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充血性心肌病的心音图研究

[Phonomechanocardiographic study of congestive myocardiopathy].

作者信息

Guadalajara J F, Fishleder B L, Jain S, Villeda A, Friedland C

出版信息

Arch Inst Cardiol Mex. 1979 Jul-Aug;49(4):589-603.

PMID:485668
Abstract

There were studied 14 patients with congestive myocardiopathy demonstrated by cardiac catheterism at nine, echocardiogramme at five and/or necropsy at four. There were registered mytral insufficiency blowings at thirteen and tricusp insufficiency blowings at five. Of them, there were 11 that presented pathologic noises III and IV. Right apexcardiogramme showed growth of such cavity at the twelve patients that were studied. "a" index of the same precordiogramme had qualitative correlation with systolic pulmonary pression. Apexcardiogramme showed ventricular growth at twelve from thirteen patients and "a" index was also qualitatively correlated with direct deermination of the left ventricule's telediastolic pression. Chronocardiometry was anormal at all of them. Short expulsive period, long pre-expulsive period, expulsion's fraction diminution reckoned by this method and systolic quotient, all of them diminished, translated the cardiac expense fall by "pump" fail. Elongation of pre-isosystolic phase, isosystolic phase, true isosystolic phase, and diminution of ventricular pression's elevation middle velocity and contractility index were consequences of myocardic contraction's bad quality. Decrement of ventricular pression's elevation velocity, added to the important elevation of left ventricle's final diastolic pression determined the "pseudonormality" of IIa-0 interval, and of the integrated isovolumetric pression. Shortening of fast filled's phase is explained by a minor ventricular filled in order to the volume's increase and diastolic pression's increase (Board VII). By last, shortening of Q-IIa interval, coinciding with the cardiac frecuence's increase is explained by catecolamins' increased secretion like compensating mechanism of chronic cardiac insufficiency. Phonomechanocardiogramme is useful for entity's diagnostic and it informs about ventricular disfunction which characterise the suffering.

摘要

对14例充血性心肌病患者进行了研究,其中9例经心导管检查确诊,5例经超声心动图确诊,4例经尸检确诊。记录到13例二尖瓣关闭不全杂音和5例三尖瓣关闭不全杂音。其中,11例出现病理性杂音Ⅲ级和Ⅳ级。右心尖心动图显示,在研究的12例患者中,该腔室增大。同一胸前导联心电图的“a”指数与收缩期肺动脉压存在定性相关性。心尖心动图显示,13例患者中有12例心室增大,“a”指数也与左心室舒张末期压的直接测定存在定性相关性。所有患者的心动计时均异常。短射血期、长射血前期、用该方法计算的射血分数降低和收缩期商数均降低,表明因“泵”功能衰竭导致心输出量下降。等容收缩前期、等容收缩期、真正等容收缩期延长,心室压力升高的平均速度和收缩力指数降低,是心肌收缩质量差的结果。心室压力升高速度降低,加上左心室舒张末期压力的显著升高,决定了IIa-0间期和等容压力积分的“假性正常化”。快速充盈期缩短是由于心室充盈减少,以适应容量增加和舒张压升高(图板VII)。最后,Q-IIa间期缩短与心率增加同时出现,这是由于儿茶酚胺分泌增加,作为慢性心功能不全的一种代偿机制。心音心动图对疾病的诊断有用,它能反映出表征该疾病的心室功能障碍。

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