Therefore at a stenosis

Therefore at a stenosis of the specified valve the pulmonary component of the second warm tone not only becomes more silent, but also arises later. . At the massive embolism affecting the valve of a pulmonary artery, the pulmonary component of the second tone will be silent even in the presence of a pulmonary hypertensia. Century of Anomaly medrol dosepak of development at which the distance between a pulmonary artery and a stethoscope (for example is enlarged, or not-korrigirovannaja a transposition of the main vessels [see p. 205]), are accompanied by reduction of loudness of a pulmonary component even when there is a pulmonary hypertensia. If the isolated stenosis of target department of the right ventricle, caused by a hypertrophic cardiomyopathy (meets very seldom) loudness of a pulmonary component can be normal takes place, however the component arises with delay. At congenital a stenosis of a pulmonary artery the pulmonary component of the second tone can be absent. . At a calcareous infiltration or a fibrosis of the aortal valve or the valve of a pulmonary artery low-frequency components of warm tones fade. Differently, at these pathological conditions in to a picture sounds of higher frequency dominate, than at not changed valves. In the similar image, low-frequency components of cardiac sounds are not defined throughout many years after replacement of the aortal valve with a heterograft executed from tissues of a pig. Probably, it is caused by degenerate changes. Relative loudness, height and duration of the first and second warm tones 1. Because the diastole is longer than a systole, the first and second cardiac sounds usually form group of two sounds, following one behind another. In what cases such groups it is not observed? And.
At a diastole shorting in comparison with a systole, for example, at the expressed tachycardia. Such the picture has received the name of an embryocardia because of similarity to the palpitation of a foetus listened since the fifth month of pregnancy. However the term ( a rhythm) is more suitable. The note: The embryocardia can be auscultated and after a birth since on the first year of a life frequency of warm reductions can reach 190 blows in a minute, and on the second year of a life - 160 blows in a minute. Even at the four-year-old child in norm the frequency of warm reductions peer to 130 blows in minute can be observed, and in age its normal value can make 100 blows in a minute. . Adult people sometimes have a systole elongation in comparison with a diastole which reasons are unknown. Because of similarity with hours such the picture has received the name of the sentry (or ) a rhythm. The note: At ischemic illness of heart vpxl with a postinfarction cardiosclerosis or without it elongation of interval QT provokes sympathetic hyperstimulation; it is accompanied by a simultaneous shorting of interval QS2 and, accordingly, in itself cannot lead to systole elongation. Therefore the hour rhythm without a tachycardia causing a shorting of a diastole, testifies to absence at the patient of clinically significant ischemic illness of heart. Century the Hour rhythm without a tachycardia can be observed at a serious aortal regurgitation since at this heart disease for exile of the enlarged volume of blood it is required to more time, as leads to systole elongation in relation to a diastole. At the expressed aortal regurgitation frequently it is possible to accept wrongly a systole for a diastole. 2. How loudness of the first and second warm tones helps to distinguish them from each other? At absolutely healthy people in the second as on the right, and to the left of a breast bone (i.e. on the basis of heart) the second warm tone is louder than the first, probably, that the aortal valve and the valve of a pulmonary artery are in this place most close to a thoracal wall. On an apex the first warm tone is usually louder, than the second. The note: If in a projection of the basis of heart the first warm tone is louder than the second, takes place or extremely loud first tone (as, for example, at a mitral stenosis) or very silent second tone. 3. How on the basis of physical inspection it is possible to distinguish the second warm tone from the first when it does not manage to be made by comparison of their loudness? And. In comparison with first second a cardiac sound above, more distinctly and more shortly because during an exhalation it usually is not split. The first warm tone rather more deafly and more raspingly since consists of three components. These parities are reflected by a sound combination "lab-dap" (lub-dup), often used for imitation of the first and second warm tones. . Simultaneously with heart auscultation a carotid.