Heart sounds are far away

Introduction When the doctor uses a stethoscope to perform a cardiac auscultation, if the first heart sound and the second heart sound are weak, heavy, and blurred, 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. Pericardial effusions caused by tuberculous, cancerous, suppurative, rheumatic, and certain connective tissue diseases may cause distant heart sounds. Some patients with distant heart sounds are also accompanied by chest pain, shortness of breath, difficulty breathing, shallow breathing, purpura, low pulse pressure difference, and congestive splenomegaly.

Cause

Pericardial effusion caused by tuberculous, cancerous, suppurative, rheumatic, and certain connective tissue diseases.

Pericardial effusion is a common clinical manifestation, especially after echocardiography is the routine examination of cardiovascular disease, the detection rate of pericardial effusion in patients is significantly increased, up to 8.4% of most pericardial effusion Clinical signs are not present due to the small amount. A small number of patients have a prominent clinical manifestation with pericardial effusion due to a large amount of fluid. When it is more than a few months, it constitutes a chronic pericardial effusion. There are many causes of chronic pericardial effusion, most of which are related to diseases that can affect the pericardium.

an examination

Related inspection

Doppler echocardiography dynamic electrocardiogram (Holter monitoring)

At the time of auscultation, the first heart sound and the second heart sound are weak, heavy turbid, and fuzzy. There is a distant sense. This sound is a characteristic sign of pericardial effusion, which is found in various causes (tuberculosis, cancerous, suppurative, rheumatic, and some Pericardial effusion caused by connective tissue diseases.

Pericardial effusion is a more common clinical manifestation, especially after echocardiography becomes a routine examination of cardiovascular disease. The detection rate of pericardial effusion in patients is significantly increased, which can be as high as 8.4% due to most pericardial effusions. The amount is small without clinical signs. A small number of patients have a prominent clinical manifestation with pericardial effusion due to a large amount of fluid. Chronic pericardial effusion is formed when the pericardial effusion lasts for more than a few months.

Differential diagnosis

The heart sound needs to be identified as follows.

(1) The first heart sound is weakened

When the patient takes a sitting position or a supine position, when the auscultation in the apical region and the anterior region is abrupt, the first heart sound is blunt and ambiguous, and the first heart sound is weakened.

(2) The first heart sounds vary in intensity

The patient took a sitting position or a supine position and auscultated in the apical area. The intensity of the first heart sound is mostly caused by arrhythmia, so you should pay attention to changes in heart rate and heart rate during auscultation.

(3) The second heart sound is weakened

The patient was placed in the supine position and auscultated in the aortic valve and pulmonary valve area respectively. If the second heart sound in the aortic valve area or the second heart sound in the pulmonary artery area is weakened, the pitch is low and blunt, and the crispness is lost, it is called the second heart sound weakening. . The former said that the second heart sound of the aortic valve area was weakened, and the latter was that the second heart sound of the pulmonary valve area was weakened.

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