The main method of research - auscultation of the heart

When the heart is working, a number of sound phenomena arise,which are studied using auscultation. Auscultation of the heart gives an opportunity to get an idea of ​​the processes taking place in the heart during his work. In carrying out this study, you must adhere to the rules that increase its effectiveness:

- the heart must be heard in a horizontal and vertical position, sometimes on the left side;

- Auscultation of the heart can be performed with the patient's usual breathing. If it is necessary to clarify a number of points, he is also listened to when breathing is delayed;

- during listening, it is necessary to keep silence and the room should be warm;

- the valves are listened to in order of decreasing their frequency of destruction.

Heart auscultation is generally acceptedway of listening with a stethoscope or phonendoscope. Using these tools makes it possible to determine sound phenomena from different parts of the heart, which is especially important in connection with their close placement. Some sounds during heart work are better audible at an auscultation directly by an ear.

To properly assess the auscultative pictureIt is necessary to know the parts of the projection of the valvular heart, the areas of their best listening. The perception of the sounds that form during the work of the heart depends on the location of the projection of the valves, the conduct of sound oscillations in the blood flow, the location in the chest of the heart where these fluctuations are formed. This makes it possible to find certain areas on the chest, where it is better to listen to sound phenomena. Plots of the best listening of the heart are called points of auscultation.

Heart auscultation - listening points

Listening to the heart is carried out in a certainsequence, which is adhered to to correctly evaluate the data obtained. To do this, we use points of auscultation of the heart, that is, areas of the chest, where the sounds heard in this or that part of the heart are better audible.

The first point. First, a mitral valve is heard. Auscultation is carried out at the first point, which is located on the apex of the heart.

The second point. Then they listen to the operation of the aortic valve - in the second intercostal space to the right of the sternum.

The third point. Auscultation of the valves of the pulmonary trunk is carried out in the second intercostal space to the left of the sternum.

Fourth point. Listening to the operation of the tricuspid valve is performed at the base of the sword-like process of the sternum.

These are the main four points of auscultation. There are still additional, which are used to refine the data in the detection of any changes.

Normally, over the area of ​​the heart, two short, constantly alternating sounds are heard, which are called heart tones.

The first tone is formed during contractionventricles, that is, systoles, and therefore called systolic. It is longer and slower, appears after a long pause, is better heard over the tip, coincides with the arterial pulse.

The second tone was called diastolic, soas occurs during the relaxation of the heart - diastole. The diastolic tone is heard after a short pause, it is better heard over the base of the heart, it is short and high in sound.

Pathological changes in the heart lead tothe fact that heart tones can change: amplify, weaken, split, there are additional third and fourth tones. For example, with a significant weakening of the contractile function of the myocardium, a third tone appears, and the work of the heart is characterized by the rhythm of the gallop, since it resembles the sound of horses' trampling.

Auscultation of the heart can reveal cardiac murmurs,which are formed between cardiac tones during systole or diastole. Heart sounds are divided into intracardiac and non-cardiac, as well as functional and organic. They are soft and rough, quiet and loud. Noises are well listened at points of auscultation of the heart.