The note: For the unknown reasons

The note: For the unknown reasons even at a serious congenital pulmonary regurgitation the second warm tone can be on occasion only slightly split. Century of the Condition at which between a pulmonary trunk and a right ventricle there is the gradient of pressure caused valval or by a stenosis of a pulmonary artery. The of the Condition leading order decadron acute or chronic to insufficiency (for example, a massive embolism of the pulmonary artery, far come relapsing thromboembolism of branches of a pulmonary artery or a primary pulmonary hypertensia). . Conditions at which force of an elastic stretching decreases and the capacity of a pulmonary artery (for example, an idiopathic dilatation of a pulmonary artery) is enlarged. The note: Absence of wide splitting of the second cardiac sound at some patients with an idiopathic dilatation of a pulmonary artery can speak concerning small loss of an elastic tissue. At the same time at this disease extraordinary later occurrence of the pulmonary component which reasons remain unknown persons sometimes is observed. . A bilateral stenosis of branches of a pulmonary artery . Congenital absence of a pericardium. 4. Than occurrence of a pulmonary component speaks later at defect of an interventricular septum besides a volume overload of a right ventricle? Later beginning of reduction of a right ventricle which leads to elongation of interval QP2. The Interval of time from the moment of occurrence of tooth Q prior to the beginning of right ventricle reduction (an electromechanical interval) which in norm makes from 40 to 60 , at defect of an interventricular septum can be extended for 60 . Notes:
And. At defect of an interatrial septum the lowered resistance of a pulmonary vascular bed which is partially caused by a dilatation (capacity rising) a pulmonary trunk is observed. Therefore the fast stream of blood from a right ventricle does not meet due resistance. Accordingly, appear on a pressure curve in a pulmonary artery and a pulmonary component of the second warm tone later. . After operative correction of defect of an interatrial septum wide splitting of the second warm tone remains more than in 70 a case Century It testifies to justice of the theory according to which more later occurrence on a pressure curve in a pulmonary trunk is caused by its dilatation since last remains dilated and after an operative measure. Other acknowledgement of this theory is absence of significant correlation between duration of an order avandamet interval of splitting on the one hand and the size of defect with another. 5. In what cases wide splitting of the second tone is caused by earlier occurrence of an aortal component? And. At paradoxical pulse in connection with an appreciable shorting of a systole wide splitting of the second tone can be observed in the inspiration beginning. Then throughout several warm reductions the second warm tone becomes not split. Earlier occurrence of an aortal component at a cardiac tamponade speaks arising during an inspiration considerably disproportionate depression of volume of a left ventricle in comparison with the right. (Thus interval QP2 on an inspiration remains invariable.) opposite, interval QA2 is shortened, that is caused by appreciable reduction of volume of a left ventricle. . At the insufficient filling of a left ventricle caused by a tumour (more often - a myxoma) the left auricle. Notes: And. Was considered earlier, that wide splitting of the second warm tone observed at a serious mitral regurgitation is bound to earlier occurrence of an aortal component which, in turn, is caused by presence of two outlet openings and, accordingly, a shorting of the period of exile. It is incorrect, since: 1. At a mitral regurgitation not only there are two outlet openings, but also the volume of blood which is subject to exile is enlarged. 2. Wide splitting of the second tone is not observed at an easy and moderate mitral regurgitation. 3. Despite stroke output depression in rest duration of the period of exile of blood from a left ventricle at a mitral regurgitation remains normal. 4. At a mitral regurgitation left ventricle reduction can begin with delay. . It is rather important to remember that the mitral regurgitation can be accompanied by wide splitting of the second warm tone since such splitting testifies, at least, about regurgitations of the mitral valve. Thus it is not necessary to consider, that the reason of wide splitting of the second tone at a surveyed heart disease is the sequence the Aortal component - a mitral click. (Ways with which help it is possible to distinguish normal sequence of components of the second tone (22) from sequence an aortal component - a mitral click, are discussed on p. 242-246) 6.