FKG of the heart of the essence of the method of preparation and decryption

If we talk about the most accurate methods of diagnosing heart diseases, as well as blood vessels, then it is worth highlighting precisely these measures that have been used in medicine for quite some time. In this case, we are talking about a thorough examination of patients with a complete familiarization with the symptoms of pathology, as well as the use of special instrumental methods.

In world practice, instrumental examination is necessary in the process of studying the mechanical as well as electrical activity of the heart. Thanks to this, it is possible to clarify the features of the vascular system, as well as any other vital organs of the human body.

If we talk about the advantages of instrumental methods for studying the cardiovascular system, then it is worth paying attention to the fact that today more modern methods for their implementation have appeared. For example, an ECG procedure, which stands for an electrocardiogram, and other types of cardiography. It is worth paying attention to the popularity of electrocardiography and many other procedures that significantly reduce the time to determine a specific ailment.

In addition, modern research methods can significantly increase the range of pathologies that a person may encounter. Thanks to modern equipment, it is possible to obtain the most accurate knowledge and with a greater guarantee to determine in which organ or adjacent tissues one or another pathology develops.

These diagnostic measures are an integral part of working with patients who complain of poor condition. Thanks to these studies, it is possible to identify hundreds of pathologies that cannot be determined based solely on the ECG. In addition, the use of expensive equipment is not always available for a large number of patients.

If we consider clinical cardiology, it is worth noting that today it is possible to divide such a diagnosis into two types. First of all, a general blood test of the patient is performed. His urine is also studied. However, in most cases, experts prescribe additional studies in the form of:

  1. Biochemical blood test. This is a more detailed study.
  2. Biochemical analysis of urine.
  3. Blood tests for its acid-base condition.

Also, if necessary, an analysis of blood coagulation is performed.

In the first case, this is a preliminary diagnosis. However, biochemistry provides the doctor with much more useful data. This certainly plays a role in the choice of follow-up treatment tactics.

Human physiology provides for the formation of various sound waves that have their own distinctive features. Sometimes they are difficult to distinguish even a professional. But to deal with the power of sound characteristics and the frequency of an order of magnitude easier.

The force is a value that is proportional to the amplitude of the produced wave. It is measured in decibels. The louder the resulting sound is, the greater force with amplitude is displayed in a graphical result.

The frequency of the studied pulses is measured in Hertz. The value is the number of sound vibrations per a specific time unit. The human ear can only capture a modest range from 20 Hz to 20 thousand Hz. All that is outside the allowable interval, it will turn out to cover, convert to graphic information only from special equipment.

A healthy heart muscle, along with all the accompanying actions, is capable of making noise approximately at the level from 150 Hz to 200 Hz, which is enough to hear it with a phonendoscope. The parameters of the product of noise are at all 1000 Hz.

But since mostly sick people come to see a cardiologist, they cannot recognize pathologies that respond with low-frequency vibrations without special equipment. Difficulties are added by the fact that from the main tone lines the doctor will hear on his own unless the first two are in the most successful scenario.

Against the background of other sound options, it is difficult to recognize the third and fourth heart sounds. They are often the basis for confirming suspicions of various diseases.

The first item is a loud enough, distinct and clear sound. In pathologies, in addition to tone, different noises become audible. They are not related to each other, and also have different strength, frequency.

Most of the noise along with the tones will be revealed even simply by using auscultation. It will be helped by the fact that at different points their volume will change. But if the patient hears from the medical staff in the diagnostic office something like: “Prepare a PCG”, this indicates the suspicion of the doctor regarding rare or complex anomalies. They can be either congenital or acquired.

Thanks to the phonocardiograph, it turns out to catch even insignificant effects, which are then converted into electrical signals in order to appear on paper in the form of specific graphs. The principle of operation is extremely similar to that of a traditional ECG.

The advantage of the phonocardiograph is the presence of a variety of filters that are aimed at eliminating background noise, which do not carry any practical use for diagnosing. So it turns out to collect in the result only the most accurate basic data.

Due to the fact that the manipulation is non-invasive, it does not cause significant discomfort, excluding pain. For this, her love cardiologists who work with small children and even newborn crumbs.

General facts

Initially, only a phonendoscope was used to evaluate sound effects emanating from heartbeats. This way of listening is properly called auscultation. But far from always, it was so easy to catch all the waves, which prompted specialists to create more advanced equipment aimed at capturing the sounds produced.

After the sound research methods gained recognition, the authors of medical devices tried to adjust their ability to capture sounds to a common denominator. This is how percussion and some other branches of diagnostics appeared. But they all could not absolutely guarantee the correctness of the suspicion of the treating doctor. The problem lay in the fact that with classical auscultation, each doctor hears his patient differently due to the nature of his personal hearing and perception.

Also, the human ear is hardly able to catch a clear amplitude, the intervals between weak sound waves and their exact duration without amplifying devices. So the idea was to make an independent unit, which would make measurements completely objectively, relying only on science.

The basis for the improvements was the attraction of the device, where a special microphone was pre-installed. All incoming information was almost instantly transformed into a diagnostic value, which is a completely understandable graphical record. An experienced diagnostician, or a narrow specialist working in the field of cardiology, can decipher it.

Initially, the methodology for assessing the health of the cardiovascular system was aimed at tracking down the location of a certain noise. A little later, experts learned how to directly associate it with a reduction in certain heart areas, which made it possible to diagnose various specialized ailments with increased accuracy.

One of the most important advantages of the survey is the ability to apply it with the same productivity for both adults and children. There are also models of devices that are fitted to the standards of the structure of the body of animals. They are established in veterinary clinics.

Despite all the efforts of technicians, FCG did not become the main and only option of the study, after which it would be possible to accurately determine the diagnosis. Even physicians with experience still insist on passing auxiliary tests like clinical tests or studying the structure of large vessels through computer tomography with contrast.

Also, the problem is added by the fact that only the master who is well versed in auscultational signs should deal with decoding. Be sure to ensure that the sensors fit in accordance with strict regulations. And for this you can not do without the skills of handling the stethoscope.

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Electrocardiogram

It is worth paying attention that if the doctor does not conduct an electrocardiogram, then in this case there is no need to talk about getting an accurate diagnosis. It is worth noting that today there is practically no adult who has not undergone an ECG procedure at least once in his life (this is what the electrocardiogram is called for short).

Therefore, it is not surprising that many doctors consider this method of studying the cardiovascular system to be the main one. If we talk about its essence, then it is quite simple. On the patient’s body, or rather on his chest and limbs, several multi-colored sensors are installed. Thanks to these elements, the cardiograph is able to detect and register any electrical vibrations that occur in the heart.

Of course, for an ordinary person, such results of a study of diseases of the cardiovascular system do not represent absolutely no informational content. However, an experienced cardiologist will be able to read the cardiogram without any difficulties and immediately determine that the heart works with some deviations from the usual norms or in the normal mode.

Accordingly, we can say that already thanks to the electrocardiogram, it becomes possible to make a primary diagnosis. An ECG is a very effective measure if there is a suspicion of myocardial ischemia or the presence of necrosis, i.e. heart attacks. These studies help to clarify how the pathology has spread, as well as to find out other parameters related to the heart problem.

In addition, the ECG allows you to very quickly determine that arrhythmia or electrolyte disorders have occurred. With the help of this study, it is possible to predict the approaching pericarditis of cardiac tamponade and other dangerous conditions. In some situations, this procedure is performed with additional load. This means that the sensors are fixed at a time when the patient is not in a calm position, but during running or sports.

In order to get the most accurate result, it is recommended to conduct an examination not only when the patient is in a horizontal position, but also in 12 different states (running, jumping, etc.). However, more often, only a few changes in positions are enough to get an extremely accurate picture. In particular, experienced doctors are often limited to a single study of the cardiovascular system to make a diagnosis.

Echocardiogram

This functional method of studying the cardiovascular system is considered one of the most accurate. Echocardiography (this name is abbreviated in this way) is performed using ultrasound in the format of an electrocardiogram. In this case, the procedure (for the patient) is practically no different from the ECG. For its implementation, the patient should be placed in a horizontal position, after which the doctor places a special sensor on his chest.

Thanks to this research method, in diseases of the cardiovascular system, one or another pathology can be determined with greater accuracy. It is worth noting that the echocardiogram is successfully used today in Europe and is considered one of the most progressive for working with patients suffering from CVS problems.

Ultrasound diagnostics are used today in almost every cardiology clinic or specialized center in all major cities. If we talk about another decoding or reduction of this event, then everyone will probably be better acquainted with such an abbreviation as ultrasound. In fact, this is an echocardiogram, which, as a rule, takes no more than 20 minutes.

Advantages and disadvantages

In addition to the absence of pain during the manipulation, it has several significant advantages. We are talking about objectivity, especially in situations where you need to correctly measure the intervals between the tone and the noise following it.

To do this, during the preparation, you just need to properly fix the sensors, choosing the optimal contact point.

But against the background of the numerous advantages of the method, it has several disadvantages. The point is that the device does not always capture absolutely all vibrations. This is explained by the fact that in some cases a person’s ear is more susceptible to a certain number of sounds that the device simply does not perceive.

To avoid such an imbalance, the nurse must write in conclusion, not only the results of the PCG itself, but also the primary examination by the doctor. Confusion is possible here, so doctors have established a tacit rule for themselves. If the vibrations are not monitored through the phonendoscope, but are visible on phonocardiography, then the preference is given to what the doctor heard himself. The only exception is a record of low frequencies. It follows from this that without preliminary auscultation the analysis is senseless.

Another snag is the determination of the timbre, which is also not within the competence of the machine. Instead, the issue involved a specialist on duty. In this case, the timbre still remains a subjective characteristic that does not protect the patient from medical error. But without timbral errors, it will not be possible to detect a variety of valve flaws.

In order for the final presentation to be as truthful as possible, you must first listen to the chest in order to identify the individual best points for listening. Preliminary assessment of hearing is an important preparatory measure due to the fact that during the development of diseases the heart tends to change:

If you rely on standards without being tied to a specific victim, the incorrect position of the microphone ensures a reduction in sound power.

Due to its safety, as well as the lack of radioactive loading, PCG has recently been used to confirm or refute fetal hypoxia.

Blood pressure measurement

According to medical practice, a heart attack can happen at almost any time, and it does not matter what time of year or day is at the moment. Of course, it is simply physically impossible for any doctor to monitor the patient’s condition around the clock. However, in order to determine the presence of a particular pathology, it is necessary to pay attention to any failures that occur during the work of the heart.

In this case, we can say that the so-called permanent ECG is used, which is performed for 24 hours. As a rule, for this, a compact cardiograph must be fixed to the patient’s body, which will be with him throughout the day and night. A small device will record all the readings that the human body transmits.

However, in addition to this, certain actions are required on the part of the patient himself. Throughout the day, he must very accurately record any of his actions, recording the exact time of any movement in a special diary. After the unit is removed, the doctor will compare the data of the records and ECG indicators.

This functional method of studying the cardiovascular system is considered one of the most modern, therefore it has been used for a long time in Europe, America and many other countries. Moreover, most doctors conclude that it is time to include such studies in a number of mandatory ones. Especially when it comes to people who already suffer from cardiac arrhythmias, as well as those who are diagnosed with so-called fainting conditions.

Doctors often use this diagnostic method, which is abbreviated as SMAD. This method of studying the human cardiovascular system is very similar to the previous one, but still differs from it.

The essence of the procedure is that using a special device, automatic measurements are carried out, which are also performed for 24 hours. In this case, a device is used that, just like in the case described above, must be fixed on the patient’s body. It should be noted that the study of the cardiovascular system in children is very often carried out precisely with the help of ABPM.

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Thanks to the data obtained, the doctor will be able to assess how the dynamics of pressure changes depending on the behavior of a person during the day or at night. This allows you to determine who in the near future may have to deal with arterial hypertension or autonomic dysfunction. An important condition for such a study is also the use of a diary, in which the patient must necessarily describe in detail everything that happens to him during the day and night.

This is another procedure that is mandatory if the patient first visited a doctor and complained about possible problems with the cardiovascular system. To do this, the doctor uses a tonometer, which allows you to determine blood pressure indicators, as well as the frequency of heart beats. The cuff of the device is placed on the patient’s hand.

In this case, we are also talking about preliminary diagnostics. Moreover, such a study of the cardiovascular system can be carried out independently at home.

Standard indications

Phonocardiography is not a prophylactic diagnosis like an ECG. She is appointed only strictly on the basis of concomitant evidence, and the final decision is made by the attending doctor. The main reasons for issuing a referral for testing are:

The ability to dynamically monitor reproducible effects is highly valued by both cardiologists and therapists. Sometimes even a rheumatologist becomes the author of a referral.

It is believed that the apparatus for the study is available in every public hospital or almost every medical center. But in practice it turns out that not all private clinics are ready to buy equipment, which is increasingly called obsolete. And in clinics, devices are written off without receiving new ones in return.

In order to obtain more reliable data, it is better to arrange FCG in the morning after a person has had a good night’s sleep. No need to refuse breakfast, but drinking tea, coffee and alcohol is not recommended. The reason for this is the high chance of provoking tachycardia or other rhythm disturbances.

At the very beginning of the procedure, the victim is placed on a couch, and then periodically asked:

  • hold your breath;
  • take a deep breath.

During the manipulation, the microphone will have to be moved along different parts of the chest, using the information obtained from the auscultation picture for the outline. In rare cases, additional pharmacological agents are used to:

  • to expand the vessels;
  • change heart activity.

If the prescription drug load is not provided, then the reception will have to spend about ten minutes. But if you need to attract drugs, you will have to wait about half an hour. It is also worth considering the factor of whether the phonocardiography is a pure procedure, or it is connected to an ECG for increased clarity of the results.

Interpretation of the norm

A healthy muscle allows you to clearly hear the first and second tones without any extra devices. But not all the inhabitants understand that allows us to evaluate each of these parameters.

The first tone is formed when the valves are closed, which are localized between the ventricles and the atria. Closing the doors produces a loud enough sound, which has the following distinctive features:

  • average frequency;
  • amplitude – 25 mm;
  • Duration – 0,15 seconds.

To capture the effect of each individual valve is not possible because of the speed of implementation of the physiological response. Therefore, it is much more productive to try to catch at once all the vibrations inherent in the slamming of valves, which are superimposed on each other, creating a single whole – the first tone.

The second tone covers the closing parameters of the aortic valves along with the pulmonary artery. It will be better to hear if you move the microphone to the second intercostal space. We are talking about the right and left side, respectively, because these are the points most closely in contact with the heart base.

In contrast to the predecessor tone, in this case there is at once a duet of components that emanate from each valve. Distinguish the sounds will turn out as just an ear, and the apparatus. The easiest way to listen to the following persons:

The first item fixes the closure of the aortic valve. It is much louder than its counterpart, and its amplitude sometimes exceeds the sound of a valve from the pulmonary artery by approximately two times. Anatomically, this phenomenon is explained by the fact that the pressure in the aorta is much higher.

Difficulties arise at the stage of need to cover the third and fourth tone with the help of PCG. But if suddenly they made themselves felt, then this is not a reason to label the patient on the patient.

The third tone is sometimes heard in people of slim build, as well as babies. He is going on the basis of vibrations of the walls of the ventricles. It is also closely related to physical exertion, manifesting itself after activity. Just to listen to it is problematic, so it is recommended to record in the low-frequency range.

The fourth tone makes itself felt even rarer than the third. But if it manifested itself, it is more likely to indicate a threatening anomaly.

Treadmill Test

Such a functional study of the cardiovascular system must be performed exclusively at the moment when the patient is in a state of stress. That is, it performs certain physical activities. For example, a patient can run on the spot or use a treadmill while special sensors are fixed on it, which help to obtain data on the work of the heart.

It is noteworthy that thanks to such tests, it is possible to obtain data not only about CVS, but also about all other organs of the patient. The doctor evaluates how much each system is loading during physical activity. It is also worth noting that during the test it is recommended to perform several exercises at once. For example, a patient can first run on a track, and then spend some time on an exercise bike.

Pathology characteristics

Starting to study the results of analyzes given out on hands, people are far from being far from medicine. They are told nothing by the configuration of the systolic discharge noise, and any comments regarding the change in the size of the amplitude lead to panic.

The last aspect really says that the victim has a chance of developing pathology, but here you need to consider in detail each parameter. If there was a weakening of the sound, which is recorded in the column “a decrease in the intensity of the first tone,” then usually the deviation indicates:

  • mitral valve insufficiency;
  • stenosis;
  • decrease in contractile function of the left ventricle.

In the development of the first scenario, the victim will face the destruction of the valve leaflets, which is a consequence of an extensive inflammatory process, or atherosclerosis. The desired sound wave is not fixed due to incomplete slamming of the valve “doors”.

Specific stenosis, which is characterized by additional deposition of calcium salts, is capable of blocking the complete closure of the opening. Similar development becomes pledge of shortening of shutters of the mitral valve.

A decrease in contractile capacity traditionally signals:

  • cardiomyopathy;
  • chronic ischemia;
  • myocarditis of rheumatic type.

An experienced expert also necessarily adopts auxiliary factors, which also lead to an identical sound outcome, but have a mediocre attitude to cardiac activity. This is about:

  • emphysema;
  • obesity;
  • some types of pleurisy;
  • pericarditis.

It rarely happens that the tone even intensifies. Classical primary sources of changes for the worse are called thyrotoxicosis, anemia, mitral stenosis. But with the stenosis of both valves, the first tone is split into a couple of sub-tones. The same can be traced when blocking the legs of the bundle of His.

The second tone is also able to change. Thus, an increase in amplitude can be traced in case of arterial or pulmonary hypertension. A similar clinical picture describes the sealing of the aortic valve leaflets during the development of syphilis.

But sometimes it is quite normal if other tests do not confirm anything, and the patient is thin. But even in such people a weakening of the second tone is found, which indicates aortic valve insufficiency and a decrease in blood flow through the pulmonary artery.

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The situation with the third and fourth tones is a bit confusing. Their abnormalities will tell about a much larger list of possible pathologies, among which are hypertension, myocardial infarction, cardiosclerosis with concomitant heart failure.

When the third and fourth tones are unbalanced, they create a gallop rhythm. This is the first alarm bell, suggesting a future heart attack, myocarditis, pronounced hypertension.

But no matter how detailed the result of the diagnosis may be, it is necessary to take note of the results of other examinations. On the basis of the collected material, together with the patient’s current complaints, the doctor will be able to more accurately determine the diagnosis.

Coronary angiography

Experts often call this method of studying the functional state of the cardiovascular system the gold standard. This is not surprising, because with the help of coronagraphy it is possible to determine with the greatest accuracy the state of the coronary arteries.

During the course of diagnostic measures, the doctor determines whether atherosclerotic constrictions are present. If the patient really suffers from this pathology, then thanks to the study, it is possible to determine not only the extent of the contractions, but also other serious indicators. This is important when diagnosing.

Thanks to this clinical study of the cardiovascular system, the specialist gets the opportunity to assess the state of the heart, blood vessels and make the best treatment, which will be optimized in accordance with the specific parameters of the patient. However, it should be noted that not everyone is assigned coronagraphy.

As a rule, such a procedure is performed only if the doctor is at a crossroads and with a 50% probability would recommend a surgical operation. To eliminate the need for such an event, an additional study of the cardiovascular system in the form of coronagraphy is mandatory.

It is also worth noting that this technique can be used both planned and in emergency situations. For example, if a patient suddenly had a myocardial infarction. The reluctance to use such a diagnostic measure in all cases is explained by the fact that coronagraphy is a rather serious minimally invasive, but nevertheless surgical, intervention. That is why the procedure is not so widely practiced.

If we talk about how this study of the human cardiovascular system is performed, then it is worth explaining that for him the patient needs to make a puncture in the thigh vessel or in the radial artery. Through the hole obtained, a microscopic catheter must be inserted into the bloodstream. Passing through the human body, he takes the necessary pictures. Thanks to which the doctor gets the opportunity to analyze the state of the body in real time.

Dopplerography

Many experts note that this method of studying the cardiovascular system is very effective and helps to determine the specific condition of the patient.

This diagnostic measure is one of the varieties of ultrasound examination of the body. Thanks to this technique, a specialist identifies possible violations associated with blood flow and vascular function.

During the examination, the features of ultrasound are used, which is reflected from objects of a moving type. Due to this, the readings can change their frequency in proportion to the speed of movement of a particular object. If we talk about this study of the cardiovascular system in more detail, then in this case, the specialist must determine the peculiarity of the movement of red blood cells (it is from them that ultrasound waves are reflected), as well as the speed of blood flow. Thanks to this study, the doctor can get a clear picture of the state of the vessels.

Among other things, using dopplerography, the state of the vascular system is diagnosed not only in the heart, but also in the spine, neck, head, arms, legs and much more. For the procedure, it is necessary to use an ultrasound apparatus, which is equipped with a special sensor. This compact device is able to send waves through the skin of a person, penetrating into the tissues of his body.

If a specialist sees that a blockage has occurred, then in this case he will have the opportunity to clarify its dimensions and other important nuances. It is noteworthy that this procedure does not cause absolutely any unpleasant sensations. She is completely painless and safe. In this case, the study takes no more than half an hour, therefore, such a diagnosis today is widely used not only for adults, but also for children.

Aortography

Before exploring additional methods for investigating the cardiovascular system, we will familiarize the reader with the last main one. This event can also be called a fairly effective and modern method of diagnosis, which is used today. In this case, we are talking about an X-ray examination of the aorta.

Thanks to this method, the doctor is able to obtain information about the complex condition of the aorta. This becomes possible only after a special contrast agent is introduced into it. This tool has radioactive radiation, but do not be scared. Its quantity is so scanty that it simply is not able to harm the human body. In any case, this is necessary in order to get a high-contrast picture.

The obtained images clearly show the state of the vessels of the heart. Such a study, as a rule, is performed provided that tumors or any other abnormalities are already detected in the heart organ. It is also worth noting that very often for standard diagnostic measures, conventional radiography is also used. Thanks to an accurate picture, you can notice blackouts, which indicate problems in certain parts of the heart or its vessels.

Now it is worth briefly considering additional research methods for CVS. They are also important. Indeed, only with an integrated approach can we talk about the correctness of the diagnosis.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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