultation heart sounds can be low and blunt. In some cases, it can also occur, such as pericardial effusion, heart failure, shock, etc.

Heart sound is weak: Heart sound refers to the sound produced by vibrations caused by myocardial contraction, heart valve closure, and blood damaging the ventricular wall, aortic wall, and the like. It can be heard with a stethoscope on a certain part of the chest wall, and the mechanical vibration of the heart sound can also be recorded by an instrument such as a transducer, which is called a heart sound map.

Distal heart sound: When the doctor uses a stethoscope to perform cardiac auscultation, if the first heart sound and the second heart sound are weak, heavy, and fuzzy, there is a distant sense, and the heart sound is far away. Patients are often forced to take a semi-recumbent position and lean forward. If they are supine, the heart sound is far more obvious.

The pulse is weak and can not be clearly touched: obstetric shock is divided into shock compensation period, shock inhibition period, and shock failure period. A weak pulse or even a clear failure is a symptom of the shock inhibition period.

Cardiac arrest: refers to the sudden termination of the heart's ejection function, the aortic pulsation and heart sound disappear, important organs such as severe brain ischemia, hypoxia, leading to life termination. This unexpected sudden death is medically known as sudden death. The most common cause of cardiac arrest is ventricular fibrillation. If the patient is called without a response, the patient will be in a coma if there is no response to the pressure and the armpit. Then pay attention to observe the patient's chest and abdomen with or without undulating breathing. If there is no pulsation of the carotid artery and the femoral artery, the heartbeat can not hear the heartbeat, and the patient can be judged to have a cardiac arrest.

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