Weak heart sounds

Introduction Heart sound refers to the sound produced by vibrations caused by myocardial contraction, heart valve closure, and blood impingement on 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.

Cause

First, the heart sound intensity changes

(1) The first heart sound is enhanced; (2) the first heart sound is weakened; (3) the first heart sound is different; (4) the cannon sound; (5) the second heart sound is enhanced; (6) the second heart sound Weakened.

Second, the nature of heart sound changes

Third, heart sound split

(1) The first heart sound splits; (2) The second heart sound splits.

Fourth, third, fourth heart sounds and heart sounds far away

(1) Third heart sound; (2) Fourth heart sound; (3) Heart sound far away.

Five, extra heart sounds (three-tone)

(1) extra heart sound during systole; (2) extra heart sound during diastole.

Sixth, the tumor flutters

Seven, extracardiac sound

Eight, artificial pace sound

an examination

Related inspection

Heart sound map to check the ultrasound diagnosis of cardiovascular disease of ECG

Free triiodothyronine (FT3) -- T3 is a hormone synthesized and secreted by thyroid follicular cells. FT3 accounts for about 0.3% of T3. It can enter the tissue cells through the cell membrane and exert physiological effects. Its concentration is consistent with the concentration of triiodothyronine in the tissue, and it is also consistent with the metabolic state of the body. It also has diagnostic value for non-thyroid diseases. Clinically, the RIA method is commonly used.

Plasma thyrotropin releasing hormone (TRH) -- Plasma thyroid stimulating hormone releasing hormone (TRH) is an indicator of hypothalamic function.

Triiodothyronine inhibition test--A normal person taking exogenous T3, the blood T3 concentration increased, negative feedback can inhibit the secretion of TSH in the anterior pituitary, and the thyroid 131I rate is significantly reduced. Diffuse goiter with hyperthyroidism, due to the presence of long acting thyroid stimulator (LATS) and long-acting thyroid stimulant protectants in the blood, can stimulate the thyroid to cause an increase in 131I rate, and is not affected T3 inhibition. The thyroid absorbing 131 iodine function test sometimes overlaps with the values of normal people and hyperthyroidism, which may affect the diagnosis of the disease.

Triiodothyronine inhibition test method: for differential diagnosis of patients with high iodine intake rate. The method was as follows: 60-100 g of sodium triiodothyronine was orally administered on the 1st, and it was taken in 3 times for 6 days, and the radioactive isotope iodine iodine test was repeated.

Adrenocorticotropic hormone (ACTH) -- Adrenocorticotropic hormone is a micro-peptide hormone secreted by the pituitary gland and is a major regulator of adrenal cortical activity.

Serum aldosterone (ALD, ALS) -- Aldosterone acts to promote the reabsorption of sodium by renal distal convoluted tubule epithelial cells and promotes the release of potassium. The secretion of aldosterone has a diurnal secretion pattern similar to cortisol, which is lower in the morning than in the night. The standing position is increased compared with the lying position, and the plasma concentration is also changed accordingly.

Serum Cortisol (FC) - Cortisol is produced and secreted by the adrenal cortex and belongs to the corpus callosum glucocorticoids. Its secretion is controlled by the anterior pituitary adrenocorticotropic hormone. The determination of serum cortisol directly reflects the secretory function of the adrenal cortex.

Follicle Stimulating Hormone (FSH) -- Follicle stimulating hormone and luteinizing hormone collectively called gonadotropin promote follicular maturation and promote estrogen secretion together with luteinizing hormone.

Serum globulin (G, GL0) -- serum globulin is a mixture of various proteins, including immunoglobulin veneers and complements with multiple defense functions, various glycoproteins, metal-binding proteins, various lipoproteins, and enzymes. Classes, etc. The content of globulin is generally obtained by subtracting albumin from total protein.

Thyroid Stimulating Hormone (TSH) -- Thyroid stimulating hormone is a hormone secreted by the pituitary gland to promote the growth and function of the thyroid gland. It promotes the proliferation of thyroid follicular epithelial cells and the synthesis and release of thyroid hormone.

Lactate dehydrogenase (LDH, LD) -- Lactate dehydrogenase is a glycolytic enzyme. Lactate dehydrogenase is present in the cytoplasm of all tissue cells in the body, with a high kidney content.

Serous effusion cell count - cell count is the number of cells in the effusion. Microscopic counting and specimen dilution methods are generally used. The direct counting method is suitable for clear appearance and number of cells.

Serous effusion glucose - serous effusion glucose quantification refers to the detection of glucose content in the effusion to distinguish between leakage and exudate.

Differential diagnosis

Low heart bluntness: refers to a low heart rate. 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.

First heart sound hyperthyroidism: left ventricular filling decreased during mitral stenosis, lower mitral valve position in late diastolic, and second, due to decreased left ventricular blood volume, systolic period shortened accordingly, when left ventricular pressure rapidly increased, The low-order mitral valve suddenly becomes tense and closes, thus producing a high-key and crisp first heart sound, which sounds like a slap, commonly referred to as the slap-first heart sound. In complete atrioventricular block, the atrial and ventricular beats are not related, forming a phenomenon of compartment separation. When the atrium and ventricle are simultaneously contracted, the first heart sound is extremely loud, usually called "cannon sound". ".

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.

Running horse heart sound: normal adult heart beat has two heart sounds, called first heart sound and second heart sound. Running horse is the additional heart sound that appears after the second heart sound, combined with the original first and second heart sounds. The rhythm of the formation is similar to the sound of the horseshoes touching the ground when the horse runs, so it is called the galloping horse. According to the different time of the occurrence of galloping, it can be divided into early diastolic galloping, diastolic late galloping and overlapping galloping, which is the most common early diastolic galloping, which appears after the second heart sound 0.12-0.18 Within seconds; late diastolic gallopism occurs later, before the start of systole, which is 0.1 second before the first heart sound, so it is also called systolic galloping; when there is simultaneous diastolic early gallop and diastolic late horse At the time of the law, plus the first heart sound and the second heart sound, it sounds like four sounds that occur in parallel, also known as "four temperament", "the locomotive runs the horse". It is generally believed that early diastolic galloping is caused by excessive ventricular diastolic load, decreased myocardial tension and decreased compliance, so that when the ventricle is dilated, blood filling causes wall vibration. Therefore, the appearance of galloping horse is an important sign of severe myocardial damage.

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