Cau 5 : trinh bay cac bieu hien ben ngoai cua chu chuyen tim va UDLS

1. mom tim dap :

Khi ta nhin or so vao thanh long nguc phia truoc, ben trai, o khoang lien suon V tren dg giua don trai, ta thay tai do nho len, ha xuong trong moi chu ky tim do la mom tim dap. Co htuong nay la do luc co tim dang co, co tim ran lai va dua mom tim ra phia truoc day vao thanh nguc, lam cho thanh nguc o do nho len, khi co tim gi•n ra long nguc tai vtri do lai ha xuong

ud : quan sat mom tim dap cho ta biet vi tri cua mom tim tren long nguc de tien hah cac tham kham ve tim va co the dem dc nhip tim

2. tieng tim : dung ong nghe hay ap tai vao thanh nguc phia truoc ben trai, ta thuong nghe thay 2 tieng tim la T1 va T2, thinh thoang con nghe thay tieng T3 va T4

- T1(bum) : nghe tram va dai, nghe ro owr vung mom tim, la tieng mo dau cua thoi ky tam that thu, nguyen nhan gay ra tieng T1 chu yeu la do dong van nhi that. ting T1 co 2 tp chinh : tp1 la do dong van 2 la, nghe ro nhat la o vung mom tim, tp2 la do dong van 3 la, nghe ro o phan duoi bo uc trai

Ngoai ra tieng T1 con do mo cac van ban nguyet va dong mau phun vao dm

Trong 2 tp chinh, tp do dong van 2 la xay ra trc. Trong nghen nhnah phaI hoan toan, su dan truyen hung phan den tim phaI d• muon la cang muon them,lam cho 2 thanh phan nay cang cach xa nhau them -> T1 tach doi

Ngc lai trong nghen nhanh traI, tp van 2 la bi muon lai lam cho 2 tp nay rat lai gan nhau tham chi co the hoa vao nhau thanh 1 tieng duy nhat

- tieng T2 nghe thanh va ngan (tac): nghe ro o khoang lien suon 2, canh 2 ben xuong uc. Tieng T2 la tieng mo dau cho thoi ky tam that truong

Nguyen nhan gay ra T2 la do dong cac van to chim

+) T2 cung co 2 thnah phan chinh: tp1 la dong van DMC, xay ra trc 1 chut. Tp 2 la dong van DM phoi, xay ra sau tp1 do cac htg hd cua tim trai xay ra truoc 1 chut so voi hd cua tim phai

+) muc do tach doI tieng T2 thay doi theo cac thi cua ho hap: khi hit vao muc do tach doI tang len, o thi tho ra gan nhu ko tach doi

+) benh ly: T2 ko tach doI, gap o ng gia, o ng co cao ap DM phoi

. T2 lien tuc tach doI gap trong nghen nhanh phaI or op benh nhan bi ho nan 2 la or o ng bi thong vach lien nhi

. T2 tach doI ngc, gap trong nghen nhanh traI hoan toan

- khoang thoi gian giua T1 - T2 la khoang im lang ngan ( luc tam that thu)

+) bat thg giua T1 - T2 ->thoi tam thu, hep van dm, ho van nhi that

- khoang thoi gian giua T2 - T1 la khoang im lang dai ( luc tam that truong ). Bat thg T2 - T1 -> thoi tam truong

- tieng T3 va T4 dc tao ra khi buong tam that hung mau trong gd tam truong

- tieng T3 la do dot ngot ngung cang that luc tam truong, lam mau doi manh dap vao thanh tam that

- tieng T4 la do dot ngot gi•n that luc tam that thu ( luc nhi co)

- o tre em va ng tre tuoi tre thuong co tieng T3 binh thg, neu hit vao vf nin tho -> se ko thay nua nhung T4 ko bthg

T3 va T4 co tan so thap, nghe thay o tim trai or tim phai

Tren lsang ng ta nhan biet cky tim = tieng tim. Nvay, cky tim tren lsang ko cho biet hd cua tam nhi ma chi cho biet hd cua tam that.

3. Huyen ap: HA co gtri so toi thieu trong tky tam truong -> HA toi thieu

HA co gtri toi da trong thi tam thu -> HA toi da

4. Dien tam do

- do thi ghi lai dong dien hd cua tim trong qua trinh hd va co bop

Song P: song khu cuc cua tam nhi

Phuc bo Q R: phuc bo khu cuc cau tam that

Song T: song taI khu cuc cua tthat

Thoi gian PQ: tgian dan truyen nhi that

Thoi gain phuc bo QR la tgian cua phuc bo that

- UD:

+) phan tick 1 ban dien tam do cho phep danh gia tgian dan truyen dthe hd trong he thong nut tu dongva trong khoi co tim. Qua viec xac dinh bien do cua cac song P, QRS va T o cac chuyen dao khac nhau cho phep danh gia knang khu cuc cua tam nhi, knang khu cuc va tai cuc cua tam that => danh gia dc nhip tim, trang thaI cua co tim, bchat va su phat sinh cac roi loan nhip tim

- ghi dien tam do nhieu lan cho BN tim mach giup danh gia tien trien cua benh or danh gia knang phuc hoi cnang tim trong qua trinh dtri

- ghi dien tam do tren cac VDV giup theo doi tinh trang the luc va danh gia hieu qua bai tap dvoi tung VDV