Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo, Italy (Drs Compostella, Russo, Compostella, Setzu, and Bellotto); Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy (Drs Compostella, Russo, Iliceto, and Bellotto); and Department of Medicine, School of Emergency Medicine, University of Padua, Padova, Italy (Dr Compostella).
J Cardiopulm Rehabil Prev. 2017 Nov;37(6):397-403. doi: 10.1097/HCR.0000000000000272.
This clinical skills review describes the most common cardiac auscultatory findings in adults after heart surgery and correlates them with prognostic indicators. It was written for noncardiologist health care providers who work in outpatient cardiac rehabilitation programs.Mechanical prosthetic valves produce typical closing and opening clicks. Listening to their timing and features, as well as to presence and quality of murmurs, contributes to the awareness of potential prosthesis malfunction before other dramatic clinical signs or symptoms become evident. In patients with biological prostheses, murmurs should be carefully evaluated to rule out both valve malfunction and degeneration. Rubs of post-pericardiotomy pericarditis should prompt further investigation for early signs of cardiac tamponade. Third and fourth heart sounds and systolic murmurs in anemic patients should be differentiated from pathological conditions. Relatively new groups of heart surgery patients are those with chronic heart failure treated with continuous-flow left ventricle assist devices. These devices produce characteristic continuous noise that may suddenly disappear or vary in quality and intensity with device malfunction. After heart transplantation, a carefully performed and regularly repeated cardiac auscultation may contribute to suspicion of impending acute rejection. During cardiac rehabilitation, periodic cardiac auscultation may provide useful information regarding clinical-hemodynamic status and allow detection of heralding signs of possible complications in an efficient and low-cost manner.
本临床技能复习介绍了心脏手术后成人最常见的心脏听诊结果，并将其与预后指标相关联。它是为在门诊心脏康复计划中工作的非心脏病专家医疗保健提供者编写的。机械人工瓣膜会产生典型的关闭和开启喀喇音。了解这些喀喇音的时机和特征，以及杂音的存在和质量有助于在出现其他明显的临床体征或症状之前，发现潜在的人工瓣膜故障。对于生物假体患者，应仔细评估杂音，以排除瓣膜功能障碍和退行性变。心包切开术后心包炎的摩擦音应促使进一步调查早期心脏压塞的迹象。贫血患者的第三和第四心音和收缩期杂音应与病理情况区分开来。一类较新的心脏手术患者是使用持续流量左心室辅助装置治疗的慢性心力衰竭患者。这些设备会产生特征性的持续噪音，可能会突然消失，或者随着设备故障而改变质量和强度。心脏移植后，仔细进行并定期重复的心脏听诊可能有助于怀疑即将发生急性排斥反应。在心脏康复期间，定期进行心脏听诊可以以有效且低成本的方式提供有关临床血液动力学状态的有用信息，并可以检测可能并发症的预示迹象。
