valvular murmurs.ppt

To improve your other deed？ hear S3 S4 and mumur of mitral stenosis, have the patient roll part-way onto his left side,which brings the left ventrical（左室）across to the chest wall. Then re-check the position of the apical impulse（心尖搏动） and place the bell（钟形听诊器） lightly on it, if the patient had an audible（清晰的）S3, it would sound like this: now notice how the third heart sound disappears when the bell is placed more firmly（压更紧） on the chest wall. Listen again with light pressure（轻压）,with firm pressure, and once again with light pressure. To help detect an aortic mumurs, especially by aortic regurgitation（主动瓣返流）, have the patient sit up and lean forward, then ask him to exhale completely and hold his breath out, using the diaphragm [dai?fr?m] of the stethoscope（听诊器膜件）, listen at left second interspace（第二肋间） and down the left sternal border （胸骨左缘） to the apex（心尖）. redone completely and hold it . Pause-periodically（间停周期） to allow the patient to breath, listen for the high-pitched（高调） diastolic mumur at aortic regurgitation,if the patient heard this mumur,it could sound like this you may breath,take another deep breath, breath out and hold it , heart mumurs can be distinguished from the heart sounds by the longer duration. Diastolic murmurs, like this one, usually indicate heart disease. Systolic murmurs can incur （遇到） in healthy people or in those with heart disease. For example, a loud mid systolic murmur may be heard in aortic stenosis. If you hear such a loud murmur, palpate（触诊） area was the palm（bottom？） of your hand, palpable vibrations（明显的震动） associated with the heart murmur are called a thrill. * *