Abnormal heart sounds

Introduction It is confirmed by the heart sound map that there are four normal heart sounds, which are called first, second, third and fourth heart sounds in the order in which they appear. The first and second heart sounds are usually audible, and some children and young people sometimes hear a third heart sound. The fourth heart sound is generally inaudible, and the fourth heart sound can appear in healthy people over 40 years old.

Cause

Clinically common abnormal heart sound changes:

First, the heart sound intensity changes

(1) The first heart sound is enhanced.

(2) The first heart sound is weakened.

(3) The first heart sounds vary in intensity.

(4) Cannon sound.

(5) The second heart sound is enhanced.

(6) The second heart sound is weakened.

Second, the nature of heart sound changes

an examination

Related inspection

Electrocardiogram dynamic electrocardiogram (Holter monitoring) anticardiolipin antibody (ACA) anti-cardiolipin antibody serous effusion cell count

(1) First heart sound enhancement

The patient takes a sitting position or a supine position. When auscultating in the apical area and the anterior region, if the first heart sounds and the tone rises, it is "Le-de", with a shot. The perpetrator is called the first heart sound enhancement.

(2) 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.

(3) The first heart sounds vary in strength and weakness

The patient takes a sitting position or a supine position and auscultates in the apical area. If the intensity of the first heart sound changes, the time is strong and weak, and the regularity is different. 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.

Differential diagnosis

Extracardiac

The patient is placed in the supine or left lateral position, and a stethoscope is used to auscultate the lateral edge of the heart. If you hear a sound that is accompanied by a heart beat and is in the form of a click sound, it is an extracardiac sound. This tone can exist alone or with heart murmur or pericardial friction. The appearance of the extracardiac sound is due to the adhesion between the wall layer of the pericardium and the pleura, which is produced by pulling the adhesion when the heart beats.

Artificial pace sound

The patient (who received manual pacemaker treatment) took the sitting position or supine position, and auscultated with a stethoscope on the inner side of the apex and the 4th and 5th intercostals of the left sternal border. If a high pitch, short, and a click were heard before the first heart sound The additional sound of the sample is a manual pace sound. This sound appears on the heart sound map at 0.006 s after the pacing pulse, which is reduced or disappeared during inhalation. It may be due to the increased distance between the chest wall and the electrode, and attention should be paid during auscultation.

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