The note: Approximately 70 of patients

The note: Approximately 70 of patients with hums of dysfunction of papillary muscles have a loud first warm tone. 9. The second warm tone (S2) 1. Than the normal second cardiac sound is formed? The sound phenomena which are bound to closing of the aortal valve and the valve of a pulmonary artery (semilunar valves) ( 1). 1. The second warm tone (S2) is formed by two components which are bound to closing of the aortal valve (2) and xenical orlistat the valve of a pulmonary artery (2). Pay attention that the second warm tone arises right after d, tooth arises during a systole The note: In itself "closing" of the valve, apparently, is not accompanied by the sound phenomena. According to an echocardiography, tones arise a little after closing of cusps. Soon after cusps of semilunar valves stretch and start to vibrate under the influence of quickly accruing hydrostatic pressure caused by a return current of blood from an aorta or a pulmonary artery. 2. How on the basis of duration of interval QS2 it is possible to diagnose sympathetic hyperstimulation of cardiovascular system? In norm interval QS2 is longer than interval QT on 26±13 . Sympathetic hyperstimulation leads to a shorting of interval QS2. Thus duration of the last decreases so, that it becomes peer to interval QT or even less it [6, 14]. This phenomenon is called as syndrome and can be observed at a pheochromocytoma and a thyrotoxicosis.
The note: If interval QS2 is longer than interval QT more than on 40 such condition is called as return syndrome . This syndrome has been described at nonspecific (illness ) and at a stretching of a fibrous ring of the aortal valve (anulo-aortic ectasia). NORMAL SEQUENCE OF COMPONENTS OF THE SECOND WARM TONE 1. When there is an aortal component of the second cardiac sound (2) - against the maximum systolic pressure in an aorta or at lower pressure? The aortal valve is closed while the expelling effort of a left ventricle and peripheric vascular resistance together with an elastic strain of the stretched walls of an aorta decreases starts to prevail over decreasing pressure in the specified chamber of heart. It occurs at systolic pressure in an aorta a little below the maximum. Differently, if the maximum systolic pressure in an aorta makes 120 mm hg the aortal component of the second tone arises at pressure of 110 mm hg ( 2). 2. It is necessary to notice, that while pressure in a left ventricle becomes above aortal, the aortal valve opens and the uniform chamber - is formed. The point corresponding to the termination of emission of blood and a divergence of curves of pressure in an aorta and in a left ventricle, is called and arises simultaneously with an aortal component of the second warm tone The note: On a sphygmogram of a pulmonary artery the dicrotic cutting, or , simultaneously with a pulmonary maxalt or maxalt mlt component (2) the second warm tone also is observed. Normal pressure in a pulmonary artery makes 25/10 mm hg 2. What time parity between actual closing of the aortal valve, and an aortal component of the second warm tone? By data , true closing or (combination) of cusps of the aortal valve and the valve of a pulmonary artery usually arises little bit earlier (for 0-20 ), than corresponding and tones. The reason of it is certain inertia of a stream of blood thanks to which the blood flow proceeds even after pressure in a left ventricle becomes below intraaortal and the aortal valve will be closed. the blood flow remains during short time after occurrence of the second tone. The note: Duration a blood flow which remains even after intraaortal pressure becomes above , is defined as peripheric resistance to a blood current, namely volume (capacity), resistance and a pliability (extensibility) of a vascular bed, and inertia of mass of blood expelled from heart. Accordingly, at low peripheric resistance a blood flow proceeds long time after a point of crossing of curves intraaortal and a chamber pressure, and aortal (or pulmonary) the component of the second tone arises late enough. The interval of time from cusps before occurrence of an aortal component of the second warm tone has received the name of "a delay interval (hangout interval) ( 3). 3. A.Predstavleny curve pressure in a right ventricle and in the pulmonary artery, registered during an inspiration at the healthy 20-year-old man. Curves have been registered by B.Analogichnye on an inspiration at the healthy man at the age of 61 years. The distance between on a sphygmogram of a pulmonary artery and a pressure curve in a right ventricle is called as "a delay interval (hangout interval) and as it has been established, almost precisely corresponds to an interval between aortal (2) and pulmonary (2) components of the second tone. The delay interval represents time necessary for overcoming of inertia of a blood flow 3.