FONOKARDIOGRAFIYA - graphic method of registration of heart tones and noise. Modern fonokardiograf registers sound symptoms in the range of 15-1000 Hz. Using filters emit high and low-frequency components of sounds, as well as provide them with such a characteristic frequency, which is most consistent with the perception of sound man, that is comparable to auskultativnym impressed.

Fonokardiograf usually a multi-device electrocardiographs. Use of piezoelectric microphone, recording on moving paper. Mandatory synchronous record ECG. A study conducted in the usual position of a patient lying on his back with a delay of breath. The microphone recorded in the standard locations auskultatsii hearts or in the space referred to the doctor.

Fonokardiografiya allows clarify and sound obektivizirovat symptoms, correct noises and tones correlate with the phases of cardiac cycle (even against the backdrop of tachycardia), to determine the shape and duration of noise, some important time intervals: the interval Q - I tone, II tone - the tone for the opening of mitral valve, the expression and stability of splitting II tone, etc.

The amplitude (volume) sound - poorly reproduced fonokardiograficheskaya characteristic, depends in part on the vneserdechnyh conditions, regulations and forces pressed the microphone, that is Registration of conditions that are difficult to standardize. Sometimes amplitude noise estimate comparing with the amplitude I tone. But actually compare the volume of noise, recorded from different points or fonokardiogrammah different, insecure.

With regard to the identification of pathological noises, then, based on experience, it can be assumed that the sensitivity fonokardiograficheskogo method is not higher than medical auskultatsii. The latest in this respect more informative, as an experienced doctor listens to a greater number of points, changing the position of the patient, takes into account individual topographical features, the possible spread of noise and other factors.

EHOKARDIOGRAFIYA - method study of heart and major vessels, based on the reflection of ultrasonic signal. Used probe containing crystal capable of creating piezoelectric effect. Alternating current produce in a crystal ultrasonic radiation with a frequency of 2-5 MHz. The same crystal perceives reflected signal. Thus, the crystal works alternately as a source and receiver, altering its function once in 1000 to 1. Surveyed lies on his back. The sensor is placed on the chest, over the intercostal interval, press tightly to the skin. Ultrasound beam sent to the heart. The depth of its penetration reaches 21 cm partial reflection of the beam happens to the surface, separating environment with different densities (these surfaces should be roughly perpendicular to the direction of the beam). Reflected signal, transformed the computer, gives a calibrated screen or paper picture of moving cardiac structures. Resolution of about 2-3 mm.

Modern echocardiography allows the use of 3 mutually complementing each other modifications ehokardiograficheskogo study.

One-dimensional echocardiography (M-scanning) gives a detailed picture over time, created by ultrasonic waves reflected along the same lines, one beam. When changing tilt sensor or its provisions can be adequately investigate the structure of the heart during diastole sistoly and, to measure wall thickness, to assess the state of the valves, to determine the heart chambers (and on this basis to calculate the Cardiac Output) , Speed reduction and relaxation. Modifying characterized by high temporal resolution.

Two echocardiography (V-scanning) gives dvuhmernoe clear how tomographic image of moving structures at varying depths, in the sector with the angle of 60-90 °. Modifying permit a broad morphological and physiological description of the working heart, has a particularly high spatial resolution. When most of heart disease it is more informative.

Dopplerehokardiografiya - the study of blood flow, based on the fact that the frequency of continuous (not pulsed) ultrasonic waves reflected from erythrocytes, respectively, changing direction and speed of blood. This modification gives an impression of uniformity, direction and strength vnutriserdechnyh blood flow, which is important to diagnose ills and shunt, evaluation vnutriserdechnoy hemodynamics, the definition of cardiac output.

Has the standard position sensors ( "ehokardiograficheskie window") to systematically, consistently explored all the structures of heart. The study can be documented photographer, is usually stored in parallel with the EKG.

Echocardiography extremely useful in any of heart disease and large vessels. Method vysokoinformativen, neobremenitelen and relatively safe for the patient, has no contraindications, gives a good play, quantify the results, it is completely characterize the anatomical and functional features of the working heart. With the availability of its need to use at different stages of the survey, including the earliest.

Lung emphysema, as well as narrow intercostal intervals may impede ehokardiograficheskoe study.

RENTGENOLOGICHESKIE METHODS. Kilns study of the thorax (X-ray, x-ray) at the heart of patients to determine the size and shape of heart as a whole, its departments, large vessels, the presence of fluid in the pericardial, the state of pulmonary circulation , Some typical changes in skeletal (uzuratsiya ribs, deformed sternum). When X-rays can be seen moving kaltsifikaty (in valves, pericardial, sometimes in the coronary arteries), especially to evaluate the pulsation of heart and large vessels. In patients with pacemakers can see the situation and condition electrode. With regard to estimate the size of heart cells x-ray study concedes echocardiography (but surpasses percussion). Identification of changes in the lungs and skeletal remains the prerogative ray method.

The size of the heart chambers define standard projections - direct, skew, sometimes in the left side, contrasting with the esophagus sulfatom barium. Better cameras detected dilation, worse - concentric hypertrophy.

If you raise the left ventricle of his shadow extends down, back and left. In a study in the left oblique projection shows narrowing or filling retrokardialnogo space. The increase in the right ventricle can be found in the same projection, it leads to filling retrosternalnogo space. With a substantial increase in the right ventricle other divisions may be removed passively, while their size was difficult to assess accurately. The increase left predserdiya better seen in the right oblique projection, contrasting with the esophagus. In contrast norm esophagus at the level predserdiya not rejected. If you raise the left predserdiya he may deviate through the arc of a small radius, that is 3-6 cm (which is more characteristic of mitral stenosis) or through the arc of a large radius, that is 7-11 cm (which is more characteristic of mitral insufficiency). Increased right predserdiya better detected in the left oblique projection. To estimate the size of the heart often use cardio-thoracic index - the ratio of maximum width silhouette hearts to the maximum widths of Inland chest (in direct projection). In less than normal, he is 1:2.

In the study, lung X-ray method allows fields, in addition to actual pulmonary pathology, to identify changes in pulmonary circulation, the state of venous network, signs of edema, first interstitial, then alveolar. In the small circle of hypertension seen expansion pulmonary artery and its major branches. In the case of high peripheral resistance peripheral fields increase transparency.

Kilns study may be informative in any of heart disease. However, it is linked to radiation exposure, so this study should be conducted on specific indications, when expectancy information can not be obtained by other available methods. Preferred X-ray. All diagnostic X-ray techniques combination of pregnancy.

Computer tomography - a kind of ray method. In doing so, X-rays taken special detectors and computer reconstructed in a clear picture of horizontal sections tomographic body with spatial resolution of about 0,5-0,7 see All structures accessible to inspection, no hidden zones. Introduction contrast substance expands the diagnostic capabilities of the method. To implement this method requires expensive equipment.

Accumulate experience, indicating that this method may be useful when examining patients with heart, as well as helping to recognize aorta aneurysm, to delaminate aorta aneurysm, the voluminous formations in the heart and pericardial, defining cross aortokoronarnogo vascular transplant. With it, trying to determine the extent of myocardial infarction.

Radiation pressure higher than ordinary X-ray study.

Kilns method is also used in angiokardiografii and cardiac catheterization.

RADIONUKLIDNYE METHODS. Typed into the body radioisotopes, including in metabolism, along with neizluchayuschimi isotopes, are distributed in a certain way of blood and tissues. Lysbuedræbere (gamma camera, scanners) allows local measure radioactivity and thus to identify particular distribution of radioisotopes. Sometimes identified "hot" pockets of excessive accumulation of radioisotopes or vice versa, "cold" pockets of his nenakopleniya. For diagnostic purposes using radioisotopes with relatively short half (several hours or days).

In general, radionuclide techniques, as neobremenitelnymi for the patient, can provide a variety of useful information when examining heart patients.

Introduction 131I-albumin helps determine the minute amount of blood circulation and other hemodynamic performance left and right ventricles. Introduction of erythrocytes, tagging 99mTc; provides an opportunity to comply with radionuclide angiokardiografiyu and radionuclide ventrikulografiyu with visualization of cavities and major heart vessels, with the possible calculation of hemodynamic parameters, and even identifying sites hypokinesia.

99mTc B comprising pirofosfata concentrated in nekrotizirovannoy (not normal) myocardial tissue, forming in acute heart attack "hot" hotbed. The maximum accumulation of technetium occurs through transmuralnogo 2-4 days after a heart attack. Later, the picture becomes unclear. Identifying the epicenter at a later date showed on education aneurysm. The intensity reflects the amount of isotope accumulation of a heart attack. Melkoochagovye infarctions diagnosed bad. Resolution of about 1-2 see severe angina and some cardiomyopathy may diffuse increasing accumulation of isotope. The method has a real diagnostic value in special cases - when suspected heart attack patient with the blockade left legs, with atypical picture infarction (with unclear EKG changes and fluctuations in activity of enzymes), with suspected heart attack patient, which made the operation on the heart.

201T l after intravenous distributed in proportion to the heart miokardialnomu bloodstream. In hotbeds of ischemia, heart attack, scar thallium accumulates less ( "cold" pockets), while you can roughly determine their prevalence. Assessing veloergometricheskogo test using this method more informative in the diagnosis of ischemic heart disease than the estimate only on ECG. In unstable angina, koronarospazme "cold" pockets can sometimes be identified and at rest. The method also raises some medicinal informative samples. However, he does not reliably identify the localization artery stenosis.

Radionuclides studies performed in a specially equipped laboratories. Some radioisotopes malodostupny. Studies have linked to radiation load, which in the use of radioisotopes in the overall short-less than under normal rentgenodiagnosticheskih research. Radionuclides combination study of pregnancy.