Systole inhliziyo nokububula

Lo mkhuba systolic inhliziyo nokububula, kungenzeka ujwayelene kuwo wonke umuntu. Noma kunjalo, ukuba khona kwabo kuyaphawuleka ngoba ezimweni eziningi zivela isizinda izifo ezingathi sína kwababhemayo. It is a uhlobo zisifake isiginali olukhombisa ukuthi kwakuke kwaba khona ezinye izinkinga inhliziyo.

Asho odokotela inhliziyo ikhononda

Ukusebenzisa elithi ezifana "umsindo", maqondana inhliziyo, nangodokotela bababhekene nezifo zenhliziyo kusho mkhuba acoustic ahlobene nezinguquko e ukugeleza kwegazi izitsha kanye inhliziyo. Phakathi kwabantu abavamile kungaba uhlangabezana umbono ukuthi umsindo esifundeni inhliziyo - ke isici inkinga ebuntwaneni. Kufanele sivume - lokhu umbono iseduze iqiniso, njengoba abangaphezu kuka-90% ukusebenza umsindo ukuthola ilungiswe intsha kanye nezingane. Kodwa ngaleso nokububula efanayo systolic kwatholakala futhi intsha abaneminyaka esuka eminyakeni engama-20 kuya ku-28 ubudala.

Mbiko nangodokotela bababhekene nezifo zenhliziyo eziningi mayelana inhliziyo nokububula e abadala uyavuma: efana uphawu ukhomba zokugula ethize inhliziyo, nakho inikeza isisekelo izifundo egcwele inhliziyo.

Igama elithi "systole" kuhlobene umsindo, okuyinto alalelwa igebe phakathi lokuqala nelesibili amathoni inhliziyo. I umsindo ngokwabo ukudala ukugeleza kwegazi emhlabeni inhliziyo noma valve yayo.

Yiziphi izinhlobo umsindo inganqotshwa

In imvelo yezokwelapha, into efana nokububula inhliziyo, zihlukaniswe ngezigaba eziningana. Lokhu obusebenzayo systolic nokububula, okuthiwa elingelacala, organic, khona lapho sibonisa zokugula ethize.

imisindo ezingenacala ngakho okuthiwa ngoba kungenzeka kubangelwa izifo ezihlukahlukene, ongakaphathelani inhliziyo. Lokhu kusho ukuthi awayona uphawu isimo sokugembula zenhliziyo. Timbre lolu hlobo umsindo uthambile, engazinzile, umculo, dlala, kokuba umfutho ngokwanele ongaphakeme. imisindo ezinjalo buthaka nge nokuncipha imisebenzi ngokomzimba futhi ayakhumuka ngale inhliziyo. Ubunjalo izinguquko zabo awahlobene ne amathoni kwenhliziyo, kodwa kuncike isikhundla umzimba.

Ngokuqondene imisindo organic, kuphakama ngenxa yokuphambana septal, noma valve (ie atrial isici noma ventricular septal). The timbre umsindo kungenziwa kwachazwa ngokuthi ezinzile, kanzima, anolaka. Ngokusho umfutho bona ibukhali futhi elikhulu, nge ubude ebalulekile. Lolu hlobo umsindo owenziwa ngaphandle kwe wenhliziyo ikhwapha nesifunda interscapular. Ngemva kokuzilolonga imisindo organic kuthiwa iyakhula futhi agcinwe. kunjalo futhi, ngokungafani kuya umsebenzi abayohlanganiswa amathoni inhliziyo futhi ngokulinganayo uthephwe ngokucacile ngesikhundla umzimba ezahlukene.

nokububula systole lifaka phakathi izinhlobo ezahlukene imihlola acoustic esifundeni inhliziyo:

- ikhononda Early systolic;

- pansystolic (holosystolic);

- maphakathi no-sekwephuzile umsindo;

- Msindo srednesistolicheskie.

Kungani enhliziyweni kunezinhlobo ezihlukahlukene umsindo

Uma sinake umsindo obuningi bokuthi oyibonayo njengosongo olukhulu empilweni, kufanele kuphawulwe ukuthi zibangelwa izizathu ezimbalwa ezisemqoka.

Systole inhliziyo nokububula kungenzeka kubangelwa stenosis yomthambo i-aorta. Ngaphansi kwalo uphethwe yini kufanele kuqondwe azalwa naso noma bathenga yomthambo i-aorta constriction hole nge splicing le enezinto of valve uqobo. Le nqubo yenza kube nzima evamile igazi ligeleze ngaphakathi inhliziyo.

stenosis yomthambo i-aorta akunakubangelwa omunye ezivamile ukukhubazeka inhliziyo okwenzeka abadala. Kulesi isifo ngokuvamile ukuthuthukisa esingamahlalakhona yomthambo i-aorta ne-mitral. Ngenxa yokuthi idivayisi likhona ukuthambekela yomthambo i-aorta ukuba calcification (lapho ethuthuka stenosis), ukuthuthukiswa sifo liyakhuphuka.

Ezimweni eziningi lapho fixed sina stenosis yomthambo i-aorta, i-ventricle engakwesobunxele kakhulu ngokweqile. Ngalesi sikhathi, inhliziyo nengqondo uqale uhlushwa ukuntuleka liningi igazi.

esingamahlalakhona yomthambo i-aorta kungabuye isibaluli izizathu ukuthi ukuthuthukisa systolic nokububula. Ingqikithi lesi sifo ukuqinisekisa ukuthi valve yomthambo i-aorta akakwazi ukuvala ngokuphelele. Yena regurgitation yomthambo i-aorta ngokuvamile eba ku isizinda endocarditis infective. Ukuze nomthelela ekuthuthukiseni lesi sifo imfiva rheumatism (ngaphezu kwesigamu amacala), omzimba izicubu erythematosus, ugcunsula, futhi isifo sokuqina kwemithambo yegazi. Ngesikhathi esifanayo ke emenza le nkinga kungakubangeli ukulimala noma yokuzalwa bekhubazekile. nokububula systole ku-aorta zingase zibe Indlela okuvela kuyo isihlobo esingamahlalakhona of valve yomthambo i-aorta. isimo esinjalo kungaphumela kamanye esiyingini fibrous of valve kanye aorta uqobo.

Acute regurgitation mitral - kungenye imbangela umsindo systolic. Kulokhu kuba ukunyakaza okusheshayo zoketshezi noma amagesi, okuyinto eyenzeka ngentende isitho kwemisipha enqubeni lokwehliswa. Ukusikinyeka okunje okuphambene esiqondisweni evamile. kokutshelwa ngokukhubazeka kwengane ezimweni eziningi kuwumphumela kwezinso ezindongeni ukwahlukanisa.

nokububula systole ku Umthambo yamaphaphu ikhombisa ukuthuthukiswa endaweni stenosis. Ngesifo anjalo esikhathini yamaphaphu Umthambo umphini is ayisesemikhulu esiqeshini i-ventricle yangakwesokudla. Lolu hlobo stenosis cishe 8-12% azo zonke inhliziyo yayo yayinezinkinga ezicini azalwa nako. umsindo okunjalo wayehlale ephelezelwa jitter systolic. Ikakhulukazi liphinyiselwe umsindo ngemisebe nezitsha entanyeni.

Kuhle kokusho futhi tricuspid valve stenosis. Kulesi isifo kukhona ukuvaleka valve tricuspid. Lezi zinguquko avame umphumela umthelela imfiva rheumatism. Izimpawu lolu hlobo stenosis zihlanganisa isikhumba abandayo, ukukhathala, kabi waya engxenyeni engenhla kwesokudla esiswini nasentanyeni.

Izizathu nokububula systolic ezinganeni

Izinto ukusebenza inhliziyo zezingane, okuningi, kodwa kukhona avame okulandelayo:

- atrial septal isici. Ngaphansi isici kwakusho ukungabi khona izicubu atrial septal, okuholela ekungeneni kakhulu ukudedelwa igazi. Ubukhulu ukusetha kabusha incike sokuhambisana ventricles futhi isici osayizi.

- ezingasadingeki yamaphaphu ukubuya emithambo yegazi. Sikhuluma kumiswa olungalungile ngemithambo yamaphaphu. Ngaphezu kwakho konke, ngemithambo yamaphaphu kungukuthi babikela ATRIUM kwesokudla, falling ngokushesha zibe ATRIUM kwesokudla. Ngokuvamile ukuze ukuxuba ne ATRIUM ngokusebenzisa circle emithanjeni ezinkulu (vena kwesokudla aphakeme Vienna, Vienna ayibhangqiwe, kwesokunxele brachiocephalic ibhuthi, amehlo itheku yenhliziyo futhi ukugeleza emithambo yegazi).

- coarctation le-aorta. Ngaphansi le ncazelo efihla azalwa naso inhliziyo isici lapho kukhona ukuvaleka segmental le-aorta thoracic. Ngamanye amazwi, lo segmental inesikhala yomthambo i-aorta iba ezincane. Le nkinga iphathwa ngu ukuhlinzwa. Uma ngabe le uphethwe is hhayi ukuthatha noma yisiphi isinyathelo, ukuvaleka wengane aorta luyokhula njengoba zikhula.

- Ventricular septal isici. Le nkinga futhi esinye sezizathu ukuthi fixed nokububula systolic enhliziyweni ingane. Lokhu kungapheleli libhekene yokuthi yokuphambana eba phakathi kwalezi zinto zombili ventricles wenhliziyo - kwesokunxele bese kwesokudla. Lokhu kungapheleli inhliziyo ivame ezilotshwe isimo elingalodwa, nakuba zikhona izimo lapho isici enjalo kuyingxenye ezinye ukukhubazeka inhliziyo.

- systole nokububula e ingane kubangela inhliziyo kungenzeka ukuthi umataniswe nge evulekile lwemithambo isici. Sikhuluma esibuthakathaka iDemo okuyinto lebhokisi Umthambo yamaphaphu kanye aorta ukwehla. Isidingo salokhu shunt bokuphila ubalekela emva umoya womntwana kuqala, ukuze izinsuku ezimbalwa ke izovalwa. Kodwa uma lokhu akwenzeki (leyo, eqinisweni, yilokho okushiwo yokuphambana), igazi iqhubeka shunted kusukela kwegazi e-ezincane. Uma imbobo incane, kuba, isimiso, ngeke ibe nomthelela ongemuhle impilo yengane. Kodwa lapho sisebenzelana elikhulu ductus patent arteriosus, kukhona ingozi sina ngokweqile inhliziyo. Izimpawu zalesi simo - kungcono ingxenye Ukuphelelwa. Uma ukugeleza likhulu kakhulu (9 mm noma ngaphezulu), usana kungenzeka usesimweni esibucayi. Kulokhu, lo nokububula systolic ezinganeni akulona uphawu kuphela - Inhliziyo ngokwayo izokwenyuka ngosayizi. ukusebenza ephuthumayo esetshenziswa iwukudambisa ibe usongo olukhulu ezinjalo.

Eceleni kubalulekile ukuba uthinte isigaba ezisanda kuzalwa. Inhliziyo izingane emva kokuzalwa lizwakele ngisho esibhedlela. Lokhu kwenziwa ukuze ugweme pathologies kungenzeka. Kodwa uma kukhona sabhalwa umsindo ke ungenzi iziphetho negative kwesikhathi. Iqiniso ukuthi ngokwesilinganiso, njalo ingane yesithathu ikhomba imisindo ethile. Futhi akuzona zonke ziwubufakazi izinqubo eziyingozi (hhayi zibulale enganeni futhi kungukuthi ephelezelwa kwegazi). Kwakuphakathi yakhe (ukugeleza kwegazi), ukuhlelwa kabusha kungase kudingeke imisindo obusebenzayo ingane, naye akazange ziyingozi empilweni. Kuleli zinga, njengoba ze-X ray kanye electrocardiogram sizobonisa ukuthuthukiswa evamile inhliziyo lengane.

Ngokuqondene umsindo esivela izinsana, base liguquguquke kuze kuphele izinyanga ezintathu zokuqala ngemva kokuzalwa. Lokhu uphethwe lithi phakathi fetus inhliziyo kumiswa ingane kwaze kwaba sekupheleni ukuthuthukiswa futhi, ngenxa yalokho, has kwasekuzalweni ezithile. Uma ngezinga elithile umthelela yinhliziyo ekuthuthukiseni ingane kuyoba iphakeme kakhulu, kungenzeka ukuthi odokotela Uyonquma ngokuziphatha ukuhlinzwa ukuqeda lesi sifo.

Izici umsindo sokudlondlobala inhliziyo

Nge lolu hlobo umsindo izici wesibili bangase iyashiyana imbangela nendawo nesenzakalo.

1. olunamandla mitral valve esingamahlalakhona. Kulokhu, lo msindo lingachazwa ngokuthi iDemo. Ubonakala ekuseni (protosistolichesky). Ukusebenzisa echocardiography bungabonakala hypokinesis zone Chords igebe, izici nezinye endocarditis virus.

2. ezingamahlalakhona mitral valve esingamahlalakhona. Noises yalolu hlobo is matasa phakathi ukusikwa we ventricles (holosystolic futhi pansystolic). Kukhona kwencika oqondile yokuphambana valve, ivolumu wegazi ukubuyela ngokusebenzisa isici futhi umlingisi umsindo. nokububula systole ngesikhathi sokudlondlobala inhliziyo ngaphansi kulezi zici kungcono uthephwe endaweni evundlile. Uma isici bachubeka, kukhona vibration palpable odongeni washona ngesikhathi systole.

3. Isihlobo esingamahlalakhona mitral. Uma uchitha isikhathi eside luhlolo (-X-ray, echocardiography), kungenzeka ukuhlonza Ukuvuleka komlomo i-ventricle engakwesobunxele. nokububula systole ngesikhathi sokudlondlobala kulokhu zigcinwe phakathi naso sonke isikhathi ventricular ukusikwa, kodwa kuyoba kuqhathaniswa ethule. Uma izimpawu kokuminyaka ukuhluleka kwenhliziyo kuyehla, kanti olwenziwa yokwelapha eyanele, i-sonority ngomsindo kuzoncishiswa.

4. Dysfunction kwemisipha papillary. Phakathi luhlolo ngokuvamile kwembula izimpawu isilethikusebenza, noma (ii) ischemic. nokububula okunjalo systolic ngesikhathi sokudlondlobala inhliziyo lingachazwa ngokuthi iyashintsha. Ngaphezu kwalokho, it is a ukubukeka ngasekupheleni systole noma ingxenye maphakathi.

5. Mitral valve prolapse. Kungenzeka nge inhlanganisela ngasekupheleni nokububula systolic. Imibhobho lolu hlobo kuhamba phambili sesimweni uqotho. umsindo okunjalo kuye ngezimo zesiguli ingahluka kakhulu. nokububula okunjalo systolic ngesikhathi sokudlondlobala libhekene okubonakalisa ingxenye maphakathi systole (okubizwa ngokuthi mezosistolichesky ngokuchofoza).

Noises ngakwesokunxele we sternum (iphuzu Botkina)

Ngomsindo lolu hlobo kunezizathu eziningana:

- Ventricular septal isici. Batshengise shaking washona ngesikhathi systole kuya kwesokunxele sternum. Esikhathini izici umsindo usayizi isici akunamthelela. idolo senhliziyo itholwa e-100% amacala. Fixed anolaka nokububula systolic, okuyinto oluthatha lonke systole futhi agcinwe yonke iminyango. Ngosizo-X-ray kungembula dilatation lwaleli yomthambo i-aorta ne-pulmonary ukuminyana.

- azalwa naso stenosis yamaphaphu. Esinye sezici eziyinhloko - uphawu Elisengozini purring. Uma kubhekwa lubonakale inhliziyo idolo (protrusion thorax). ithoni Okwesibili we Umthambo yamaphaphu iba buthakathaka.

- Obstructive zenhliziyo. Systole nokububula at Botkin yalolu hlobo yisilinganiso futhi ziyahlukahluka ngegalelo kuye isikhundla umzimba lapho umuntu elibiza - liyaphuma, elele isimo - ubohle.

- Tetarda halyard. Lezi imisindo zihlukaniswa inhlanganisela shunt ka kwesokunxele kuya kwesokudla emakamelweni inhliziyo ngenxa ukuphazamiseka septum phakathi ventricles kanye yamaphaphu Umthambo ukuvaleka. Umsindo siyahedletela, ne nenkanuko edlulele ka jitter systolic. Noises izwakale engcono endaweni eziphansi sternum. Ngosizo le ECG kungenziwa izimpawu i-ventricle yangakwesokudla izinguquko hypertrophic isilungisiwe. Kodwa ngosizo X-ray embula zokugula ngeke zisebenze. Lapho noma yimuphi umthwalo kubonakala cyanosis.

Noise kuya kwesokudla sternum

Kuleli qophelo (II isikhala intercostal) auscultated ukukhubazeka yomthambo i-aorta. Noise ubuciko isiphakamiso atholwe constriction noma kokuba genesis azalwa nako.

nokububula okunjalo systolic onezici ezithile:

- indawo nenzuzo kakhulu ukuze kutholwe yayo - 4 no-5 intercostal izikhala kwesokunxele sternum;

- pensistolichesky, okukhulu, okwe ngokuvamile nokususa umsindo;

- Kwenziwa ohlangothini lwesobunxele kwesifuba, bufike emuva;

- esimweni ehlezi kwandisa umsindo;

--X-ray luhlolo kuthola ukunwetshwa yomthambo i-aorta calcification umphini walo apharathasi begodu ukwanda i-ventricle engakwesobunxele,

- ishayela inokuqukethwe abampofu futhi ezingavamile;

Inchubekelembili isici kuholela ukunwetshwa kwesokunxele ventricular arterio-izimbobo. Kulesi simo, kukhona kungenzeka kokulalela umsindo ezimbili ezihlukene. Uma nokububula systolic kwaba senziwa stenosis azalwa naso, ngeke nilethe uxoshwe obengeziwe ithoni, okuyinto ngenxa concomitant rugurgitatsiey yomthambo i-aorta.

Inhliziyo nokububula ngesikhathi sokukhulelwa

Phakathi yokuzala kungenzeka umsindo sistalicheskih. Ngokuvamile, zingabantu obusebenzayo ngokwemvelo futhi ngenxa umthwalo okwanda ku inhliziyo yowesifazane okhulelwe. isimo esinjalo isici iningi yokuthathu yesithathu. Uma umsindo ayethe njo, lena isignali kuya ukuthatha isimo abakhulelwe (izinso, umthwalo nokushintsha kokudla nokufakwa, umfutho wegazi) ngaphansi kolawulo ngokucophelela.

Uma zonke lezi zidingo zifeziwe ngokunembile ke kukhona zonke wokuthi ukukhulelwa kanye nokubeletha, umphumela uzokhombisa ukuthi unalo, ayinayo imiphumela omubi enhliziyweni.

ukuxilongwa umsindo

Okokuqala, ungaqala kanjani inqubo ekuhlonzweni kwezifo inhliziyo - kwencazelo ukungabi noma khona nokububula inhliziyo. Kulokhu, auscultation wenhliziyo wenziwa endaweni evundlile noma mpo, ngemva kokuzivivinya, ohlangothini lwesobunxele kanye at ukuphakama ephefumula futhi okhishwa ngamakhala. Izinyathelo ezinjalo zibalulekile ukuze systolic inhliziyo nokububula, izimbangela zezinkumbulo bangahluka ngokuphelele, wakhonjwa ngokunembile.

Uma sikhuluma sisakubona valve mitral, indawo elilungile kakhulu ukulalela umsindo kuleli cala ngayo ichopho inhliziyo. Endabeni zamehlo valve yomthambo i-aorta kufanele sinake eyesithathu intercostal isikhala kwesokunxele sternum noma wesibili ohlangothini lwesokudla. Uma une ukubhekana sisakubona valve tricuspid, le nokububula systolic ulalele kangcono emzimbeni sternum emaphethelweni phansi.

Ekhuluma izici umsindo, kuyafaneleka yokuthi bangase babe Isigaba ezahlukene (systole futhi diastolic), ubude, simo esishubile futhi conductivity. Enye yezinselelo ezisemqoka kulesigaba incazelo eqondile elilodwa noma ngaphezulu epicenters umsindo. Kubalulekile futhi acabangele ithoni umsindo, ngoba lokhu isici kubonisa izinqubo ezithile. Uma lula systolic nokububula kubonisani nezinkinga ezingathí sina, anolaka, sawing, ukuhwaya kubonisa stenosis we yomthambo i-aorta yomthambo i-aorta noma yamaphaphu. Ngakwelinye ihlangothi, umsindo ohlabayo iqinile e endocarditis infective futhi esingamahlalakhona mitral. Kucatshangelwe ivolumu kanye nephimbo base futhi ichopho inhliziyo.

Kubalulekile kakhulu phakathi izinyathelo kokuqala semhlahlo ngakususi umsindo extracardiac, okungukuthi, umthombo esemgwaqweni ngaphandle zenhliziyo. Ezimweni eziningi, lezi imisindo ungezwakala lapho pericarditis. Kodwa kunqunywa enjalo mkhuba acoustic ngesikhathi systole kuphela. Njengoba okuhlukile, bayakwazi ukulalela ngesikhathi diastole.

Ukuze sitholakele nesimo sezinhliziyo nezingqondo zama usebenzisa ubuchwepheshe ezahlukene. isicelo sabo kuyadingeka, ngoba iziphetho ungenisa ngesisekelo okutholakele etholwe ngokomzimba, kuncike isiqinisekiso. Ukufeza lezinhloso ochwepheshe zisebenzisa PCG, ECG,-X-ray wenhliziyo Ubukhulu ezintathu, echocardiography, kuhlanganise transesophageal.

Njengoba okwehlukile amasu koda zokuxilonga asetshenziswa enemibandela (amagesi, nezinye izindlela ukuze kuvele umehluko.).

Ukuze ukukala amandla inhliziyo umsindo usebenzisa amasampula ezithile:

- umthwalo ngokomzimba (icwecwe eliqophayo, isotonic futhi carpal dynamometry);

- ukuphefumula (ukwanda umsindo kusukela kwesokunxele nakwesokudla inhliziyo exhale)

- fibrillation atrial futhi amabhithi atrial ngaphambi kwesikhathi;

- izinguquko positional (imilenze ephakamisa ku imile, ushintsho emzimbeni isikhundla lesiguli nama-sit-ups);

- Valsalva iqhinga (clamping ukuphefumula ngomlomo avaliwe futhi ekhaleni) nabanye.

Izinto eziyinhloko ezatholwa futhi

Okokuqala kubalulekile ukuqonda ukubaluleka ukuhlola yesimanje ebukhoneni nokububula inhliziyo. isidingo sayo alichaza yokuthi nokububula systolic angeke wawusho izinkinga zezempilo eziphathekayo, kodwa ngesikhathi esifanayo uyakwazi ukuba wawubonakalisa lwesifo esibi.

Ngakho-ke, noma yimuphi umsindo ukuthi kutholwe enhliziyweni, kufanele zingachazwa ngezinqubo odokotela abaqeqeshiwe (kubalulekile ukuze kutholakale imbangela ngokuphumelelayo futhi ngokunembile). Empeleni, ngaso sonke isikhathi sibe nenhliziyo nokububula izici ngamunye elihlobene ne nezikhathi ezihlobene nokukhula. Noma yimuphi umsindo enhliziyweni udokotela ayakufanelekela. Okuvela ikhononda wenhliziyo owesifazane okhulelwe kuyisizathu esanele ukusungula control unomphela phezu isimo sakhe.

Ngisho nalapho engekho nezinkinga inhliziyo noma izimpawu kwanoma iyiphi kwezinso, kumele ngezikhathi bahlolwe. Kuvame ukwambulwa umsindo systolic kwenzeka ngezikhathi. Ngakho, ukuxilongwa gqwa uyakwazi ukuthola zokugula at esiteji lapho ukwelashwa mhlawumbe ngempumelelo.