Тиббиётнинг долизарб муаммоси

Examination of cardiac hump.
Can apex beating be seen visually? Its location if not seen (costal interspaces and distances from left middle-clavicular line). Systolic concaveness on the place of apex beating and in other regions of cardiac area. Heart beating.


Palpation of cardiac area:
Types of apex beating (limited, apex, diffuse, cardiac). Apex beating and its character (width, height, force, resistance). “Cat`s murmurs” (defining the systolic trembling on the apex, on the base of the heart, location ). Pulse palpation in the region (due to the heart, aorta, liver).


Percussion of the heart.
To define the borders of relative dullness in the heart: the right one for the account of the right edge of the breastbone (in cmes), located above the level of right dome of the diaphragm on IV-th costal interspaces, the left one on the level of apex beating in the middle clavicular line on the V-th costal interspace. The upper border on the left thoracic line on the level of III-rd rib,3 cms outside. Configuration of relative dullness of the heart (normal, mitral, aortal) defines by the mean of percussion of cardiac borders on all costal interspaces from each side. Defining the borders of absolute cardiac dullness (right, left, upper).


Auscultation of the heart.
Auscultation of cardiac sounds in carried out in each form the five points. Point out which valve is located and heard on each point of the heart, which sound is considered.
For example, the 1^st point is mitral valve which is located on the left of the breastbone in the region of fixation the 3^rd rib, the 1^st tone is heard at the apex of the heart.
The 1^st tone: normal-sound , weak, strong, clapping, broken, double.
The second tone: normal sound, marked weak, broken, double. “Quail” rhythm. “Gallop” rhythm; presystolic, mezosystolic, protodiastolic. Pendulum like rhythm, embriocardia. To point out points where all the above-mentioned changes are found. Rate of heart constractions per minute.
Listening to the sounds: their relativeness to the phases of cardiac activity: systolic, diastolic (mezo-,proto-, perisystolic). Character of heart sounds: mild, blowing, sawing, etc.
Force: sharp, weak, etc. Timbre: mild, rigid, high, low. Duration: long, short, increasing, decreasing. Point of the most intensive while listening, ways of sound extension. Forcing and weakening on exertion . sound of pericardium rubbing (point of listening); pleuropericardiac sound.