Now these terms are used only

Now these terms are used only for a designation of components of the split second warm tone independent from each other. In the domestic literature the raised loudness of the second tone in the second on the right or to the left of a breast bone is traditionally designated as accent of the second tone accordingly over an aorta or over a pulmonary artery. - a comment of recentury 2. What of components (in modern understanding of this term) the second cardiac sound is better it is auscultated in the second to the left of a breast bone (earlier known skelaxin 800mg as a projection of the valve of a pulmonary artery) at healthy people? What its clinical value? At healthy faces the aortal component of the second warm tone in the second to the left of a breast bone more loudly pulmonary in 70 of cases is more younger 20 years. After 20 years loudness of an aortal component in the specified place always above in comparison with the pulmonary. (Even at a serious pulmonary hypertensia [observed, for example, at syndrome ] in the second intercostal space to the left of a breast bone the aortal component of the second cardiac sound is louder more often, than pulmonary.) a pulmonary component frequently is better it is auscultated in the third or the fourth to the left of a breast bone. It is one more reason, on which the second should not consider an intercostal space as "a true projection of the valve of a pulmonary artery. Taking into account that last term is incorrect and can mislead, we recommend to refuse its use and to designate corresponding area simply as the second to the left of a breast bone ( 6). .
In a drawing the sphygmogram of a carotid and a phonocardiogram, simultaneously registered at the healthy 16-year-old teenager with normal splitting of the second warm tone during an inspiration are presented. Pay attention that on a heart apex the aortal component (2) and that in the second to the left of a breast bone amplitude of the last above is auscultated only, than loudness of a pulmonary component (2) Notes: And. To the left of a breast bone it is possible to name the second intercostal space "historically fixed" or "traditional" projection of the valve of a pulmonary artery. . At healthy people at the moment of closing of the aortal valve robaxin medication the pressure gradient between an aorta and a left ventricle increases faster, than between a pulmonary artery and a right ventricle. It the big loudness of an aortal component in the second at the left in comparison with the pulmonary also speaks. Besides, the aortal valve is most close to the second and third intercostal spaces to the left of a breast bone. It is one more reason on which it is not necessary to name the second on the right area of a projection of the aortal valve ( 7). 7. The proximal department of an aorta and the aortal valve are behind an average part of a breast bone 3. On what site of a forward thoracal wall in norm the pulmonary component of the second warm tone is auscultated? At adults the pulmonary component of the second cardiac sound in norm is auscultated along a breast bone left edge, frequently only on some centimetres more to the left of it. At babies and children of younger age, and also at teenagers with a thin thoracal wall and small in diameter of a thorax also it is possible to hear to a pulmonary component on a heart apex. Notes: And. It means, that if at the adult person with a thick thoracal wall the pulmonary component of the second warm tone (the split second tone) is auscultated also to the right of a breast bone or on a heart apex, that, most likely, loudness of a pulmonary component exceeds the normal. If the pulmonary component of the second tone is unexpectedly auscultated on an apex will be frequently found out the enlarged right ventricle and the apical jerk which has been not bound to reductions of a left ventricle. Therefore at defect of an interatrial septum it is possible to expect, that because of right ventricle augmentation the pulmonary component of the second tone will be distinctly auscultated on an apex even for lack of a pulmonary hypertensia. . The aortal component of the second tone is usually auscultated on any site of a thorax. 4. Where splitting of the second warm tone more often is auscultated? In the second and the third on left lines. Notes: And. At adiposity the split second warm tone frequently is better it is auscultated in the first intercostal space at the left. . At a dextrocardia, a persistent general arterial trunk or at a transposition of the main vessels (both , and ) the split second tone can be auscultated is better to the right of a breast bone ( 8). At a transposition of the main vessels the proximal department of an aorta is in front from a trunk of a pulmonary artery; the right ventricle refers venous () blood to an aorta, and the left ventricle throws out blood in pulmonary arteries.