上海交通大学：《诊断学》课程PPT教学课件（英语版）Chapter 14 Heart murmur

Heart murmur H Mis abnormal sound Produce by vibration Within the heart or large arteries

Heart murmur • H M is abnormal sound • Produce by vibration • Within the heart or large arteries

Mechanism Blood velocity个 Blood vascosityl Valve: narrowed or incompetent: organic or relative abnormal connection Vibration of loose structure Diameter of vessel↑or

• Mechanism – Blood velocity – Blood vascosity – Valve: narrowed or incompetent; organic or relative – Abnormal connection – Vibration of loose structure – Diameter of vessel or 

Laminar Flow In the absence of an obstruction to flow, blood cells move in a uniform Turbulent Fl A high velocity yet is created ut the ste of an obstruction. Beyond the obstruc tion, blood cells mowe erratically in different directions and at varving velocities

Ss 器质性关闭不全 血流加速形成旋满 相对性关闭不全 器质性狄罕 常通道 和刈性狭 漂浮物

character of murmur Location Murmur of valvular origin are usuall best heard over their respective valve area Timing Murmurs are timed according to the phase of cardiac cycle during which they occur SM. DM. CM Early. middle late

• character of murmur • Location: – Murmur of valvular origin are usually best heard over their respective valve area • Timing: – Murmurs are timed according to the phase of cardiac cycle during which they occur. – SM, DM , CM. – Early, middle, late

C 11Ac. I HI S2 Fig 14-2, A-D

A2 P2

Quality Depend on: frequency and intensity o sound wave Related to: pathology and hemodynamic changes of the heart Soft harsh musical SM: blowing, harsh, musical(seagull DM: blowing, sigh-like, rumbling. Mr CM: machine-like. hum

• Quality – Depend on: frequency and intensity of sound wave – Related to: pathology and hemodynamic changes of the heart – Soft harsh, musical. – SM: blowing, harsh, musical (seagull) – DM: blowing, sigh-like, rumbling. – CM: machine-like, hum

Radiation transmitted direction With the bloodstream by which they are produced or propagated from their point of origin in many directions As MR MS

• Radiation: transmitted direction – With the bloodstream by which they are produced or propagated from their point of origin in many directions – AS – MR – MS

e Intensity Related to The severity of abnormal The velocity of blood flow The pressure gradient of valve The myocardial contraction

• Intensity: – Related to : • The severity of abnormal • The velocity of blood flow • The pressure gradient of valve • The myocardial contraction