Preventive Cardiology and Rehabilitation, Istituto Codivilla-Putti, Cortina d'Ampezzo (BL), Italy (Drs Compostella, Compostella, Russo, 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 Sep;37(5):315-321. doi: 10.1097/HCR.0000000000000262.
During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.
在急性冠状动脉综合征或充血性心力衰竭发作后的门诊心脏康复期间，仔细定期评估患者的临床和血液动力学状况至关重要。简单而传统的心音听诊可提供有价值的预后信息。第一心音（S1）强度降低，尤其是伴有心尖搏动延长和附加音出现时，可能有助于识别左心室（LV）功能障碍或传导障碍，有时与短暂性心肌缺血相关。如果 S1 和第二心音（S2）的强度均降低，则可能怀疑有心包积液；而 S2 强度增加可能表明肺动脉压升高。急性冠状动脉综合征后舒张早期杂音（S3）持续存在提示严重的 LV 功能障碍和预后不良。充血性心力衰竭患者中，S3 与心率升高相关提示即将发生失代偿。收缩前期杂音（S4）通常与 LV 衰竭患者的 S3 相关，但也可能存在于高血压患者和 LV 动脉瘤患者中。仔细评估心尖收缩期杂音可帮助识别可能的 LV 功能障碍或二尖瓣病变，并将其与乳头肌破裂或室间隔破裂区分开来。急性心肌梗死后的心包摩擦音，由于反应性心包炎或 Dressler 综合征，常与复杂的临床病程相关。在心脏康复期间，定期的心音听诊可提供有关患者临床血液动力学状况的有用信息，并以高效且低成本的方式及时发现可能导致并发症的迹象。
