At x-ray study of the heart and blood vessels follow a certain sequence. The study begins with an examination of the lungs, attention is drawn to the condition of the pulmonary pattern of the roots, the mobility of the diaphragm, etc. Then the condition of the skeleton is studied. chest(according to radiographs) and only after that they begin to study the cardiovascular shadow and study the position, shape, size, displacement and pulsation of the heart and blood vessels.
A heart and vessels in X-ray examination are displayed as an intense median shadow against the background of light lung fields. The contours of the cardiovascular shadow consist of arcs, which correspond to separate cavities - the chambers of the heart and adjacent large vessels.
median shadow consists of two sections: the vascular part and the actual cardiac shadow. The vascular part is elongated oblong, in the lower section it passes into the cardiac shadow; the place of transition of the vascular shadow into the cardiac shadow is called the atrio-vasal angle or the waist of the heart, this emphasizes the narrowest section of the cardiovascular shadow. The waist of the heart is a very important detail in the study of the heart and great vessels. By its severity determine the configuration, position of the heart, as well as the size of its individual cavities.
anatomical substrate vascular shadow are: aorta - ascending, arc and part of its descending section; superior vena cava; pulmonary artery.
Heart position. Many factors influence the position and shape of the cardiovascular shadow.
It is customary to distinguish three basic heart positions- vertical, oblique and transverse (horizontal). The position of the heart is determined by the angle of inclination, which represents the angle formed by the length of the heart and the horizontal drawn through the upper point of the right dome of the diaphragm. The length of the heart is the line connecting the right atriovasal angle with the apex of the left ventricle.
With vertical heart position the angle of inclination is approximately 55°, the waist of the heart is very weakly expressed, the base of the cardiac shadow is in contact with the diaphragm for a short distance. With an oblique position of the heart, the angle of inclination is approximately 45 °, the waist is visible, the area of contact of the heart with the diaphragm is larger than in the vertical position. The transverse position of the heart is characterized by an inclination angle of approximately 35°, the heart is widely "lying" on the diaphragm - "flattened" and is distinguished by the presence of a deep waist.
Specified heart position shapes reflect to some extent the constitution of a person: the vertical position is mainly found in asthenics, oblique - in normostenics and the transverse position is characteristic of people with a picnic constitution.
heart shape. The configuration of the heart is closely related to the position of the cardiovascular shadow. "Drip" is a vertically located heart, characterized by a long vascular bundle and a small cardiac shadow, which occupies a median position. A “lying” heart is a heart with a transverse shadow, a short vascular bundle, and a “deep” waist. The severity of the waist characterizes one form or another of the cardiovascular shadow in diseases of the heart and in malformations.
Used to denote pathological conditions mitral configuration and aortic. With a mitral configuration, there will be no heart waist, it will be smoothed out, or “bulging”, an additional arc, will even be determined at the site of the waist; on the contrary, with the aortic configuration there will be a deep waist - a distinct depression at the place of transition of the vascular bundle into the heart shadow, as a rule, along the left contour.
However, the use of the term mitral or aortic configuration is competent only with the exclusion of the constitutional features of the subject, plus data indicating the actual presence of one or another heart disease.
The heart is an airless organ surrounded by air-rich lung tissue.
As an airless organ, the heart produces a dull sound on percussion. But due to the fact that it is partially covered by the lungs along the periphery, the dull sound is not uniform. Therefore, there is a relative
and absolute stupidity.
Percussion of the region of the heart covered by the lungs reveals relative, or deep, dullness, which corresponds to the true boundaries of the heart.
Above the region of the heart, not covered by lung tissue, absolute, or superficial, dullness is determined.
Technique and rules of percussion of the heart
Percussion is performed in the vertical position of the patient (standing or sitting on a chair) with arms lowered along the body. In this position, due to the omission of the diaphragm, the diameter
hearts are 15-20% smaller than in the horizontal. In severe patients, percussion should be limited only in a horizontal position. A person sitting on a bed with horizontally located, not lowered legs has a high position of the dome of the diaphragm, the maximum displacement of the heart and the least accurate results of heart percussion. Percussion is performed with calm breathing of the patient.
The position of the doctor should be convenient for the correct location of the finger-pessimeter on the chest of the examined and the free application of percussion blows with the finger-hammer. In the horizontal position of the patient, the doctor is on the right, in the vertical position - opposite him.
Percussion of the heart is performed according to the following scheme:
determination of the limits of relative dullness of the heart,
determination of the contours of the cardiovascular bundle, the configuration of the heart, the size of the heart and the vascular bundle,
determination of the limits of absolute dullness of the heart.
Percussion of the heart is performed in compliance with all the "classical" rules of topographic percussion: 1) the direction of percussion from a clearer sound to a dull one; 2) the finger-plessimeter is installed parallel to the intended border of the organ; 3) the boundary is marked along the edge of the plessimeter finger facing the clear percussion sound; 4) quiet is performed (for
determining the boundaries of the relative dullness of the heart and the contours of the cardiovascular bundle) and the quietest (to determine the boundaries of the absolute dullness of the heart) percussion.
Determination of the boundaries of relative dullness of the heart
The relative dullness of the heart is a projection of its anterior surface onto the chest. First, the right, then the upper and then the left limits of relative dullness are determined.
hearts. However, before determining the boundaries of the relative dullness of the heart, it is necessary to establish the upper boundary of the liver, i.e. the height of the right dome of the diaphragm, above which
the right side of the heart is located.
It should be borne in mind that the upper border of the liver, corresponding to the height of the dome of the diaphragm, is covered by the right lung and gives a dull sound during percussion (relative
dullness of the liver), which is not always clearly defined.
Therefore, in practice it is customary to determine the upper limit of the absolute dullness of the liver, corresponding to the lower limit right lung, which is guided by when finding the right
borders of the heart.
To determine the location of the upper edge of the liver by percussion, a plessimeter finger is placed in the II intercostal space to the right of the sternum, parallel to the ribs, along the mid-clavicular
lines and, changing the position of the plessimeter finger downwards, apply percussion blows of medium strength until dullness appears (the lower edge of the lung, which in healthy people is
at the level of the VI rib).
Determination of the right border of relative dullness of the heart.
The plessimeter finger is placed one rib above the hepatic dullness, i.e., in the IV intercostal space. Its position changes to vertical - parallel to the expected border of the heart. They are tapped from the right mid-clavicular line in the direction from the lungs to the heart until a clear sound passes into dullness.
The appearance of a shortened sound determines the most distant point of the right contour of the heart. Normally, the right border of relative dullness of the heart is located in the IV intercostal space 1-1.5 cm outward from the right edge of the sternum and is formed by the right atrium.
The definition of the upper limit of the relative dullness of the heart is carried out 1 cm outward from the left edge of the sternum with the horizontal position of the finger-pessimeter, moving from the I interre-
take down until dullness of percussion sound appears.
Normally, the upper limit of relative dullness of the heart is at the level of the III rib or in the III intercostal space, in persons with an asthenic constitution - above the upper edge of the IV rib, which is largely determined by the height of the dome of the diaphragm. The initial part of the pulmonary artery and the left atrial appendage are involved in the formation of the upper limit of the relative dullness of the heart.
Determination of the left border of relative dullness of the heart.
The most distant point of the left contour of the heart is the apex beat, which coincides with the left border of the relative dullness of the heart. Therefore, before starting the definition
the left border of the relative dullness of the heart, you need to find the apex beat, which is necessary as a guide. In those cases when the apex beat is not visible and not palpable, the determination of the left border of the relative dullness of the heart by percussion is carried out along the V and, in addition, along the VI intercostal space, in the direction from the anterior axillary line to the heart. The finger-plessimeter is placed vertically, i.e., parallel to the supposed left border of the relative dullness of the heart, and percussed until dullness appears. Normally, the left border of the relative dullness of the heart is located in the V intercostal space 1-2 cm medially from the left mid-clavicular line and is formed by the left ventricle.
Determination of the right and left contour of the cardiovascular bundle, the size of the heart and vascular bundle, the configuration of the heart
Determining the boundaries of the contours of the cardiovascular bundle allows you to find the size of the heart and vascular bundle, to get an idea of the configuration of the heart. The right contour of the cardiovascular bundle runs to the right of the sternum from the I to IV intercostal space. In the I, II, III intercostal spaces, it is formed by the superior vena cava and is 2.5-3 cm away from the anterior midline. In the IV intercostal space, the right contour is formed by the right atrium, is 4-4.5 cm away from the anterior midline and corresponds to the right limit of relative dullness of the heart. The place of transition of the vascular circuit into the circuit of the heart (right atrium) is called the “right cardiovascular (atriovasal) angle”.
Left contour of the cardiovascular bundle
passes to the left of the sternum from I to V intercostal space. In the I intercostal space, it is formed by the aorta, in II - by the pulmonary artery, in III - by the auricle of the left atrium, in IV and V - by the left ventricle. The distance from the anterior median line in I-II intercostal spaces is 2.5-3 cm, in III - 4.5 cm, in IV-V - 6-7 cm and 8-9 cm, respectively. The border of the left contour in the V intercostal space corresponds to the left border of the relative dullness of the heart.
The place of transition of the vascular circuit into the left atrium circuit is an obtuse angle and is called the “left cardiovascular (atriovasal) angle”, or the waist of the heart.
Methodically, percussion of the boundaries of the contours of the cardiovascular bundle (first the right, then the left) is carried out in each intercostal space from the midclavicular line towards the corresponding edge of the sternum with the finger-plessimeter in a vertical position. In the I intercostal space (in the subclavian fossa), percussion is performed along the first (nail) phalanx of the finger-plessimeter.
According to M.G. Kurlov, 4 sizes of the heart are determined: length, diameter, height and width.
Heart length
Distance in centimeters from the right cardiovascular angle to the apex of the heart, i.e. to the left border of the relative dullness of the heart. It coincides with the anatomical axis of the heart and is normally 12-13 cm.
To characterize the position of the heart, the definition of the angle of inclination of the heart, enclosed between the anatomical axis of the heart and the anterior median line, is of known importance. Normally, this angle corresponds to 45-46 °, in asthenics it increases.
Diameter of the heart
The sum of 2 perpendiculars to the anterior midline from the points of the right and left borders of the relative dullness of the heart. Normally, it is 11 - 13 cm ± 1 - 1.5 cm, adjusted
on the constitution - in asthenics it decreases (“hanging”, “drip” heart), in hypersthenics it increases (“lying” heart).
Heart Width
The sum of 2 perpendiculars lowered to the length of the heart: the first - from the point of the upper border of the relative dullness of the heart, the second - from the top of the cardiohepatic angle formed by the right border of the relative dullness of the heart and the liver (practically - V intercostal space, at the right edge of the sternum). Normally, the width of the heart is 10-10.5 cm.
Heart height
The distance from the point of the upper limit of the relative dullness of the heart to the base of the xiphoid process (first segment) and from the base of the xiphoid process to the lower contour of the heart (second segment). However, due to the fact that the lower contour of the heart is almost impossible to determine percussion due to the fit of the liver and stomach, it is believed that the second segment is equal to one third of the first, and the sum of both segments normally averages 9-9.5 cm.
oblique heart size
(quercus) is determined from the right border of the relative dullness of the heart (right atrium) to the upper limit of the relative dullness of the heart (left atrium), normally equal to 9-11 cm.
Width of the vascular bundle
determined by the II intercostal space, normally 5-6 cm.
Determining the configuration of the heart.
Distinguish normal, mitral, aortic and in the form of a trapezoid with a wide base of the configuration of the heart.
In a normal configuration of the heart, the size of the heart and cardiovascular beam is not changed, the waist of the heart on the left contour is an obtuse angle.
The mitral configuration of the heart is characterized by smoothness and even bulging of the waist of the heart along the left contour due to hypertrophy and dilatation of the left atrium, which is typical
for mitral heart disease. At the same time, in the presence of isolated mitral stenosis, the boundaries of the relative dullness of the heart expand up and to the right due to an increase in
left atrium and right ventricle, and in case of insufficiency mitral valve- up and to the left due to hypertrophy of the left atrium and left ventricle.
The aortic configuration of the heart is observed in aortic malformations and is characterized by a displacement outwards and downwards of the left border of the relative dullness of the heart due to an increase in the size
left ventricle without changes in the left atrium. In this regard, the waist of the heart along the left contour is emphasized, approaching the right angle. The length and diameter of the heart increase without changing its vertical dimensions. This configuration of the heart is traditionally compared to the contour of a duck sitting on the water.
The configuration of the heart in the form of a trapezium with a wide base is observed due to the accumulation of a large amount of fluid in the pericardial cavity (hydropericardium, exudative pericarditis), while the diameter of the heart increases significantly.
Pronounced cardiomegaly with an increase in all chambers of the heart - "bull heart" (cor bovinum) - is observed with decompensation of complex heart defects, dilated cardiomyopathy.
Determination of the boundaries of absolute dullness of the heart
Absolute dullness of the heart is a part of the heart that is not covered by the edges of the lungs, adjacent directly to the anterior wall of the chest and giving an absolutely dull sound during percussion.
Absolute dullness of the heart is formed by the anterior surface of the right ventricle.
To determine the boundaries of absolute dullness of the heart, the quietest, or threshold, percussion is used. There are right, top and left borders. The definition is carried out according to the general rules
topographic percussion from the boundaries of the relative dullness of the heart (right, upper, left) towards the zone of absolute dullness.
The right border of absolute dullness of the heart runs along the left edge of the sternum; upper - along the lower edge of the IV rib; left - 1 cm medially from the left border of the relative dullness of the heart
or matches it.
Auscultation of the heart
Auscultation of the heart is the most valuable method of examining the heart.
During the work of the heart, sound phenomena occur, which are called heart tones. Analysis of these tones during listening or graphic recording (phonocardiography) gives
understanding of the functional state of the heart as a whole, the work of the valvular apparatus, the activity of the myocardium.
The tasks of auscultation of the heart are:
1) determination of heart sounds and their characteristics: a) strength;
b) solidity; c) timbre; d) rhythm; e) frequency;
2) determination of the number of heart contractions (according to the frequency of tones);
3) determination of the presence or absence of noise with a description of their main properties.
When conducting auscultation of the heart, the following rules are observed.
1. The position of the doctor is opposite or to the right of the patient, which makes it possible to freely listen to all the necessary auscultation points.
2. Position of the patient: a) vertical; b) horizontal, lying on the back; c) on the left, sometimes on the right side.
3. Certain techniques of auscultation of the heart are used:
a) listening after dosed physical activity, if the patient's condition allows; b) listening in different phases of breathing, as well as when holding the breath after the maximum
inhale or exhale.
These provisions and techniques are used to create conditions for amplifying noise and their differential diagnosis, which will be discussed below.
Heart waist narrowing of the x-ray shadow of the heart on the border between the shadows of the heart and large vessels in the anterior projection; with some heart diseases T. s. is flattened or deformed.
1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.
See what "Waist of the Heart" is in other dictionaries:
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MITRAL HEART- MITRAL HEART, a special shape of the silhouette of the heart, determined by X-ray transmission, rays in the dorso-ventral direction on X-rays, images, ortho-diagrams and with accurate percussion of the boundaries of the relative dullness of the heart; this one is called... Big Medical Encyclopedia
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The following options for the abnormal position of the heart are possible:
Dextrocardia (congenital condition);
Displacement of the heart to the right (observed with left-sided pneumothorax, obstructive atelectasis of the right lung,
right-sided pneumothorax);
Displacement of the heart to the left (observed with right-sided pneumothorax, right-sided exudative pleurisy, obstructive atelectasis of the left lung, left-sided pneumosclerosis).
3. Determination of the configuration of the heart, the size of the diameter of the heart and the vascular bundle.
The right and left contours of the heart are determined. To determine the right contour of the heart, percussion is performed at the level of IV, III, II intercostal spaces. To establish the left contour of the heart, percussion is performed at the level of V, IV, III, II intercostal spaces. Since the boundaries of the heart at the level of the IV intercostal space on the right and the V intercostal space on the left have already been established when determining the boundaries of the relative dullness of the heart, it remains to determine them at the level of the IV, III, II intercostal space on the left and III, II intercostal space on the right.
Determination of the contours of the heart at the level II I and II intercostal spaces on the right and IV - II intercostal space on the left. The initial position of the plessimeter finger is on the mid-clavicular line on the corresponding side. The middle of the middle phalanx of the plessimeter finger should be in the corresponding intercostal space. Percussion is carried out with medium-strength strikes. The plesimeter finger is moved towards the heart. When a dull sound appears, a border is marked along the edge of the plessimeter finger facing a clear pulmonary sound (i.e. from the heart).
Normally, the right contour of the heart at the level of the II and III intercostal spaces is located along the right edge of the sternum, at the level of the IV intercostal space, 1-2 cm outward from the right edge of the sternum. The left contour of the heart at the level of the II intercostal space is located along the left edge of the sternum, at the level of the III intercostal space along the left parasternal line, at the level of the IV and V intercostal spaces, 1-2 cm medially from the left mid-clavicular line.
The following pathological changes of the heart are of diagnostic value:
1) mitral;
2) aortic;
3) trapezoidal.
mitral configuration. It is characterized by outward bulging of the upper part of the left contour, due to dilatation of the left atrium and cone of the pulmonary artery. The waist of the heart is flattened. This configuration is detected with stenosis of the left atrioventricular orifice and with mitral valve insufficiency.
aortic configuration. It is characterized by outward bulging of the lower part of the left circuit, due to dilatation of the left ventricle. The waist of the heart is underlined. The heart is shaped like a felt boot or a duck sitting on the water. The aortic configuration is observed with insufficiency of the aortic valves, with aortic stenosis.
Trapezoidal configuration. It is characterized by an almost symmetrical bulging of both contours of the heart, more pronounced in the lower sections. This configuration is observed in exudative pericarditis and hydrothorax.
Width vascular bundle. The contours of the heart, determined in the second intercostal space on the right and left, correspond to the width of the vascular bundle. Normally, the right border of the vascular bundle runs along the right edge of the sternum. It is formed by the aorta or superior hollow foam. A clear border of the vascular bundle normally runs along the left edge of the sternum. It is formed by the pulmonary artery. Normally, the width of the vascular bundle is 5-6 cm. An increase in the size of the diameter of the vascular bundle is observed with atherosclerosis and aortic aneurysm.
Measurement of the diameter of the heart. The length of the diameter of the heart is a summand of two sizes - right and left. The diameter of the heart in a healthy person is 11-13 cm. The right size is the distance from the right border of the relative dullness of the heart to the anterior midline. Normally, it is 3-4 cm. The left size is the distance from the left border of the relative dullness of the heart to the anterior midline. Normally, it is 8-9 cm.
An increase in the size of the right component of the heart diameter occurs in pathological conditions accompanied by dilatation of the right atrium and right ventricle. Exudative pericarditis and hydropericardium also lead to an increase in the size of the right component of the diameter of the heart.
An increase in the size of the left component of the heart diameter occurs in pathological conditions accompanied by dilatation of the left, and in some cases, the right ventricle.
Right the contour follows right side of the sternum in 2 and 3 intercostal space and
on the 1 cm outward from the right edge of the sternum in 4 intercostal space. Left contour
goes to 2 intercostal space on the left edge chest, in 3 - on parasternal
lines, in 4 - in the middle of the distance between parasternal and midline-
but-clavicular line, descends in the form of a convex outward arc and reaches
forms the apex of the heart, which is 1.5 cm medially from the left middle
dino-clavicular line. This is the normal configuration of the heart.
The angle that is located between the left ventricle and the vessels
radiologists call waist hearts.
The shape of the heart is of great importance in radiodiagnosis. Most-
more frequent heart diseases - valvular defects, myocardial damage and
ricarda - lead to typical changes in the shape of the heart. Allocate mit-
ral, aortic, trapezoidal (triangular) shape, the configuration of the heart with cor bovinum and with cor pulmonare.
Mitral configuration of the heart. Observed with mitral porosity
kah heart. With mitral valve insufficiency, there is a regur-
gyration of blood from the left ventricle to the left atrium during systole.
The left atrium, which receives blood from the pulmonary veins and blood
returning from the left ventricle, hypertrophies, increases pressure
leniya in a small circle of blood circulation, subsequently develops hypert-
rofia of the right ventricle. Mitral stenosis is even more unfavorable,
when the whole weight of the defect lies on the left atrium. Percussion brings out
expansion of the heart up and to the right. On the radiograph, there is an expansion
rhenium of the middle left arch, that is, the pulmonary artery and the left atrium
dia, as well as the lower right arch due to the expansion of the right ventricle.
The waist of the heart is flattened. The upper left contour is located outward from
parasternal line. The left ventricle is less dilated than
with mitral valve insufficiency.
The mitral configuration is characterized by three signs: 1. Elongation
the second and third arcs of the left contour shrink and become more convex
cardiovascular shadow corresponding to the trunk of the pulmonary artery and
left atrial appendage; 2. The angle between these arcs decreases, then
There is a left atriovasal angle. There is no retraction of the contour -
("heart waist" flattened); 3. The right atriovasal angle is displaced
up. If at the same time the left ventricle is enlarged, then the
the fourth arc of the left contour and its edge is determined to the left than in the normal
Aortic configuration. It is noted in aortic malformations, which
rye are characterized primarily by an increase in the left ventricle. AT
In these cases, the left border shifts down and to the left, sometimes reaching
middle axillary line in 6-7 intercostal spaces. In these cases, there is
lower left arc, the waist of the heart is expressed. The heart is shaped like a shoe
or a sitting duck.
Thus, the radiographic features of the aortic configuration
the following: a deep recess between the first and fourth arcs of the left
contour of the cardiovascular shadow. Because of this, the width of the cardiovascular
the shadow at the level of the atriovasal angles seems quite small (they say
that "the waist of the heart is underlined"); lengthening of the fourth arc
left contour, indicating an increase in the left ventricle. Except
of these two obligatory signs, three more can be observed: an increase in the first arch on the right due to the expansion of the ascending aorta; increased-
the first arch on the left due to the expansion of the arch and the descending aorta;
shift of the right atriovasal angle from top to bottom.
With the accumulation of fluid in the pericardial cavity, the boundaries of the heart expand
rush evenly in both directions, but more in the lower sections, and such
the configuration is called trapezoid, or triangular. At the same time,
there is no uniform increase in the heart with the loss of a clear division
its contours into arcs.
In chronic lung diseases, the main burden falls on
right parts of the heart, the right border of the heart expands and the right con-
tour - cor pulmonale(cor pulmonale).
The expansion of the cavities of the heart determines the configuration of the heart type
cor bovinum.
The width of the vascular bundle is measured in the second intercostal space between
two points found percussion. It is equal to 5-6 cm.
The diameter of relative cardiac dullness is determined as a sum
we are the distances from the right border to the midline and from the left border
to the midline. It is equal to 3-4 cm plus 8-9 cm and is equal to 11-13 cm.
To determine the boundaries of absolute cardiac dullness, that is, that
part of the heart that is not covered by the lungs and on percussion gives a dull
sound. Produced quiet percussion.
They start from the definition of the right border of relative stupidity
hearts and percussion inside to a dull sound. The border is located at 4
intercostal space on the left side of the sternum. The left one coincides with the boundary of the relative
dullness or is located 1-1.5 cm medially from it. Upper Gra-
The neck is located along the upper edge of the 4th rib along the parasternal line.
Absolute dullness is formed by the right ventricle, directly
lying to the anterior surface of the chest.
Reducing the area of absolute dullness observed in emphysema
lungs, during an attack bronchial asthma, with left-sided pneu-
motorax.
Increasing the area of absolute dullness seen with wrinkling
anterior edges of the lungs, with inflammatory compaction of the anterior edges
lungs, with a dull sound from the anterior edges that have become airless
of the lungs merges with the absolute dullness of the heart, which makes it seem
a continuing increase in the latter, which occurs with exudative pleurisy,
with exudative pericarditis. In this case, the anterior edges of the lungs can
crowd from the heart, and then all stupidity is absolute, being in
the center is conditioned by the heart itself, and at the edges by the liquid.
PERCUSSION OF THE HEART
Determination of the boundaries of relative dullness of the heart
a) Determination of the standing height of the right dome of the diaphragm
b) Determination of the intercostal space along which percussion will be carried out
this right border of relative cardiac dullness
c) Determination of the right border of relative cardiac dullness
d) Determination of the intercostal space along which percussion will be carried out
this left border of relative cardiac dullness
e) Determination of the left border of relative cardiac dullness
f) Determination of the upper limit of relative cardiac dullness
g) Measurement of the diameter of relative cardiac dullness and its
semiological assessment
Norm: 11-13 cm
More than 13 cm - its increase due to:
right ventricle
left ventricle
both ventricles
h) Comprehensive analysis of the displacement of the boundaries of the relative cardiac
1. Conform to the norm
2. Shift of all boundaries of relative dullness to the right or left
in: extracardiac diseases leading to displacement
mediastinum in one direction or another (fluid in the pleural
cavities, lung cirrhosis with coarse adhesions, condition after
pulmonectomy), deformity of the spine and chest.
3. Local displacement of one of the boundaries outward
Right: diseases leading to dilatation of the right stomach
Left: diseases leading to hypertrophy and dilatation
left ventricle
Upper: diseases leading to dilatation of the left pre-
heart and pulmonary artery
4. Total displacement outward of all the boundaries of the relative ser-
stupidity:
Moderate
Expressed - dilatation of all cavities of the heart
5. Total displacement inward of all the boundaries of the relative heart
dullness - diseases and physiological conditions, sop-
born by low standing diaphragm
Determination of the contours of the heart
a) Definition of the right cardiac contour (in 2,3,4 intercostal spaces
and lower, depending on the height of the right dome of the diaphragm
b) Determination of the left cardiac contour (in 2,3,4,5 intercostal spaces
and lower depending on the localization of the apex beat)
c) Measurement of the width of the vascular bundle in the 2nd intercostal space
1. Along the edges of the sternum - the norm
2. More than 6 cm - increase
extracardiac reasons for the increase in the width of the vascular bundle - for-
pain, accompanied by an increase in the size of the organs of the upper
mediastinum or the appearance of additional tissue (retrosternal
goiter, increase lymph nodes- Primary tumors
metastases)
cardiac causes - aneurysm of the aortic arch
d) Determining the configuration of the heart
1. Normal configuration
2. Outward displacement of the middle part (3rd intercostal space) of the left con-
tour and lower part (3.4 intercostal spaces) of the right contour -
mitral configuration
3. Significant displacement outward of the lower part (4.5 intercostal spaces)
left contour - aortic configuration
4. Outward displacement of the middle (3rd intercostal space) and lower parts
left contour and lower part of the right contour - mixed