El corazón y sus ruidos cardíacos normales y agregados. Una somera revisión del tema / The heart, normal sounds and murmurs

Resumen Los ruidos cardíacos son la expresión sonora del cierre de las válvulas cardíacas, su funcionamiento fisiológico siempre es unidireccional, lo cual permite la correcta circulación de la sangre a través del circuito cardiovascular. La auscultación del área precordial permite la identificación de estos ruidos y sus matices en los 5 focos de auscultación. Existen ruidos que no son producidos por el cierre de las válvulas, por mencionar algunos podemos encontrar los llamados soplos y los ruidos de Korotkoff, ambos producidos por la interrupción del flujo natural de la sangre (flujo laminar) al convertirse en flujo turbulento cada vez que se encuentra una disminución del radio de los conductos por donde ésta circula.

Abstract The heart sounds are an audible expression of the heart valves closing. Their physiological function is always unidirectional, allowing the proper blood flow through the cardiovascular circuit. Listening - by auscultation- to the specific chest areas allows the identification of these sounds and nuances in the five auscultation areas. There are sounds that are not produced by the closing of the valves; to mention a few, we can find the so-called puffs and Korotkoff sounds, both produced by interrupting the natural flow of blood flow (laminar flow) that becomes a turbulent flow whenever there is a reduction of the radius of the conduits through which this the blood circulates.

Diagnostic ability of Physical Examination in aortic Valve stenosis / La capacidad diagnóstica del examen físico en la estenosis valvular aórtica

background: Physical examination is essential to detect aortic stenosis but there is scarce information currently available. Objectives: The goal of this study is to evaluate the diagnostic yield of physical examination, the interobserver agreement of clinical signs, and to establish a score to identify severe aortic stenosis. Methods: One-hundred patients were included in the study. Before echocardiographic evaluation, two cardiologists independently evaluated the clinical signs of the physical examination in aortic stenosis. Sensitivity, specificity, and inter-observer agreement were calculated, and the area under the curve was analyzed to develop a score for predicting severe aortic stenosis. results: The decreased intensity of the first heart sound and the crescendo-decrescendo shape of the murmur had sensitivity >90% and specificity <70%. The specificities of an absent second sound, a murmur that peaks later in systole and the presence of a parvus et tardus pulse were >95%, but the sensitivities were <50%. Inter-observer agreement was good for most criteria, except for murmur shape and intensity. The best area under the curve was achieved by the score composed of heart sounds of decreased or absent intensity, duration of the holosystolic murmur, parvus et tardus carotid pulse and a grade 3-4 systolic murmur. Conclusions: Physical examination findings have low sensitivity but good specificity. Inter-observer agreement of clinical signs of severity was moderately good. Correct identification of patients with severe aortic stenosis can be achieved using a simple score.