Examen Cardiovascular Mariana

7/17/2019 Examen Cardiovascular Mariana

http://slidepdf.com/reader/full/examen-cardiovascular-mariana 1/72



ORIENTACIONES GENERALES Dejar des!"#er$a %a re&#'( )!e *a+,s a e-.%,rar/

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INSPECCIÓN

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INSPECCI>N GENERAL

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SITUACIÓN

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VARIACIONES EN ESTADO FISIOL>GICO E( %,s .8(#,s/ e( %,s ,"es,s e( %as

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CAUSAS DE DESPLAAMIENTO DEL

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ALTERACIONES DEL 7PEX

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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'(

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OTROS LATIDOS AHENOS AL COUE

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ELEMENTOS OJTENIDOS CON LA

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%a$#d, ard#a, e( de"#$, s!.#(, e( $a($, )!e e(ad!%$,s de +4s de 90 a,s/ %, ,+( es (,

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de 90 a,s/ de"e aer s,s.ear a%&!(a a%$era#'(ard#aa

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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

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LOS ESTREMECIMIENTOS CATARIOS

PUEDEN OCURRIR DURANTE6 %a s8s$,%e6 thrill s#s$'%#,

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PERCUSI>N

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e% ,(, de %a ar$er#a .!%+,(ar a#a arr#"a



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 $erer,/ !ar$, )!#($,

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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

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,"%#!, a#a a"aj, a!era e-$e(d#(d,sedesde e% *r$#e as$a !( .,, .,r de($r, de%,)!e de %a .!($a



PERCSIÓN DEL !REA

PRECORDIALINCREMENTO DE LA

MATIDE CARDÍACA

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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%

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@ A$e%e$as#a derea



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



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$#,

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"ase de% !e%%,/

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re&#'( e.#&4s$r#a



MKTODO SECUENCIAL SISTEM7TICO/

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OTRA SECUENCIA

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I. DETERMINE EL RITMO " LA

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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

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,+.%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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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,



EN RESUMEN

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AUMENTO DE INTENSIDAD DEL

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,(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



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



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



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



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



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



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



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,



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



#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



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,((,$a#'( e+,d#(4+#a es de#r/ ser4 s#s$'%#,



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$'%#,



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



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



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



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($,



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



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



TONO

A%$, , A&!d,

Jaj, , Gra*e



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%



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 #%,



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



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



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+#(



JIJLIOGRAFÍA

Pr,.ed!$#a se+#,%,&8a 1 de (a*arr, P&s6 120?192



CARDIOPATIA ISUEMICA



CARDIOPATIAIPERTENSIVA



VALVULOPATIAS

Examen Cardiovascular Mariana

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