Lecture topic: «differential diagnosis of heart noise. Tactics of general practitioner»

Tetralogy of Fallo. Classic tetralogy of Fallo consists of stenosis or atresia of the output department of pulmonary artery, ventricular septal defect, aortic dekstrapozitsii (right shift) and right ventricular hypertrophy. In the triad of Fallo, dextraposition of aorta is absent. Hemodynamics in tetralogy of Fallo is primarily dependent on the degree of narrowing of the pulmonary artery. Discharge of blood happens from right to left. There are determined dyspnea, cyanosis, fingers in a "clubbing". In auscultation 1 ton, as a rule, is not changed, II tone of the pulmonary artery is weakened or does not listen.
Along the left edge of the sternum sharp, there is auscultated systolic murmur with the greatest intensity in the second - the third intercostal space. Noise is well performed on vessels of the neck and in the lower-interscapular region. Deflection on the ECG electrical goes to the right. In X-rays, there is revealed the depletion lung pattern due to insufficient blood supply. Aorta expanded and shifted to the right.
Ductus arteriosus is more common in women. The clinical picture is determined by the discharge of blood through the shunt. Discharge of blood from the aorta is the pulmonary artery. At a low discharge, patients remain disabled for many years, there often found fault with a random survey. With significant relief sooner, there isshortness of breath, fatigue, impaired physical development. Systolic-diastolic noise in the second intercostal space to the left of the sternum is determined in auscultation and in PCG. The noise is associated with the movement of blood flowing from the aorta to the pulmonary artery, both during systole and diastole. This noise is metaphorically compared with the noise "crash a train in the tunnel", "engine noise." He amplified on the breath, because at this time the pressure in the pulmonary artery is reduced. On the ECG, signs of hypertrophy are on the left heart. Radiographically, there are defined in the lungs increased lung markings due to the overflow of the arterial bed, expansion and pulsation roots of the lungs.
ASD is diagnosed more often in adults (10% of congenital heart defects). In most patients, long flowing is relatively favorable. Shunt happens from left to right. Patients complain of shortness of breath, fatigue, stabbing pain in the heart, heart. In auscultation , there is moderate systolic murmur in the second - the third intercostal space on the left of the sternum. In right ventricular failure, intensity of noise is greatly weakened. There is determined intensification of Eaton on pulmonary artery. X-ray reveals the enlargement of the heart to the left due to a shift enlarged right ventricle and the pulmonary artery bulging, increased lung markings. On the ECG, there are signs of partial or complete right bundle branch block, right ventricular hypertrophy.
Lyutembashe syndrome - a combination of atrial septal defect and mitral stenosis. The latter is more common rheumatic etiology, but may be congenital. In syndrome of Lyutembashe, shunt left to rightamplifies, in connection with the earlier manifested hemodynamic disturbances. Diagnosis is based on the identification of the symptoms of atrial septal defect and mitral stenosis.
Ventricular septal defect (illness Tolochinova-Roger) can be isolated or associated with other cardiac anomalies. More common in the upper third of the septum, the size - 1-2 mm wall or completely absent. Shunt from left to right. Symptoms depend on the defect size of the defect. In the natural state of the defect, patients usually get progressively deteriorated after 20-25 years. There are fatigue, palpitations, shortness of breath. There can be identified heart hump, systolic tremor in the third - fourth intercostal space on the left of the sternum. In auscultation, there is heard loud systolic murmur ("much ado about nothing"), with a maximum playing time in the third or fourth intercostal space on the left of the sternum.
In X-rays, there is revealed a bulging arc pulmonary artery, the increase of the left ventricle. On PCG, systolic murmur is in the form of an oval or diamond, amplification and cleavage / / tone in the pulmonary artery.
Common atrioventricular canal - a large septal defect, an exciting bottom of the atrial septum and the adjacent part of the interventricular septum, and the split common atrioventricular valve, overhanging component ventricular septal defect.
Isolated pulmonary stenosis is relatively benign, often associated with other defects of the heart. Emission reduction of blood right ventricle leads to a reduction of pulmonary blood flow. Develop shortness of breath, fatigue. In auscultation and the PCG, in the second intercostal space to the left of the sternum, there is defined rough systolic murmur in the shape of a diamond. Second tone of the pulmonary artery sharply weakened and bifurcated.
Ebstein's disease appears bias the tricuspid valve into the right ventricle due to anomalous attachment of its wings. Abnormally located valve hole divides the right ventricle to the proximal portion and a distal functional small ventricular chamber. Hemodynamic disturbances are due to inefficient functioning of the small right ventricle.
Coarctation of the aorta - a significant narrowing of the aorta, usually in the area of ​​blood flow, sometimes in the lower thoracic or abdominal aorta. Some of the patients can be treated at the hypertensionlong time before the diagnosis. Coarctation of the aorta leads to the development of hypertension and collateral circulation around space narrowing. Blood pressure rises due to mechanical obstruction to blood flow and the inclusion of an endocrine mechanism (the renin - angiotensin - aldosterone). Patients complain of headache, fatigue, pain in the ankle joints. On examination of blood pressure, there issystolic murmur. Blood pressure on the legs is decreased or even not determined, also pulseweakened. These patients are usually well developed upper body than the lower limbs. Pulsation of the carotid artery is strengthened. At the base of the heart (in the second intercostal space to the left or right, in the third intercostal space on the left) is heard systolic murmur. It is well performed in the vessels of the neck and in the interscapular region. On the ECG, there are signs of left ventricular hypertrophy. In X-rays revealed an increase in the left ventricle. Characterized uzuratsiya III-VII pairs of ribs due to a sharp increase in the diameter of the intercostal arteries and tortuous course. Setting definite diagnosis helps aortography.
Aortic stenosis is an obstacle to blood flow from the left ventricle. More common aortic valve stenosis - congenital deformation of the cusps or narrowing the valve ring, at least - subvalvular (fibrous or muscular), aortic stenosis and even more rarely - supravalv(ul)ar stenosis. Clinical symptoms of this vice basically reminds manifestations of acquired aortic stenosis.
Treatment of heart disease in most cases is carried out by surgery. Main operations - valve replacement. When the surgical correction of heart disease is impossibly, then there is conducted a treatment with the help of drugs. Treatment of decompensated heart disease follows the same principles as in the treatment of chronic heart failure of other origin.
Primary prevention:

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  Prevention aimed at the prevention of disease, wheredevelops heart disease
  
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  Prevention of CHD: medical and genetic counseling, and advocacy of the contingent risk of the disease
  
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  Fighting inbreeding
  
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  Careful observation and study of women who were exposed to the rubella virus or who have comorbidities that could lead to the development of congenital heart defects.
  Secondary prevention
  

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  Prevention of adverse development of heart disease: the timely establishment of vice, ensure proper care and determine the best method of defect correction (surgical at UPU)
  Tertiary prevention
  
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  Surgery (acquired heart disease)
  Prevention of complications of congenital heart disease (bacterial endocarditis)
  

List of the literature
1. Jeffrey Bender, Kerry Russell, Lynda Rosenfeld, Sabeen Chaudry-Oxford American Handbook of Cardiology, 2011
2. A.Zaza An introduction to cardiac electrophysiology
3.ABC of Interventional Cardiology - Ever D. Grech, 2004
4. Cardiovascular Disease in the Elderly - Wilbert S.Aronow, Jerome L.Fleg,
5.www.vidal.ru /кардиология
6.medlistok.com./infarct.asp
7.health. mail.ru /disease/infarct/
8.мedportal.ru>…>кардиолоия
9.www.it-med.ru/library/p/heart1.htm
10.ru.wikipedia.org/wiki/пороки сердца
11.www.gutaclinik.ru>cтатьи