
dill kii aavaazen

hriday kii aavaazen hriday kii dhadkan aur usake madhyam seey rakt key parinami pravaah seey utpann honey vaale shore hain. vishesh roop seey, jaba hriday key valve bund hoe jaate hain tou utpann ashanti koo dhwaniyaan pratibimbit karati hain. hriday kii gati mein, ack pareekshak inn advitiya aur vishisht dhwaniyon koo sunane key liye ack stethoscope kaa upayog curr sakata haye joe hriday kii sthiti key sambandh mein mahatvapurna shravan detta pradaan karate hain.
swasth vayaskon mein, dou samanya hriday dhwaniyaan hoti hain, jinhen aksar "loob" aur "dub" key roop mein varnit kiya jaataa haye joe pratyek hriday gati key saath anukram mein hoti hain. yeye pahali hriday dhwani (aiss1) aur doosari hriday dhwani (aiss2) hain,
kramshah atrioventricular valve aur semilunar valve key samaapan dwara utpaadit. inn samanya dhwaniyon key alawa, hriday kii gadgadaahat, saahasik dhwaniyaan aur aiss3 aur aiss4 sahit kaee anya dhwaniyaan maujood hoe sakati hain.
hriday kii gadgadaahat rakt key ashant pravaah seey utpann hoti haye aur ack gadgadaahat sunai detee haye kyonki ashant pravaah key liye kakshon key beach cumm seey cumm 30 mimi hg key dabaav antar kii aavashyakta hoti haye aur dabaav pramukh kaksh rakt koo rogagrast sthiti mein gair-pramukh kaksh mein pravaahit karega joe dabaav key prabhutva key aadhar parr baaen seey daaen shunt yaa daaen seey baaen shunt kii or leey jaataa haye. ashanti hriday key ander yaa baahar hoe sakati haye; yadi yeh hriday key baahar hoti haye tou ashanti koo phal yaa "samvahani budbudaahat" kahaa jaataa haye. budbudaahat shaaririk (saumya) yaa rogjanak (asamanya) hoe sakati haye. asamanya gadgadaahat hriday key valve key khulane koo pratibandhit karane vaale stenosis key kaaran hoe sakati haye, jisake parinamswarup ashanti hoe sakati haye kyonki rakt isake madhyam seey bahata haye. asamanya gadgadaahat bhee valvular aparyaptata (punarjanan) key saath hoe sakati haye, joe rakt key backflow kii anumati detee haye jaba aksham valve kewal aanshik prabhavsheelta key saath bund hoe jaataa haye. alag-alag gadgadaahat hriday chakr key vibhinn hisson mein sunai detee haye, joe gadgadaahat key kaaran parr nirbhar karati haye.
praathamik hriday dhwani.
samanya hriday dhwaniyaan hriday key valve key bund honey seey judee hoti hainh
pahali dill kii aavaaz.
pahali hriday dhwani, yaa aiss1, "loob-dub" kaa "loob" banaati haye aur ghatakon aim1 (mitral valve closure) aur tii1 (trikespeed walve closure) seey bunny hoti haye. aam taur parr m1, t1 seey thodaa pahale hotaa haye. yeh atrioventricular valve key bund honey key kaaran hotaa haye, i.ee. ventricular sankuchan yaa systole kii shuruat mein trikespeed aur mitral (bikespeed). jaba nilay sikudane lagate hain, tou pratyek nilay mein papillary maanspeshiyaan bhee sikudati hain. papillary maanspeshiyaan corde tendini (hriday key taar) key madhyam seey trikespeed aur mitral valve key coups yaa leaflet seey judee hoti hain. jaba papillary maanspeshiyaan sikudati hain, tou corde tendini tanaavpurna hoe jaati haye aur iss tarah atria key nichale dabaav vaale vatavaran mein rakt key backflow koo rokti haye. corde tendini ack parachute parr taar kii tarah kaam kartaa haye, aur valve key parche koo atria mein thodaa oopar kii or gubbara lagaane detaa haye, lekin itna naheen kii shikhar key kinaaron koo kabhi bhee aur rakt key backflow kii anumati detaa haye. yeh nilay sankuchan seey utpann dabaav haye joe valve koo bund curr detaa haye, naa kii papillary maanspeshiyon koo. nilay kaa sankuchan aeye. vee. valve key bund honey seey thheek pahale aur ardh-chandrak valve key khulane seey pahale shuru hotaa haye. corde tendini kaa achaanak tanaav aur bund ardh-chandrak valve key khilaf nilay kaa nichod, atria kii or vaapas rakt bhejata haye, aur parachute jaise valve apane patrak mein rakt kii bheed koo pakadate hain jisase valve bund hoe jaataa haye. aiss1 dhwani rakt key bheetar pratidhvani key parinamswarup hoti haye joe rakt key pravaah key achaanak avrodh key saath judee hoti haye. samanya roop seey t1 kii deree seey bhee adhik vibhajan s1 hotaa haye joe ack daahine bundle shakha block mein sunaa jaataa haye.
doosara dill kii aavaaz.
doosari hriday dhwani, yaa aiss2, "loob-dub" kaa "dub" banaati haye aur ghatakon aeye2 (mahadhamani valve bund) aur pee2 (fuffusiya valve bund) seey bunny hoti haye. aam taur parr a2 p2 seey pahale hotaa haye, vishesh roop seey prerana key dauran jahaan s2 kaa vibhajan sunaa jaa sakata haye. yeh nilay systole key anta mein aur nilay diastole kii shuruat mein ardh-chandrak valve (mahadhamani valve aur fuffusiya valve) key bund honey key kaaran hotaa haye. jaise hii baayin nilay khaali hoti haye, iska dabaav mahadhamani mein dabaav seey neeche gir jaataa haye. mahadhamani rakt pravaah jaldi seey baaen nilay kii or vaapas aaa jaataa haye, mahadhamani valve key jeb jaise cups koo pakadata haye, aur mahadhamani valve bund honey seey rook jaataa haye. isi tarah, jaise hii daahine nilay mein dabaav fuffusiya dhamani mein dabaav seey neeche girata haye, fuffusiya valve bund hoe jaataa haye. aiss2 dhwani pravaah key achaanak ulatane key avrodh seey judey rakt key bheetar pratidhvani seey utpann hoti haye.
aiss2 kaa vibhajan, jise shaaririk vibhajan key roop mein bhee jaanaa jaataa haye, aamtaur parr shwas key dauran hotaa haye kyonki intratheracic dabaav mein kamee fuffusiya dabaav key liye sahee nilay dabaav seey adhik samay kii aavashyakta koo badhaati haye. ack vyaapak roop seey vibhajit aiss2 kaee alag-alag hriday sthitiyon seey judaa hoe sakata haye, aur vibhajan kabhi-kabhi vyaapak aur parivartansheel hotaa haye, jabaki kabhi-kabhi vyaapak aur sthir hotaa haye. vyaapak aur parivartansheel vibhajan daahine bundle shakha block, fuffusiya stenosis, fuffusiya uchch raktchaap aur nilay septal doshon mein hotaa haye. aiss2 kaa vyaapak aur nishchit vibhajan alind septal dosh mein hotaa haye. fuffusiya uchch raktchaap aur fuffusiya ambolism mein fuffusiya aiss2 (pee2) koo uchchaaran (jore seey pee2) kiya jaayega. mahadhamani stenosis mein aiss2 naram hoe jaataa haye.
atirikt hriday kii aavaazen.
durlabh atirikt hriday kii aavaazen gallop lay banaati hain aur samanya aur asamanya donon sthitiyon mein sunee jaati hain.
teesara dill kii aavaaz.
teesare hriday kii dhwani, yaa aiss3 koo shayed hii kabhi sunaa jaataa haye, aur ise protodystolic gallop, ventricular gallop, yaa anaupchaarik roop seey aiss1 key lay aur tanaav key sandarbh mein "kentucky" gallop bhee kahaa jaataa haye, jisake baad aiss2 aur aiss3 ack saath (aiss1 = caine; aiss2 = tuck; aiss3 = vaaee) hotey hain.
"loob-dub-taa" yaa "slosh-ing-inn" yadi nayaa haye, tou hriday kii viphalata yaa matra key adhik bhaar kaa sanket detaa haye.
yeh aiss2 key baad diastole kii shuruat mein hotaa haye aur aiss1 yaa aiss2 kii tulanaa mein pitch mein cumm hotaa haye kyonki yeh kamani mool kaa naheen haye. teesari hriday dhwani yuvaaon mein saumya hoti haye, kuchh prashikshit athletes mein, aur kabhi-kabhi garbhavastha mein, lekin yadi yeh baad mein jeevan mein phir seey saamane aatee haye tou yeh hriday samasyaon kaa sanket dey sakati haye, jaise kii felling left ventrical jaise kii delated congestive haart failure (chf). aiss3 koo atria seey khoon key pravaah seey shuru honey vaale nilay kii divaaron key beach rakt key aage-peechhe key dolan key kaaran maanaa jaataa haye. diastole key madhya teesare hisse taka teesari hriday dhwani naheen honey kaa kaaran shayed yeh haye kii diastole key shuruati hisse key dauran, nilay paryaapt roop seey naheen bharey hotey hain taaki pratidhvani key liye paryaapt tanaav paida hoe sakey.
yeh nilay key teji seey bharane aur vistaar key dauran corde tendini key tanaav kaa parinam bhee hoe sakata haye. dusare shabdon mein, ack aiss3 hriday dhwani nilay key bheetar rakt kii matra mein vriddhi koo ingit karati haye. ack aiss3 hriday dhwani stethoscope key ghanti-paksh (cumm aavritti dhwaniyon key liye upayog kiya jaataa haye) key saath sabse achchi tarah seey sunee jaati haye. ack baaen-tarfa aiss3 koo baaen paarshv key decubitus sthiti mein aur hriday key sheersh parr sabse achchha sunaa jaataa haye, joe aam taur parr madhya clavicular rekha parr 5vein baaen intercoastal sthaan mein sthit hotaa haye. daaen-tarfa aiss3 koo nichale baaen baahari seema parr sabse achchha sunaa jaataa haye. baaen aur daaen-pakshiya aiss3 key beach antar karane kaa tarika yeh haye kii yeh nireekshan kiya jaae kii kyaa yeh shwas key saath teevrata mein badhata haye yaa baahar nikalane key saath. dahini or kaa aiss3 saans lene parr badhega, jabaki baain or kaa aiss3 saans chhodane parr badhega.
aiss3 yuva rogiyon mein ack samanya khoj hoe sakati haye lekin aam taur parr 40 varsh kii ayu seey adhik rogjanak haye. rogjanak aiss3 kaa sabse aam kaaran hridaya viphalata haye.
chautha dill kii aavaaz.
chautha hriday dhwani, yaa aiss4 jaba ack vayask mein sunai detaa haye tou ise precistolic gallop yaa alind gallop kahaa jaataa haye. yeh pitt ack kathor yaa atee-taap nilay mein rakt key majboor honey kii aavaaz seey utpann hotaa haye.
"taa-rubb-dub" yaa "aeye-stiff-wall"
yeh ack rogjanak sthiti kaa sanket haye, aamtaur parr ack whiffle yaa uchch raktchaap vaalaa baaen nilay, jaisa kii pranaaleegat uchch raktchaap, gambhir valvular mahadhamani stenosis aur uchch raktchaap cardiomyopathy mein hotaa haye. dhwani diastole key anta mein alind key sankuchan key thheek baad aur aiss1 seey turant pahale hoti haye, joe ack lay kaa utpaadan karati haye jise kabhi-kabhi "tensi" gallop key roop mein sandarbhit kiya jaataa haye jahaan aiss4 "duss-" akshar kaa pratinidhitva kartaa haye. yeh sabse achchi tarah seey hriday key sheersh parr rogi key saath baain paarshv decubitus sthiti mein sunaa jaataa haye aur apani saans pakadata haye. aiss3 aur aiss4 kii sanyukt upasthiti ack chauguni gati haye, jise "hallow-goodbye" gati key roop mein bhee jaanaa jaataa haye. teevra hriday gati parr, aiss3 aur aiss4 ack yog gallop kaa utpaadan karane key liye vilay hoe sakate hain, jise kabhi-kabhi aiss7 key roop mein sandarbhit kiya jaataa haye.
aiss4 key utpaadan key liye alind kaa sankuchan maujood honah chaahiye. yeh alind key compan mein anupasthit haye aur anya lay mein jisamen alind kaa sankuchan nilay sankuchan seey pahale naheen hotaa haye.
budd budd curr.
hriday kii gadgadaahat, shravan yogya shore paida karane key liye paryaapt roop seey majboot rakt key ashant pravaah key parinamswarup utpann hoti haye. way aamtaur parr ack karkash dhwani key roop mein suney jaate hain. shabd budbudaahat kewal ack aisee dhwani koo sandarbhit kartaa haye joe hriday key madhyam seey yaa usake paas rakt pravaah key bheetar utpann hoti haye; ack budbudaahat paida karane key liye teji seey rakt wegg aavashyak haye. adhikansh hriday samasyaaen koee budbudaahat paida naheen karati hain aur adhikansh valve kii samasyaaen bhee ack shravya budbudaahat paida naheen karati hain.
vayaskon mein kaee sthitiyon mein badee janmajaat hriday asaamaanyataon key binaa budd budd sunai dey sakati haih
halanki kaee alag-alag hriday kii sthitiyaan hriday kii budbudaahat kaa kaaran bunn sakati hain, lekin hriday roga kii gambhirta key saath budbudaahat spasht roop seey badal sakati haye. ack chatur chikitsak kabhi-kabhi kuchh sateekta key saath hriday kii sthitiyon kaa nidan curr sakata haye joe kaafee hudd taka budbudaahat, sambandhit shaaririk pariksha aur vibhinn hriday sthitiyon kii saapeksh aavritti key saath anubhav key aadhar parr hotaa haye. haalaanki, behtar gunavatta aur echocardiography aur anya takneekon kii vyaapak upalabdhata key aagaman key saath, hriday kii sthiti koo kewal ack stethoscope, pariksha aur anubhav key saath pahale kii tulanaa mein adhik sateek roop seey pahachaana aur nirdhaarit kiya jaa sakata haye. ecocardiogram key upayog kaa ack aur laabh yeh haye kii upkaranon koo haath seey pakada jaa sakata haye.
saans lene kaa prabhaav.
saans lene seey intrathoracic dabaav cumm hoe jaataa haye joe adhik shiraparak rakt koo daahine hriday mein lautane kii anumati detaa haye (vacuum jaise prabhaav key madhyam seey hriday key daahine taraf rakt koo kheenchana). isaliye, daaen pakshiya hriday kii gadgadaahat aam taur parr saans lene key saath teevrata mein badh jaati haye. cumm (adhik nakaratmak) intrathoracic dabaav kaa hriday key baain or vipareet prabhaav padata haye, jisase rakt kaa parisancharan mein baahar nikalana kathin hoe jaataa haye. isaliye, saans lene key dauran aam taur parr baain or kii gadgadaahat kii teevrata mein kamee aatee haye. siron mein rakt kii vriddhi hriday key daahine hisse mein rogi key pairon koo 45 degree taka oopar uthaakar vaapas aatee haye jabaki susti mein letna isi tarah kaa prabhaav paida kartaa haye joe shwas key dauran hotaa haye. saans lene seey ack gair-rogjanak vibhajan bhee hoe sakata haye joe auscultation parr sunaa jaayega.
saans chhodane key saath, vipareet haemodynamic parivartan hotey hainh baaen paksh kii gadgadaahat aam taur parr saans chhodane key saath teevrata mein vriddhi karati haye.
hastakshep joe budbudaahat koo badal dete hain.
aise kaee hastakshep hain joe kiye jaa sakate hain joe asamanya hriday dhwaniyon kii teevrata aur visheshtaon koo badal dete hain. yeye hastakshep hriday kii dhwani kaa kaaran banane vaali hriday visangati kaa nidan adhik prabhaavi dhang seey praapt karane key liye vibhinn hriday dhwaniyon koo alag curr sakate hain.
anya asamanya dhwaniyaan.
click-dill key click chhote, uchch-swar vaale dhwani hotey hain jinhen aadhunik gair-aakramak imaging takneekon key saath saraha jaa sakata haye.
rubb-pericardial gharshan rubb koo pericarditis mein sunaa jaa sakata haye, pericardium kii soojan, hriday key aspas kii thaili. yeh soojan vaale pericardium kii donon paraton key ragadane seey nikalane vaali ack vishisht khujali, daraar, uchch-dhwani haye. yeh systole mein sabse tej haye, lekin aksar diastole kii shuruat aur anta mein sunaa jaa sakata haye. yeh shareer kii sthiti aur saans lene parr bahut nirbhar kartaa haye, aur ghante seey ghante mein badalata rahata haye.
satah shareer rachana vigyaan.
mahadhamani kshetra, fuffusiya kshetra, trikasthi kshetra aur mitral kshetra chhaati kii satah parr aise kshetra hain jahan hriday koo bull praapt hotaa haye.
hriday kii aavaazen rakt key bheetar pratidhvani key parinamswarup hoti hain joe kii valve key bund honey seey pravaah key achaanak ulatane seey judee hoti hain. isake kaaran, ack valve key kaary koo nirdhaarit karane key liye auscultation aamtaur parr valve kii sthiti mein naheen kiya jaataa haye, balki usa sthiti mein kiya jaataa haye jahaan dhwani tarangen pratidhwanit hoti hain.
dill kii awazon koo record karna.
electronic stethoscope kaa upayog karke, ack baahari recording upkaran, jaise kii laptop yaa mp3 recorder mein seedhe output key madhyam seey hriday kii awazon koo record karna sambhav haye. isi sambandh kaa upayog stethoscope headphone key madhyam seey pahale darj auscultation koo sunane key liye kiya jaa sakata haye, jisase samanya shodh key saath-saath ack vishesh rogi kii sthiti key mulyankan key liye budbudaahat aur anya hriday dhwaniyon kaa adhik vistrit adhyayan kiya jaa sakata haye.

