VASCULAR NOISE — the sounds listened over an aorta and peripheral vessels (arteries and veins).
Depending on frequency characteristics auskultativno the revealed sounds divide into tones and noise. Tones are fluctuations of any one frequency, noise are formed by fluctuations of different frequency. NL depending on a phase of a cardial cycle call systolic and diastolic, depending on area of emergence — wire or a local origin.
Emergence of NL is caused by passing of quickly current blood through the narrowed opening; the vibration arising at jet blow of blood about a wall or a partition; relatively drift of blood through an opening; roughnesses and roughnesses of an inner surface of a vessel. Emergence and character of NL are influenced by a form of an obstacle and its density (at the expressed density noise is louder), and also viscosity of blood (the hydremia is more expressed, the easier there is a noise).
NL have various shades: they can be gentle and weak, rough, WHISTLING, howling, hissing, reminding peep of a mosquito.
Listening of NL is made directly by an ear, a stethoscope or a phonendoscope (see Auscultation). The stethoscope shall freely (without pressing) to adjoin to the place of listening, otherwise the so-called pressure murmur appears; at strong pressing when the gleam of an artery is almost completely closed, tone from a prelum is formed. NL are well fixed on a soundtrack (see Fonokardiografiya) and have a typiform.
Arterial vascular noise
Arterial tones in fiziol. conditions are listened generally over carotid, subclavial and femoral arteries. Over carotid and subclavial arteries two tones are listened, from them the first — systolic silent — is caused by the sudden tension of an arterial wall, the second — diastolic, louder — is wire and is caused by a zakhlopyvaniye of semi-lunar valves of an aorta. At insufficiency of aortal valves (see the Heart diseases acquired) over carotid and subclavial arteries the second tone disappears and there is a diastolic noise, and on a femoral artery instead of one tone heard normal two tones (Traube's phenomenon) are defined that is explained by back motion of blood and bystry change of conditions of tension and relaxation of a vascular wall. At patol. states listen to tones also over less large arteries, napr, over humeral and elbow (at insufficiency of aortal valves it is better to listen to them at the raised hands). Tones over peripheral vessels can be listened also at the states which are followed by acceleration of a blood flow (inf. diseases, pregnancy, thyrotoxicosis, chlorosis, sharp anemia, etc.).
Arterial noise in fiziol. conditions are listened at women over a uterus at the end of pregnancy (uterine noise) and at babies over a big fontanel (a sort-nichkovy noise), and also at the movement and a postural change of a body. At pathology arterial noise arise at aneurism, narrowing or expansion of an artery because of a sclerosis, its prelum outside. At the diseases which are followed by fever at an anemia, the general nervous excitement, a thyrotoxicosis emergence of noise is connected with acceleration of a blood flow, and in some cases also with expansion and a branching of arterial vessels.
In a wedge, practice the greatest value has listening of noise over an aorta and its branches. At sclerous damage of the ascending aorta (see Atherosclerosis) more or less expressed systolic noise is in most cases listened, to-ry sometimes appears or amplifies during the lifting of hands up and their mortgaging for the head (Sirotinin's symptom — Kuko-verova) and is usually carried out on a blood flow on carotid and subclavial arteries. Systolic noise on an aorta is connected not only with an aortectasia, but also with deformation of aortal valves. The sharp scraping systolic noise caused is sometimes listened having attached-pshmsya narrowing of an aortal opening as a result of sclerous process.
At coarctation of an aorta (see) over all surface of heart rough systolic noise with a point of the maximum sounding in the field of the second or third mezhreberye to the left of a breast is listened, to-ry it is carried out on vessels of a neck and it is well heard in interscapular space at the level of II — the V chest vertebrae. Systolic noise extends from top to bottom and is listened over edges on the parasternal line (on the course of an internal chest artery). Its emergence is connected with an aortostenosis and existence of numerous large and gyrose collaterals. At an atresia of an aorta (see) systolic noise has the same genesis and arises in connection with a blood flow on expanded intercostal arteries in the descending aorta below the place of narrowing.
At aneurism of the ascending department of an aorta and its arch sharp systolic noise is heard (see the Aortic aneurysm). The blowing systolic noise sometimes is listened at an open mouth of the patient or during the applying of a phonendoscope to his lips and a trachea. If aneurysmal expansion causes stretching of an aortal opening or there is an insufficiency of the aortal valves struck, e.g., with syphilitic process, also diastolic noise can be listened.
At the stratifying aortic aneurysm (see the Aneurism stratifying) sometimes over it diastolic noise, emergence is listened to-rogo it is connected with expansion of an aortal ring.
Auscultation of the descending aorta is important in diagnosis of a nonspecific aortoarte-riit and compression stenosis of a celiac trunk; identification of systolic noise serves frequent the indication for an aortografiya (see). Systolic noise in epigastric area can demonstrate damage of an upper mesenteric artery. However it must be kept in mind that approximately at 30% of patients with hron. diseases went. - kish. a path the systolic noise connected, apparently, with disturbance of laminarity of a flow of blood during the narrowings, excesses of the small and average arteries caused by inflammatory processes in the fabrics surrounding them and also change of position of bodies, napr at a visceroptosis is listened. Systolic noise in a stomach is possible also at diseases of a liver, tumors of a pancreas.
Localization of systolic noise in a navel and over femoral arteries can indicate damage of an aorta in the field of its bifurcation.
At a stenosis of a ventral aorta one of important diagnostic characters is the systolic noise most often listened over femoral and ileal arteries from this or that party.
Over a femoral artery at a gradual prelum its stethoscope, except pressure systolic murmur, the second, weaker diastolic noise (double noise of Vinogradov — Dyurozye) caused by emergence of a reversed current of blood towards heart during a diastole and which is observed at insufficiency of aortal valves can be listened.
At aneurism of a ventral aorta diagnostic value has detection of the systolic noise over palpatorno the defined pulsing education arising in connection with eddy of blood in an aneurysmal bag. However at fibrinferment of an aneurysmal bag noise can be absent.
Typical points of listening of arterial noise. Auscultation of a carotid artery and its bifurcation is made behind a corner of a mandible, a vertebral artery — otstupya 2 cm up from the middle of a clavicle, a subclavial artery — behind a nodding muscle at a clavicle, an anonymous artery — in the same point on the right. In the second boundaries-reberye to the right of a breast noise of the ascending department of an aorta are listened; in the third mezhreberye to the left of a breast — the noise arising at insufficiency of the aortal valve. Noise of a chest and ventral aorta, and also a celiac artery is listened under a xiphoidal shoot. On the middle of distance between a xiphoidal shoot and a navel on the right and to the left of direct muscles of a stomach noise of renal arteries is listened sometimes. In the middle of a pupartovy sheaf or an inguinal fold there is a point of listening of a femoral artery, and on the line connecting this point to a navel noise of an ileal artery is listened.
Venous vascular noise
Auscultation of veins normal does not allow to reveal any sound phenomena. Sometimes on an internal jugular vein between chest and clavicular parts grudino - a clavicular and mastoidal muscle a peculiar continuous blowing or buzzing noise — noise of «top» is listened, to-ry it is better listened on the right in a standing position at turn of the head to the left. Its origin is explained by either acceleration of a blood flow, or expansion of a venous bed in the place of transition of a jugular vein to its bulb. Noise of «top» is more often observed at an anemia, but is possible also at healthy people in the presence at them a wide bulb.
Arteriovenous noise are listened over arteriovenous aneurisms (see Aneurism), occupy all cardial cycle, amplify during a systole and weaken during a diastole. At a prelum of a vein proksimalny aneurisms noise disappears that is explained by equalization of pressure in an artery and a vein and the termination of transition of blood from an artery in a vein. Arteriovenous aneurisms quite often are the reason of the expressed circulatory disturbances and therefore recognition is of them great importance.
Vascular noise of a brain
Vascular noise of a brain are caused by hl. obr. defeat of vessels or their prelum. NL at an arteriovenous anastomosis and aneurisms of vessels of a brain (see) depends on the sharp pressure difference, eddy of blood and trembling of the vessels participating in patol. process. In arterial aneurisms and at trombotichesky processes noise is created by the movement of blood. Tumoral or cicatricial processes in a head cavity lead to narrowing of a gleam of arteries and emergence of NL, to-ry disappears at a decompression of a vessel.
NL it is always synchronous with cordial activity and amplifies in a phase of a systole. At wound and a prelum of large venous sine of NL can have the constant buzzing character.
At a carotid and cavernous anastomosis (see Arterio-sinusnye of an anastomosis) there is NL, to-ry is best of all listened over eyeglobes. Often over eyeglobes also respiratory noise therefore the research needs to be conducted at the held breath are listened. In 3 — 5% of cases of carotid and cavernous soustiya even at an accurate pulsation of an eyeglobe of NL it is not possible to listen. The research of NL gives valuable information on sources of collateral blood supply of an anastomosis (see Collaterals vascular). The prelum of a carotid artery seldom leads to total disappearance of NL since the anastomosis continues to function, receiving blood from a pitchfork-liziyeva of a circle. The prelum of the second carotid artery allows to establish the main source of retrograde blood supply of an anastomosis: disappearance of noise testifies to a good blood-groove to an anastomosis through a front connecting artery and to poor development of a back connecting artery.
At an arteriosinusny anastomosis (between occipital, meningeal, average or back brain arteries and sigmoid, more rare the cross sine) listens accurate NL in the field of a mastoid. NL completely disappears from a prelum of a carotid or occipital artery only in cases of an anastomosis of a sine from one of the bringing arteries.
At a carotid yugulyarnykh an anastomosis on a neck NL is always listened strong. At a prelum of a carotid artery an anastomosis is lower if there is well developed blood supply of an anastomosis from a villiziyev of a circle, NL can remain.
At arteriovenous polusharny aneurisms (angiomas) of NL are found approximately in 10% of observations. At large aneurisms of NL are listened on all head and over jugular veins. At the developed collateral circulation in case of arteriovenous aneurism there is only an insignificant reduction of noise in response to a prelum of a carotid artery that complicates definition of localization of process.
At an arteriovenous anastomosis in an eye-socket NL, similar to noise is almost always defined at a carotid and cavernous anastomosis. Cavernous angiomas in an eye-socket seldom are the reason of NL.
At arterial, or false, aneurisms of the main vessels of a neck NL, as a rule, is found. If arterial aneurisms have intracranial localization, NL is observed very seldom.
At fibrinferment of carotid arteries with partial closing of a gleam of a vessel noise over a carotid artery can be listened.
NL has great diagnostic value. At complaints of the patient to noise in the head it is necessary to carry out careful auscultation of the head, an eye and necks that gives the chance to make the correct diagnosis. The nature of change of vessels shall be specified by means of an angiographic research (see Vertebralnaya an angiography, the Carotid angiography).
Bibliography: Zograbyan S. G. A symptom of «hum» at traumatic damages of a skull, the Collection nauch. works Ere-vansk. nauch. - issled. in-that orthoitem and vosst hir., century 1, page 32, 1949; Nesterov V. S. Clinic of heart troubles and vessels, Kiev, 1974; Pokrovsky A. V. Diseases of an aorta and its branches, M., 1979, bibliogr.; R and sh m of e p P. Dynamics of cardiovascular system, the lane with English, M., 1981; Fitileva JI. M. Clinical phonocardiography, M., 1968; Holldak K. and Wolf. The atlas and the guide to a phonocardiography, the lane with it., M., 1964; The Cherepnomozgovy injury, under the editorship of A. A. Arendt, etc., page 156, M. 1962.
E. I. Sokolov, A. N. Kozin; F. A. Serbinenko (vascular noise of a brain).