semiologie partea 2.pdf
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SEMIOLOGIE
MEDICALA
DE
BAZA
SEMIOLOGIA
APARATULUI
CARDIOVASCULAR 167
166
Fig.
100
lsincronisrnul
untlei
de
puls, prin
intirziereasa
Ia una din
arterele
simetrice,
este intotdeauna
patologic;
cl
se
insolegte,
obligatoriu,
;i
cle
inegalitatea
pulsului
9i
se
intilne;te
in:
anevrismul aortic,
tlmorile
sau
adelopatiile
care
cotnprim[
trn trunchi
arterial
male,
coarctalia
aortei
(o intirzierc
a
pulsnlui
in
jumltatea
inferioarl
a
corpului,
in raport
cu
jumil,atea
superioarS).
-
2.
Tensiunea
untlci
tle
puls
se apreciazl
dupir
forla
utilizatl
pentru
a
comprima artera
;i
pcntnr
a
obline disparifia
prtlsului.
Din
ac_est
P,q1Lgt
de
veciere,
distingem:
a) puls clur,
tare
(pulsus
fortis,
durus),
in
IA,
FITA;
b)
puls
moale,
slab, tlepresibil
(pulsus
debilis),
in._IC
gravl,
tahicardie
parbxisticl,
colaps,
stlri
febrile
;
in
accste situa ii,
pulsul
cste
mic,
rnoale
;i
tahicardic
(,,puls
filifolm").
3. \tollaruil
(mfuintea,
anplitutlinca)
pnlsttlui
estc
hr
laport
cu
forla
de
contraclie
a
miocarclului,
presiullea
sallguini
;i
debitul bitaie.
Din
acest
punct
de
r.eclere.
putem intilni
:
a)
puls dc
volum
nrarc
(pulsus
magnris, pulsus
altus),
iu
IA,
FI'f,\;
b) puls tlc
volum
rnic
(pulsus
parYus),
in
st[ri
cle
;oc
;i
tahicarclii
(c1
cit
f
recvenfa
t'ste
urai
mare, c1t atit pulsul
cste
mai mic,
deoarece
rlmplerea cliastolicit
este
mai
redus[).
4.
Ritmttl
pulsului
erprim[
ritmul
bltlilor
cardiace.
Ritmul
poate
fi: a) regulat,-
pulsaliile
se
succed
in
mod regulat,
ritmic,
la
acela;i
interval
de
timp
(estc
pulsul
i)ersoanelor
sS.nltoase)
;
b)
n e
t e'
11
tt
I
tt
I
(arituric),
care
sc
prt'zintir
sttb
doul
formc : 1) ncregulari-
tate
(aritmie) completi
sau
absolutl,
in
fibrilalia
aulicularit
(FA)
;
2)
ncrcgular:itate
(aritrnie) intermitctrt,ii,
in
care, pe
un
lond
dc
ritm
rcguiat,
iltervin,
din
timp
in
timp,
ullele
neregularit[li
izolate,
fie
sub
foima
unor
b[tdi
nrai
precoce
(extrasistole),
fie sub forma lipsei unei
Fig.
100
-
Tehnica
palpdrii
pulsului:
a)
radial;
b)
carotidian
;
c)
pedios'
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'l
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SEMIOLOGIE
MEDICALA
DE
BAZA
este
injectatl
pe
un
cateter
introdus
itrin
artela
femurali
sau
brahial5,
al
cdrui
virf este pozilionat
in
fiecare arter5
coronar[.
ELIICTROCAHDI0Gn,\FIA
(ECG)
ECG
I;ORT,I,TLA
Nomenclatur{.
Interpretalea
corecti
a
ecg impune
cuuoagtereg
perlecti
a aspectului
normil.
'I-raseului
ecg
i
se
descriu
defleriuni (unde),
segmente
gi
intervale
(fig.
116).
,
Defleriunile
(undele)
se inscriu in
timpul
procesului
de
depola-
rizare
;i
repolarizare auricnlarS.
;i
ventricularS.
Plin
convenlie
interna-
lionali,
deflexiunile sint
notate
cu anumite
litercr,
in
raport
cu
orclinea
inregistrlrii
lor:
P
(depolarizarea
anricularl),
Q
(trirna
und[
iregatir-it
a complexului
ventricular),
R
(prima
undl pozi[ir'5
dupl
Q),
S
(prima
Fig.
116
-
ECG normal6.
und6
negativl
dupI
R), T
(repolarizarea
venLricular[).
Fiecare
de-
flexiune
se
definelte
prin sens
(pozitivl
lsau
negativd,
dupI
cum
este
situatS.
deasupra
sau
dedesubtul
liniei
izoelectrice),
durat[
;i
am-
plitudinc.
Segmenlele
reprezintl
liuii
izoelectrice
cuprinsc
intre
dou5. cle-
llexiuni (exempiu
:
segme:^iul
ST).
Irig.
I0J
-
Iruagincil
r.aclioiogicir
uolnrali
a corcltrlui
in
ir-rciclenla A-P.
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I.'ig.
ll3
-
Peri-
calditii
cott-stric-
tiv:i.
l'ig.
I
I
.l -- Ircli-
c;l:clitii
e\Lrclativii.
139
-
Stt,rrozii
ntitlirlri
(c'stttninitt't:
in O,\l)
*-
tt'attzit birtitlt. csofir.qiittt):
rlrlrlitsa;'r'rr
llostclicrai'lt
u
csol;,tgrtltti
plin
AS
dilatat.
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189
188
SEMIOLOGIE MEDICALA
DE BAZA
2,
Iliperlrolia
ventriculari ilreapti (H\ID)
Cauze:
afecliuni care
su]lrasolicite
\:D prirr
rezisten 5
Ium
(SM,
SP,
IT).
Criterii
ecg de diaqnostic
(iig.
121)
:
a)
devierea
axei
spre
dreapta
;
b)
unde
R donrinante
in
precordialele
drepte
rYL
SEMIOLOGIA
APARATULUI
CARDIOVASCULAR
sau
vo-
electrice
(Vr-r).
r
r
'ru
*\f^\/^
a,*rv1,*
^4-.^4--
fi[
;L[J-J-^{-{r{.-
o-l^{r-.4r
A"-4-
&.4-
'1030
Fig.
121
-
Hipertrofie
ventriculard
dreaptd.
TUTBUN,iRILE
DE CONDUCERE
INTRAVENTRICULARE
reprt,zintd
consecinla
blocirii
par'fiale
sau courplete
a
excitaliei
la
nive-
Iui
uneia sau
al mai
multor ramuri
sau
fascicule
ale
sistemului
de
conduce-
re
intraventricular.
Cauze
:
cardiopatii
organice
(ischemicl,
hipertensiv[,
reumaticl
;i
congenitali),
cardiomiopatii, CPC,
tulburdri
electrolitice,
intoxicalii
merlicamentoase
(chinidin6,
digital6)'
Clasif
icare.
Dupi nivelul
unde
se
produce
tulburarea de
conducere,
blocurile
intraventriculare
pot
fi: 1)
blocuri
de
ramur[
(drept;i
sting)
;
2)
blocuri
de
filete
sau
fasCicule
(hemiblocul
sting anterior
;i
posterior)
;
3) blocuri
de
arborizafie.
-I^t-A-
aIrR
:hhh
+
1
tro
*fftn
FiS.
122
-
Bloc
cle
ratnurit
sting6.
aVL aVF
-=,..-ft#6.L
FiS.
123
-
Bloc
de
ramurA
dreaptS.
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LIEDAC'IOI{
:
VICDNTTU
DONOSE
Tehnoredactor
: MIHAI
BUJDEI
ApSrut
1989.
Format
61X86/16. Coli
tipo
14,?5
plus
11
pagini
ilustratii
pe
hirtle
cretafi
Bun de tipar
1a
11,VII.19B9
Editura
Junimea, str.
Cuza
Vode
nr,
29
Tiparul et:eculat
sub
coml.ndd, nr, 63 ld
lntreprinderea Poligra
ticd
la$i
Str.
7
Nolembrle
nr,
49
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