examen cardiovascular mariana
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7/17/2019 Examen Cardiovascular Mariana
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ORIENTACIONES GENERALES Dejar des!"#er$a %a re&#'( )!e *a+,s a e-.%,rar/
.reere($e+e($e desde e% ,+"%#&, a#a arr#"a E% e-.%,rad,r de"e ,%,arse a %a derea de%
e-a+#(ad, E% e-a+e( de"e rea%#3arse ,( %a .ers,(a
a,s$ada/ , +ej,r re%#(ad, e( %a a+#%%a , e( %aa+a
La e-.%,ra#'( se ar4 .,r %,s !a$r,.r,ed#+#e($,s %4s#,s )!e a ,(,e+,s6 %a#(s.e#'(/ %a .a%.a#'(/ %a .er!s#'( %aa!s!%$a#'(
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7REAS O FOCOS PRECORDIALES E% ,, a'r$#,/ %,a%#3ad, e( e% se&!(d, es.a#, #($er,s$a%
dere,/ e-a$a+e($e a% %ad, de% ",rde dere, de%es$er('(
E% ,, .!%+,(ar/ %,a%#3ad, e-a$a+e($e a% %ad, de% ",rde#3)!#erd, de% es$er('(/ e( e% se&!(d, es.a#, #($er,s$a%#3)!#erd,/ re.rese($a %a *4%*!%a .!%+,(ar
E% ,, $r#!s.8de,/ %,a%#3ad, e( !( 4rea dea.r,-#+ada+e($e 9 a : cm/ a %a #3)!#erda de% es$er('( e(
s! .ar$e #(er#,r/ a %a a%$!ra de %a )!#($a ar$#!%a#'(,(dr,,s$a% #3)!#erda/ re.rese($a %a *4%*!%a $r#!s.8dea/
E% ,, +#$ra% , a.#a%/ s#$!ad, e( e% 5$, es.a#, #($er,s$a%#3)!#erd,/ e( %a %8(ea +ed#,%a*#!%ar/ re.rese($a !(a*4%*!%a !(a 4+ara ard#aa
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7REAS O FOCOS ADICIONALES E% 4rea es$er(,%a*#!%ar/ desa(sa s,"re e% es$er('(
s! !(#'( ,( a+"as ,s$#%%as/ as8 ,+, .ar$e de %,s 1r,ses.a#,s #($er,s$a%es #3)!#erd, dere, Es$ases$r!$!ras .!ede( ser*#r de %8(eas de de+ara#'( .ara
e*a%!ar e% ar, a'r$#, %a ar$er#a .!%+,(ar E% 4rea *e($r#!%ar derea/ s,"re e% *e($r8!%, dere,
)!e e(re($a e% $'ra- a($er#,r/ se e-$#e(de desde e% 9eres.a#, #($er,s$a% as$a e% e-$re+, d#s$a% de% es$er('(E% ",rde %a$era% dere, de% 4rea se e(!e($ra s,"re %a
a!r8!%a derea E% *e($r8!%, #3)!#erd, es$4 s,"re s!",rde %a$era% #3)!#erd,
E% ,, de Er" , 2d, ,, a'r$#,/ e( e% 9er es.a#,#($er,s$a% #3)!#erd, se #(%!e e( e% 4rea *e($r#!%arderea Es ,(s#derad, .,r %a +a,r8a ,+, e% 5$,
,, .r#(#.a% de a!s!%$a#'( .re,rd#a%
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INSPECCIÓN
,"ser*e $,d,s %,s e('+e(,s *#s#"%es6
,%,ra#'( de %a .#e%/
ar)!#$e$!ra de %a re&#'(/
,(;&!ra#'( e-$er(a/
+ed#a($e %a inspección estática dinámica <%a$#d,s.,s#$#*,s e( e% se($#d, de %e*a($a+#e($,/ , (e&a$#*,s e( e%se($#d, de de.res#'(= e( %a re&#,(es .re,rd#a%/ e.#&4s$r#a er*#a%
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INSPECCI>N GENERAL
1?A$#$!d , .,s$!ra6
@ Se+#se($ad, , se($ad,
@ Or$,.(ea e( as,s de d#s(ea #($e(sa @ S#&(, de% a%+,ad'( 6 #(%#(a#'( de% $'ra- a#a ade%a($e
a.,ad, e( !(a a%+,ada
2? 4"#$, ,(s$#$!#,(a%
9? C,%,ra#'( de .#e% +!,sas6
Pa%#de3/ #a(,s#s/ #$er##a :? Prese(#a de ede+as
5? Ca"e3a6 +,*#+#e($,s s#(r'(#,s ,( %a FC
S#&(, de Ma33a 6 ,j, $!+ea$, r,j#3,
B? C!e%%,6 .!%s, *e(,
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INSPECCI>N DIN7MICA Per+#$e a.re#ar e% ,)!e de %a .!($a <%e*a($a+#e($, )!e
e-.er#+e($a %a re&#'( a.e-#a(a/ .,r e% e+.!je a#a de%a($e de%a .!($a de% *e($r8!%, #3)!#erd, d!ra($e e% ,+#e(3, de %as8s$,%e ard#aa=
La #(s.e#'( de% ,)!e de %a .!($a .er+#$e ;jar6 s#$!a#'( , %,a%#3a#'(/
,r+a/
#($e(s#dad/
e-$e(s#'(/ re!e(#a r#$+,
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SITUACIÓN
ad!%$,6 V es.a#, #($er,s$a% #3)!#erd,
(#,6 IV es.a#, #($er,s$a% #3)!#erd,
a(#a(,6 VI es.a#, #($er,s$a% #3)!#erd,
S,"re %a %8(ea +ed#,%a*#!%ar <LMC= <,, +#$ra%= ,!( .,, +4s ade($r,/ %#+#$4(d,se a !"r#r !(ae-$e(s#'( red!#da/ )!e a"ara a.r,-#+ada+e($e%a e+a de !( ded,/ )!e (, de"e ser +a,r de2?9 + de d#4+e$r,
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VARIACIONES EN ESTADO FISIOL>GICO E( %,s .8(#,s/ e( %,s ,"es,s e( %as
e+"ara3adas/ e% %a$#d, de %a .!($a as#e(de .!ede ,"ser*arse .,r e(#+a de% 5$, es.a#,
#($er,s$a% a%&, a#a !era E( %,s %,(&#%8(e,s e( %,s de%&ad,s/ se s#$a +4s
a"aj, ade($r,
E( de"#$, %a$era% #3)!#erd, <.,s##'( de Pa'(=/%a .!($a se des*8a de 2 a 5 cm a#a %a re&#'(a-#%ar
Las a%$era#,(es ;s#,%'&#as de% ,)!e de %a .!($ase ,"ser*a( +ej,r e( e% #(d#*#d!, se($ad,
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CAUSAS DE DESPLAAMIENTO DEL
7PEXCARDÍACAS
#.er$e(s#'( ar$er#a%
Es$e(,s#s a'r$#a I(s!;#e(#a a'r$#a
M#,ard#,.a$8a#.er$r';a
M#,ard#,.a$8a d#%a$ada
EXTRACARDÍACAS
A$e%e$as#a .!%+,(ar
#3)!#erda Adere(#as.%e!ra%es
#3)!#erdas
Ne!+,$'ra- dere,
Derra+e .%e!ra% dere,
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ALTERACIONES DEL 7PEX
IPERDIN7MICO
CARDÍACAS
I(s!;#e(#aa'r$#a
C,r$,#r!#$, de#3)!#erda aderea
EXTRACARDÍACAS F8s$!%as
ar$er#,*e(,sas
T#r,$,-#,s#s
SOSTENIDO
CARDÍACAS
#.er$r,;a VI6
TA
Es$e(,s#s a,r$#a
D#s!(#'( *e($r#!%ars#s$'%#a
A(e!r#s+a*e($r#!%ar #3)!#erd,
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FORMA, INTENSIDAD Y EXTENSIÓN.
La #($e(s#dad de% ,)!e de %a .!($a de.e(de6 de% &r,s,r de %a .ared/
de% $a+a, de% ,ra3'(
de %a !er3a de s! ,($ra#'(
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FRECUENCIA Y RITMO.
,"ser*ar %a re!e(#a de% ,)!e de %a .!($a s# s$e es r8$+#, , (,/ a es !( ade%a($, .ara.re#sar es$,s as.e$,s ,( +a,r , +e(,r.r,!(d#dad/ d!ra($e %a a!s!%$a#'(
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OTROS LATIDOS AHENOS AL COUE
DE LA PUNTA6 La$#d, e.#&4s$r#,6 Se ,"ser*a e( ,(d##,(es
(,r+a%es e( #(d#*#d!,s de%&ad,s
Des.!s de %a s8s$,%e *e($r#!%ar se .r,d!e %a.r,e#'( a#a de%a($e de %a re&#'(e.#&4s$r#a
O$ras *ees/ e% %a$#d, e.#&4s$r#, ,(s#s$e e(!(a re$ra#'( s#s$'%#a de esa re&#'(/ %a$#d,(e&a$#*,/ +,$#*ada .,r %a $ra(s+#s#'( de% %a$#d,ard#a,/ %, )!e .!ede s!eder e( e% $erre(,;s#,%'&#,
s#( e+"ar&,/ $a% a%%a3&, .!ede ser a(,r+a%<*e($r8!%, dere, #.er$r,;ad,=
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ELEMENTOS OJTENIDOS CON LA
PALPACI>N
M,*#+#e($,s .!%s4$#%es <C,)!e de %a .!($a ,$r,s=
V#"ra#,(es *a%*!%ares .a%.a"%es <,)!es*a%*!%ares=
Es$re+e#+#e($, a$ar#, <r+#$, , thrill=
R#$+, de &a%,.e d#as$'%#, R,es .er#4rd#,s .a%.a"%es <r+#$,
.er#4rd#,=
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CHOQUE DE LA PUNTA E( %,s (#,s e( %,s j'*e(es es re!e($e .er#"#r e%
%a$#d, ard#a, e( de"#$, s!.#(, e( $a($, )!e e(ad!%$,s de +4s de 90 a,s/ %, ,+( es (,
e(,($rar (#(&( %a$#d, .a%.a"%e e( de"#$, d,rsa% Pa%.ar%, e( esa .,s##'( !a(d, e% s!je$, $#e(e +4s
de 90 a,s/ de"e aer s,s.ear a%&!(a a%$era#'(ard#aa
S! ,+.r,"a#'( es ,(s$a($e e( de"#$, %a$era%#3)!#erd,
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ESTREMECIMIENTO CATARIO
(FRMITO O THRILL! Es !(a se(sa#'( .er#"#da .,r %a +a(, )!e
.a%.a/ ,+.ara"%e a %a se(sa#'( )!e se
,"$#e(e a% .a%.ar a ,($ra.e%, e% d,rs, de !(&a$, )!e r,(r,(ea
E( s!je$,s ,( ere$#s+, ard#a, <j'*e(es/s#+.a$#,$'(#,s/ #.er$#r,#de,s/ e$= .ared$,r4#a de%&ada/ .!ede .er#"#rse !(ase(sa#'( *#"ra$,r#a .are#da a% thrill/ d!ra($e%a s8s$,%e/ a %a )!e se de(,+#(a tr"m#r c#r$i%E% tr"m#r aree de s#&(#;a#'( .a$,%'&#a
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LOS ESTREMECIMIENTOS CATARIOS
PUEDEN OCURRIR DURANTE6 %a s8s$,%e6 thrill s#s$'%#,
e( .%e(a d#4s$,%e6 d#as$'%#,
, a"arar %,s d,s $#e+.,s s#( #($err!+.#rse6s#s$,d#as$'%#,
S! %,a%#3a#'( es *ar#a"%e .!ede( rad#ar6 e( %a .!($a/
e( %a "ase/ e( %,s *as,s de% !e%%,/
e( e% +es,ard#,
e-e.#,(a%+e($e/ e( %a re&#'( -#,#dea
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E% thrill a.e-#a(, s!e%e .er#"#rse +ej,r e(
de"#$, %a$era% #3)!#erd, L,s "asa%es se e-$er#,r#3a( +4s 4#%+e($e
,rde(a(d, a% s!je$, )!e se s#e($e s# es$4a,s$ad, s# es$4 se($ad,/ .ed#r%e )!e #(%#(e e%
$r,(, a#a de%a($e a %a #3)!#erda
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PERCUSI>N
E-#s$e( d,s 3,(as ,(a e( ,($a$, d#re$, ,( %a .ared $,r4#a6
3,(a de +a$#de3 a"s,%!$a
,(a se.arada .,r $ej#d, .!%+,(ar6 3,(a de+a$#de3 re%a$#*a <dada .,r %a a!r8!%a dereae($re e% $erer, e% )!#($, es.a#,s#($er,s$a%es= +4s arr#"a .,r %a .,r#'( #(##a%de %a a,r$a ase(de($e E% ",rde #3)!#erd, es$4,r+ad, .,r e% *e($r8!%, #3)!#erd, a#a a"aj,
e% ,(, de %a ar$er#a .!%+,(ar a#a arr#"a
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MATIDEZ RELATIVA. TCNICA DE LA
EXPLORACIÓN De$er+#(ar e% ",rde s!.er#,r de %a +a$#de3 e.4$#a/
,+e(3a(d, a .er!$#r desde %a re&#'( #(ra%a*#!%ara#a %a "ase de% $'ra-
De$er+#(ar e% ",rde dere, de% 4rea ard#aa.er!$#e(d, e( se($#d, $ra(s*ersa% desde %a %8(ea a-#%ara($er#,r derea a#a e% es$er('(/ a% (#*e% de %,ses.a#,s #($er,s$a%es $erer,/ !ar$, )!#($,
De$er+#(ar e% ",rde #3)!#erd, .er!$#e(d, e( se($#d,$ra(s*ersa% ,"%#!, desde %a %8(ea a-#%ar a($er#,r#3)!#erda a#a e% es$er('(/ $a+"#( e( se($#d,*er$#a% ase(de($e , dese(de($e
Orde(ar a% e(er+, )!e rea%#e *ar#as es.#ra#,(es,r3adas +arar ,( !( %4.#3 der+,&r4;, ada %8+#$eas$a ,(;&!rar d#a 4rea
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MATIDEZ ABSOLTA
T#e(e %a ,r+a de !( $r#4(&!%, !, *r$#e es$4a %a a%$!ra de% !ar$, ar$8%a&, ,s$a% !a"ase se ,(!(de s#( de%#+#$a#'( ,( %a+a$#de3 e.4$#a
E1 ",rde dere, *er$#a% ,rres.,(de a% ",rde#3)!#erd, de% es$er('( e% ",rde #3)!#erd, es
,"%#!, a#a a"aj, a!era e-$e(d#(d,sedesde e% *r$#e as$a !( .,, .,r de($r, de%,)!e de %a .!($a
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PERCSIÓN DEL !REA
PRECORDIALINCREMENTO DE LA
MATIDE CARDÍACA
Card8aas6• Card#,+e&a%#a &%,"a%• Derra+e .er#4rd#,
P!%+,(ares• Ne!+,$'ra- dere,• Derra+e .%e!ra% dere,• A$e%e$as#a .!%+,(ar
derea
DISMINUCI>N DE LAMATIDE CARDÍACA
Card8aas6• De-$r,ard#a
P!%+,(ares6@ Derra+e .%e!ra%
#3)!#erd,
@ A$e%e$as#a derea
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SEMIOTECNIA E% ",rde dere,/ se ,%,a e% ded, .%es8+e$r,
e( %a d#re#'( de% eje %,(&#$!d#(a% de% $'ra- e(e% %8+#$e dere,/ )!e de$er+#(a+,s e( %a
+a$#de3 re%a$#*a a*a(3a(d, e( se($#d,$ra(s*ersa% a#a %a #3)!#erda as$a e(,($rar+a$#de3 a"s,%!$a Es$a ,.era#'( se rea%#3a a(#*e% de% !ar$, )!#($, es.a#,s
Para de$er+#(ar e% ",rde #3)!#erd, ae+,s!(a ,.era#'( s#+#%ar .er, e( se($#d, ,($rar#,/s#e+.re .ar$#e(d, e( ,r+a .ara%e%a de% %8+#$e#3)!#erd, de %a +a$#de3 re%a$#*a
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ASCLTACIÓN De"e rea%#3arse e(6
!a$r, ,,s .r#(#.a%es de a!s!%$a#'(6$r#!s.8de,/ +#$ra%/ .!%+,(ar a'r$#,
,,s ad##,(a%es de% .re,rd#, <2d, ,,a'r$#, , V ,, de a!s!%$a#'( +es,ard#,=
"ase de% !e%%,/
4rea es$er(,%a*#!%ar/
re&#'( e.#&4s$r#a
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MKTODO SECUENCIAL SISTEM7TICO/
C,+e(3a+,s .,r e% ,, $r#!s.8de,/ des.!sse .asa a% ,, +#$ra% a ,($#(!a#'(/ a %,s,,s de %a "ase6 a% .!%+,(ar a% a'r$#,/ .ara errar e% #r!#$, de %,s ,,s/ de"e.asarse a% 2d, ,, a'r$#,
Des.!s se re,rre $,da %a re&#'( .re,rd#a%/"ase de% !e%%,/ re&#'( es$er(,%a*#!%ar/re&#'( e.#&as$r#a
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OTRA SECUENCIA
C,+e(3ar .,r e% ,, a'r$#,/ d,(de se
#de($#;a +! "#e( e% 1r, 2d, r!#d,s/ se&!#da+e($e a!s!%$ar %,s *as,s de% !e%%, ,.asar a% ,, .!%+,(ar L!e&, se *adese(d#e(d, .,r e% ",rde es$er(a% #3)!#erd,/ a%2d, ,, a'r$#,/ as$a e% $r#!s.8de, %a re&#'(
e.#&4s$r#a/ .ara $er+#(ar e( e% ,, +#$ra% +es,ard#,
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AUSCULTACI>N SISTEM7TICA C,( %a .ers,(a e( s!.#(,/ .r,eda s#s$e+4$#a?
+e($e de !( ,, a% s#&!#e($e A!s!%$e ada 4rea !sa(d, e% d#ara&+a .ara
de$e$ar %,s s,(#d,s +4s a&!d,s/ ,+, e% 1erR!#d, <R1=/ e% 2d, R!#d, <R2= !se %a a+.a(a.ara de$e$ar %,s s,(#d,s +4s &ra*es/ ,+, e% 9r, :$, R!#d,s <R9 R:=
A!s!%$e %a "ase de% ,ra3'( ,( %a .ers,(ase($ada #(%#(ada a#a de%a($e
E*a%e e% a.e- ,( %a .ers,(a e( de"#$, %a$era%#3)!#erd,
Es!e d!ra($e *ar#,s #%,s ard#a,s e( ada,, a!s!%$a$,r#,
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I. DETERMINE EL RITMO " LA
#RECENCIA CARDIACA E% $itm% a"#$!a%+e($e ser4 re&!%ar
P!ede *ar#ar e( (#,s ad!%$,s j'*e(es/ e( %,s)!e se .!ede a.re#ar !( r#$+, #rre&!%ar )!e
*ar8a ,( %a res.#ra#'( Arr#$+#a s#(!sa% N,$#e(e s#&(#;a#'( .a$,%'&#a
D!ra($e %a #(s.#ra#'( e% re$,r(, *e(,s, es+a,r %a re!e(#a .!ede a!+e($ar .ara
,+.e(sar e% +a,r *,%!+e( de sa(&re/+#e($ras )!e e( %a es.#ra#'( %a re!e(#ad#s+#(!e
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CUANDO LOS RUIDOS SON ARRÍTMICOS6 a$$itmia e&t$asistó'ica6 Se .!ede .re#sar !(a
ade(#a r8$+#a de "ase/ d,(de se #(ser$a(%a$#d,s .re+a$!r,s se&!#d,s de !(a .a!sa<e-$ras8s$,%es=
a$$itmia c%mp'eta6 S# %,s %a$#d,s a!s!%$ad,ss,( ,+.%e$a+e($e arr#$+#,s/ s#( )!e se.re#se !(a ade(#a de "ase/ )!e s#e+.re es.a$,%'&#a )!e se de"e a"#$!a%+e($e a !(a
;"r#%a#'( a!r#!%ar C!a(d, se de$e$a !(a arr#$+#a de"e
,+.%e$arse e% e-a+e( a!s!%$a(d,s#+!%$4(ea+e($e ,( %a .a%.a#'( de% .!%s,rad#a%
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Las e-$ras8s$,%es , %a$#d,s .re+a$!r,s .!ede( ser*e($r#!%ares/ s# se ,r#&#(a( e( es$e s#$#,/ ,s!.ra*e($r#!%ares/ s# se ,r#&#(a( .,r e(#+a de% +#s+,
La ,($ra#'( *e($r#!%ar de %,s %a$#d,s .re+a$!r,ss!.ra*e($r#!%ares se .r,d!e e( +,+e($,s e( )!e aa s!;#e($e sa(&re e( %,s *e($r8!%,s .ara sere-.!%sadas a %a .er#er#a e% %a$#d, .re+a$!r, %%e&a a%.!%s, rad#a%/ .,r %, )!e %a e-$ras8s$,%e s! .a!sa.,s$er#,r se de$e$a( s#+!%$4(ea+e($e a %a a!s!%$a#'(ard#aa a %a .a%.a#'( de% .!%s,
C!a(d, %a e-$ras8s$,%e es de ,r#&e( *e($r#!%ar/ %a,($ra#'( *e($r#!%ar .re+a$!ra se .r,d!e !a(d, e%*e($r8!%, #3)!#erd, (, $#e(e sa(&re s!;#e($e .arae-.!%sar a %as ar$er#as .er#r#as %a e-$ras8s$,%e sea!s!%$a/ .er, (, se $ra(s+#$e a% .!%s, rad#a% %a.a%.a#'( de s$e (,s .r,d!e %a se(sa#'( de )!e a%$a!( %a$#d,
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EN RESUMEN
%as e-$ras8s$,%es s!.ra*e($r#!%ares&e(era%+e($e se $ra(s+#$e( a% .!%s,/ +#e($ras)!e %as *e($r#!%ares (, se $ra(s+#$e(/ se.a%.a e% .!%s, ,+, a!se(#a de !( %a$#d,
La arr#$+#a ,+.%e$a .,r ;"r#%a#'( a!r#!%ar se,rr,",ra .,r .a%.a#'( s#+!%$4(ea/ .,r)!e$,d,s %,s %a$#d,s arr8$+#,s %%e&a( a% .!%s, esde#r/ se ,e( se .a%.a( s#(r'(#a+e($e
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AUMENTO DE INTENSIDAD DEL
PRIMER RUIDOFISIOL>GICAS6
A,r$a+#e($, de %a
d#4s$,%e6
• Ejer##,• F#e"re
EXTRACARDÍACAS6
A!+e($, de% CG de%!j, AV6
• T#r,$,-#,s#s
• F8s$!%a ar$er#,*e(,sa
CARDÍACAS6
1? Pr,%,(&a#'( %%e(ad, *e($r#!%ar6
• Es$e(,s#s +#$ra%
2?C,(d!#'( AV r4.#da6
• S8(dr,+e P ,r$,
9? Re$ras, #erre *4%*!%a +#$ra%
:? M#-,+a a!r8!%a
#3)!#erda
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DISMINCIÓN DE INTENSIDAD DEL
PRIMER RIDOCARDÍACAS
1 D#s+#(!#'( de %a
,(d!#'( AV6
J%,)!e, AV .r#+er &rad,
2 C#erre a(,r+a% de %a
+#$ra%6
I(s!;#e(#a *a%*!%ar
9 Gas$, ard8a,
d#s+#(!#d,6
• I(ar$, a% +#,ard#,
• #.,$#r,#d#s+,
EXTRACARDÍACAS• Derra+e .er#4rd#,• Derra+e .%e!ra%• E(;se+a .!%+,(ar•
O"es#dad se*era
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DESDOBLAMIENTO DEL
PRIMER RIDO
ACENTUACI>N EN
INSPIRACI>N
@ J%,)!e, ,+.%e$, de
ra+a derea de% a3de #s
DESAPARICI>N ENINSPIRACI>N
• Es$e(,s#s +#$ra%
• M#-,+a a!r#!%ar#3)!#erd,
• J%,)!e, ,+.%e$, ra+a#3)!#erda de% a3 de #s
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AMENTO DE INTENSIDAD SE(NDO
RIDO
COMPONENTE A>RTICO
1? F#s#,%'&#as6
Pers,(as j'*e(es/a$%e$as/ $'ra- as$(#,
2? Pa$,%'&#as6
#.er$e(s#'( ar$er#a%/
C,ar$a#'( a'r$#aI(s!;#e(#a a'r$#a
A(e!r#s+a a,r$a
ase(de($e
COMPONENTE PULMONAR
Pa$,%'&#as6#.er$e(s#'( .!%+,(ar
.r#+ar#a , se!(dar#a
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DISMINCIÓN DE INTENSIDAD
SE(NDO RIDO
EXTRACARDÍACAS
• O"es#dad
• EJOC
COMPONENTE PULMONAR
Es$e(,s#s .!%+,(ar
COMPONENTE A>RTICO
Es$e(,s#s a'r$#a
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DESDOBLAMIENTO DEL
SE(NDO RIDOFISIOL>GICAS6
I(s.#ra#'( .r,!(da
ACENTUADO EN
INSPIRACI>N
• J%,)!e, ,+.%e$, de
RD
• C,+!(#a#'( IA
• Es$e(,s#s .!%+,(ar
• I(s!;#e(#a .!%+,(ar
DISMINUIDO EN
INSPIRACI>N
• Es$e(,s#s +#$ra%
ACENTUADO EN
ESPIRACI>N
• #.er$e(s#'( .!%+,(ar
• J%,)!e, ,+.%e$, RI• Es$e(,s#s a'r$#a
• M#,ard#,.a$8a d#%a$ada
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TERCER RIDO)
Se .r,d!e .,r %a d#s$e(s#'(s"#$a de %,s *e($r8!%,s e% ,)!e de %a ,rr#e($esa(&!8(ea ,($ra s! .ared
d!ra($e %a ase de %%e(ad,*e($r#!%ar .as#*, r4.#d,
FISIOL>GICAS6
• E+"ara3,
• Ejer##,
EXTRACARDÍACAS• F#e"re
• A(e+#a
• #.er$#r,#d#s+,
CARDÍACAS
•
C,+!(#a#'( IV• C,(d!$, ar$er#,s, .ers#s$e($e
• M#-,+a a!r#!%ar
• I(s!;#e(#a ard#aa
• I(s!;#e(#a +#$ra%
•
Per#ard#$#s ,( derra+e
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CARTO RIDO
6Se .r,d!e .,r %a *#"ra#'( de%as .aredes *e($r#!%ares/.,r desae%era#'( s"#$ade %a sa(&re de% %%e(ad,a$#*, *e($r#!%ar
FISIOL>GICAS
• Ejer##,
• E+"ara3,
• Pers,(as j'*e(esDERECO6
• #.er$e(s#'( .!%+,(ar
• C,+!(#a#'( IA
EXTRACARDÍACAS
• F#e"re
• A(e+#a
• #.er$#r,#d#s+,
CARDÍACAS
• #.er$r,;a *e($r#!%ar#3)!#erda
• E(er+edad *a%*!%ar a'r$#a
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SOPLOS CARDIACOS
S,( !(a ser#e.r,%,(&ada de
*#"ra#,(es s,(,ras/ de#($e(s#dad *ar#a"%e/re!e(#a/ $#+"re/,(;&!ra#'( d!ra#'(/ )!e se
a!s!%$a( d!ra($e %,ss#%e(#,s de% #%,ard8a,
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SOPLOS CARD*ACOS)SIST>LICOS
• Pr,$,s#s$'%#,s6
C,+#e(3,
• Mes,s#s$'%#,s6 +#$ad
• Te%es#s$'%#,s6 ;(a%
• ,%,s#s$'%#,s6
T,da %a s8s$,%e ,( #&!a%
#($e(s#dad
DIAST>LICOS
• Pr,$,d#as$'%#,s6.r#(#.#,
• Mes,d#as$'%#,s6 +#$ad
• Te%ed#as$'%#,s6 ;(a%
• ,%,d#as$'%#,s
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#RECENCIA CARDIACA
Se de$er+#(a ,($a(d, %,s %a$#d,s e( !( +#(!$,
,+.%e$,/ ,( !( re%,j )!e +ar)!e %,sse&!(d,s/ +#e($ras se a!s!%$a
P!ede dejarse .ara e% ;(a% de %a a!s!%$a#'(/.er, $#e(de a ,%*#darse
La re!e(#a (,r+a% de re.,s, es B0?100%a$#d,s+#(/ .er, .!ede ser +e(,r e( .ers,(ase( "!e(as ,(d##,(es 8s#as
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II. IDENTI#I+E LOS RIDOS
CARDIACOS EN CADA #OCO.E% .r#+er r!#d, ard#a, <R1= es de $,(,
%#&era+e($e "aj, $#e(e !(a d!ra#'( a%&, +a,r <0/1:se&= )!e e% se&!(d, r!#d, S! ,(,+a$,.ea es d!+
T#e(e +a,r #($e(s#dad e( %a .!($a !a(d, se a!s!%$a,( e% d#ara&+a/ d,(de se ,e ,+, !( s,(#d, (#,
E( %a .r4$#a R1 re.rese($a e% #erre de %as *4%*!%as+#$ra% $r#!s.8dea +ara e% #(##, de %a s8s$,%e*e($r#!%ar
E% s#%e(#, )!e +ed#a e($re e% .r#+er, e% se&!(d,r!#d,s/ , .e)!e, s#%e(#,/ es !( es.a#, s#s$'%#, de+a(era )!e $,d, r!#d, s,"reaad#d, $e(dr4 es$a,((,$a#'( e+,d#(4+#a es de#r/ ser4 s#s$'%#,
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SE(NDO RIDO ,R-
E% se&!(d, r!#d, ard#a, es de $,(, %#&era+e($e +4sa%$, es +4s ,r$, <0/11 se&= S! ,(,+a$,.ea es %,.
T#e(e +a,r #($e(s#dad e( %,s ,,s de %a "ase E(
ad!%$,s j'*e(es .!ede .er#"#rse (,r+a%+e($edesd,"%ad, a% ;(a% de %a #(s.#ra#'(
E% a$,r de$er+#(a($e de% se&!(d, r!#d, ard#a, es e%#erre s#+!%$4(e, de %as *4%*!%as s#&+,#deas a'r$#as .!%+,(ares e #(##, de %a d#4s$,%e *e($r#!%ar
E% s#%e(#, )!e +ed#a e($re es$e r!#d, e% .r#+er r!#d,de% s#&!#e($e #%, ard#a,/ re.rese($a !( es.a#,d#as$'%#, $,d, e('+e(, )!e ,!rra e( es$e .er#,d,ser4 d#as$'%#,
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O"sr*ese )!e e( e% ,ra3'( (,r+a% e% #errede %as *4%*!%as .r,d!e r!#d,s/ +#e($ras )!e %aa.er$!ra es s#%e(#,sa
E( !(a .ers,(a ,( r#$+, re!e(#a (,r+a%/e% .r#+er, se&!(d, r!#d,s ser4(
#(+ed#a$a+e($e d#s$#(&!#"%es/ .,r e% #($er*a%,de $#e+., +4s ,r$, e($re R1 R2
Ta+"#( R1 .!ede ,8rse as# s#+!%$4(ea+e($e,( %a .a%.a#'( de% ,)!e de% .!%s,
ar,$8de,/ %, )!e .!ede a!dar a #de($#;ar R1 R2 e( .ers,(as ,( re!e(#as ard#aase%e*adas
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TERCER RIDO ,R/ Se .r,d!e .,, des.!s de% se&!(d, r!#d, <0/19 a 0/1%"&=
Se ree $#e(e ,r#&e( e( %as *#"ra#,(es de %a .ared*e($r#!%ar )!e res!%$a( de% #+.a$, de %a ,rr#e($e de
sa(&re )!e e($ra d!ra($e e% %%e(, *e($r#!%ar r4.#d, P,rs! .,a #($e(s#dad $,(, "aj, (, se es!a,+(+e($e/ a!()!e se re&#s$ra ,( #er$a re!e(#a e(%,s ,(,ard#,&ra+as
E-#&e !(a "s)!eda +e$#!%,sa/ .ara %, !a% se !$#%#3a %aa+.a(a
E( (#,s j'*e(es se a!s!%$a ,( #er$a re!e(#a a%(#*e% de %a .!($a S!e%e desa.areer des.!s de %,s 25a,s de edad C!a(d, a.aree e( edades +4s $ard8ass#e+.re es .a$,%'&#, e( es$e as, #(d#a %a e-#s$e(#ade !(a #(s!;#e(#a *e($r#!%ar se ,r#&#(a as8 !( r#$+, a$res $#e+.,s .re%!d#, de !( r#$+, de &a%,.e
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V. IDENTI#I+E LA PRESENCIA DE
SOPLOS1 DESCRIBA SSCARACTER*STICAS. S,( %,s r!#d,s )!e a.aree( e( re%a#'( ,( e%#%, ard8a, e( %a re&#'( .re,rd#a% , e( s!*e#(dad/ ,( ara$er8s$#as as$#as )!e a(s#d, ,+.arad,s a% r!#d, de !( !e%%e a% a*#*ar e%!e&,
L,s s,.%,s/ e( s! +a,r8a/ s,( .r,d!#d,s .,r !(!j, $!r"!%e($, La a.ar##'( e% &rad, de %a$!r"!%e(#a de.e(de( de %a *e%,#dad *#s,s#dad de %a sa(&re/ de% $#., ,(;&!ra#'(de% ,"s$4!%, )!e s!rja e( %a ,rr#e($esa(&!8(ea
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CRITERIOS PARA DESCRIJIR LOS
SOPLOS #($e(s#dad $,(, $#+"re +,+e($, de %a re*,%!#'( ard#aa e( )!e se
.r,d!e( d!ra#'(/ s#$#, e( )!e se ,e( ,( +4s #($e(s#dad/
.r,.a&a#'( , #rrad#a#'( +,d#;a#,(es )!e e-.er#+e($a( %,s s,.%,s "aj, %a
#(!e(#a de %a res.#ra#'(/ de% es!er3, +!s!%arde %,s a+"#,s de .,s##'( de% $ra$a+#e($,
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1 INTENSIDAD1? M! d"#% Ma%a+e($e a!d#"%e
2? D"#% A!d#"%e s'%, e( e% s#%e(#,
9? M,derad, C%ara+e($e a!d#"%e
:? I($e(s, P!ede as,#arse a Tr#%%
5? M! #($e(s, $r#%% .a%.a"%e P!ede ,8rse ,(
e% es$e$'s,., .ar#a%+e($e !era de% .e,B? M! #($e(s,/ de #($e(s#dad +4-#+a Tr#%%
.a%.a"%e/ se ,e/ a( s#( e% es$e$'s,.,
FORMA EN UE UN SOPLO PASA DE LA
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FORMA EN UE UN SOPLO PASA DE LAINTENSIDAD MÍNIMA A LA M7XIMA OVICEVERSA
a I(rese(d, , Cre#e($e
" Derese(d,
I(rese(d,?Derese(d, , r,+",#da% , e(d#a+a($e C!a(d, e% s,.%, es re#e($e as$a
a%a(3ar s! #($e(s#dad +4-#+a des.!sderee .r,&res#*a+e($e as$a desa.areer
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TONO
A%$, , A&!d,
Jaj, , Gra*e
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TIMJRE Se as,#a a !(a !a%#dad ,(,#da de ,$r, s,(#d,
Eje+.%,s6
s!a*e , as.#ra$#*, s,.%a($e
ras.,s, , 4s.er,
e( +a)!#(ar#a
a ,rr, de *a.,r
+!s#a%
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DURACI>N
PANSISTÓLICO ,2OLOSISTÓLICO O!.a $,da %as8s$,%e/ $,d, e% es.a#, de% .e)!e, s#%e(#,/ e($re e% 1er 2d, r!#d,s &e(era%+e($e e(+asara es$e %$#+,
2OLODIASTÓLICO O!.a $,da e% es.a#, de% &ra(
s#%e(#,/ e($re R2 e% R1 de% s#&!#e($e #%, PROTOSISTÓLICO 3 PROTODIASTÓLICO O!rre$e+.ra(, e( %a s8s$,%e %a d#4s$,%e/ res.e$#*a+e($e
MESOSISTÓLICO <DE EQECCI>N= C,+#e(3a des.!s de,8rse R1/ .#, e( +es,s8s$,%e $er+#(a a($es de ,8rse R2
MESODIASTÓLICO O!rre e( +ed#, de %a d#4s$,%e TELESISTÓLICO Se ,e .ar$e de% .e)!e, s#%e(#, e%
s,.%, ,+#e(3a #(+ed#a$a+e($e a($es de ,8rse e% 2d,r!#d,/ $ard8, e( %a s8s$,%e
TELEDIASTÓLICO % PRESISTÓLICO O!rre $arde e( %ad#4s$,%e/ #(+ed#a$a+e($e a($es de% R1 de% s#&!#e($e #%,
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LOCALIACI>N
Es e% ,, , s#$#, d,(de es es!ad, ,( +a,r#($e(s#dad de ,r+a +4s (8$#da/ %, )!e .er+#$eded!#r e% a.ara$, *a%*!%ar , %a 4+ara )!e %,.r,d!e
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PROPAGACI>N O IRRADIACI>N
De$er+#(ad, e% s#$#, de +a,r #($e(s#dad/ %a#rrad#a#'( es e% , %,s s#$#,s a#a d,(de e% s,.%,se .r,.a&a/ de a!erd, a %a d#re#'( de% !j,de %a sa(&re/ a% .r,d!#rse s$e
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EHEMPLO DEL REGISTRO ESCRITO DELEXAMEN DE UN PRECORDIO NORMAL
I(s.e#'(6 La$#d, de %a .!($a *#s#"%e e( e% :$, es.a#,#($er,s$a%/ e( %a LMC N, se ,"ser*a( de,r+#dades (# ,$r,s+,*#+#e($,s .!%s4$#%es
Pa%.a#'(6 C,)!e de %a .!($a .a%.a"%e e( e% +#s+, %!&ar*#s#"%e N, se .a%.a( ,$r,s +,*#+#e($,s .!%s4$#%es/ r+#$,s ,$r#%%s/ (# r,es
Per!s#'(6 7rea ard#aa .er!$#"%e de($r, de %8+#$es (,r+a%es
A!s!%$a#'(6 R!#d,s ard#a,s (,r+a%es/ r8$+#,s de "!e($,(, e #($e(s#dad N, se a!s!%$a( r!#d,s aes,r#,s/ s,.%,s (#r,es FC6 0+#(
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JIJLIOGRAFÍA
Pr,.ed!$#a se+#,%,&8a 1 de (a*arr, P&s6 120?192
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CARDIOPATIA ISUEMICA
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CARDIOPATIAIPERTENSIVA
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