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The increased paraphrasing a sentence force may more apparent than real in those cases in which the valve uncovered the retraction the thin lung border in lung disease. If accentuation present for any considerable length time implies hypertrophy the ventricle upon the corresponding side, such increase in size and power the muscle being necessary overcome the resistance which has caused the increased pressure with consequent accentuation the valve closure.

Cabot has shown that in youth the pulmonary sound commonly louder than the aortic, while after middle age the contrary holds true. In the middle third life either valve may give the louder sound.

Judgment should therefore not based solely upon mparison with the other basic sound, but upon the usual force dissertation research proposal such a sound in an individual similar age and physique.

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Arteriosclerosis and nephritis are the chief causes aortic accentuation, while mitral disease and chronic disease the lungs tending narrow the pulmonary blood paths are the chief factors in increasing the sound the pulmonic valvular closure.

In event an increase pressure greater than the ventricle can sustain permanently, the auriculoventricul valve commonly becomes incompetent through stretching its muscular ring, and the pressure upon the corresponding side the circulation thereupon falls. Weakening the First Sound.

Aside from those conditions obesity, interposition abnormal tissue elements, as the enlarged emphysematous lung or thickened pleura, or other mechanical condition rendering the first sound less easily audible, may become weakened because failure muscular power in the heart wall.

This generally the result some degenerative process aflFecting the muscle tissue, such as results from starvation, the effects continued fever, chronic enfeeblement from lack blood supply in atheroma the coronary artery, etc.

When the muscle sound greatly decreased such causes the valve sound, more snapping in quality, Decrease in intensity the basic sounds arises chiefly from lowering the blood pressure, systemic or pulmonic, or both, as the case may Loss a part the general mass blood, as in severe hemorrhage, incomplete filling the vessels, as write my paper for money in valvular disease, lack the usual resistance in the peripheral vessels, as in Graves disease, or damage the structure the valves may a factor in lessening the pressure.

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Marked weakening the basic sounds help with homework handwriting serious import as an indication pronounced cardiac In studying changes in strength the first how to buy a term paper sound at the apex should correlate our findings with the knowledge derived from palpation the apex-beat If contracting disease the lung uncover the base personal statement writing company the heart may feel the sharp closure the basic valves placing the finger in the second interspace.

near the sternum, much more commonly when contracting disease the apex the lung uncovers the conns arteriosus than upon the aortic side.

Variations in pressure cover a much greater range in the aorta than in the pulmonary artery, and the sharpest ringing sound heard at the base in cases involving the systemic circulation and, Changes in the Rhythm Heart Sounds.

Emhryocardia. This name applied the feeble and rapid action the heart which develops after the prolonged action causes tending weaken the heart muscle. The first sound the heart heard with much increased frequency, this being naturally at the expense the diastolic pause, and the heart has then the tick-tack sound that the fetus. It significant profound exhaustion the heart muscle, and found in the course serious febrile diseaseSj, in loss compensation in heart disease, and also in cases acute collapse Oallop Rhythm. In serious cardiac exhaustion, occasionally when this acute in character, may have, in conjunction with shortening the diastolic pause, the interpolation another sound, due the doubling or splitting the first or second cardiac sound, with the result that have at the apex three sounds, often diflFering but little one from the other, with the rhythm the hoofbeat a galloping horse, or the rub-a-dub a drum beat. The general impression heart failure given this gallop rhythm more import the clinician than any particular indication derived from an exact analysis the condition. Reduplication Heart Sounds. Sewall has shown. that splitting the basic heart sounds extremely common at the end a long inspiration and under some other conditions, without any special pathological import, being due increased pulmonary pressure and asynchronous someone write my essay closure the basic valves. French authors have long laid much stress upon doubling the basic sounds in the diagnosis mitral stenosis, the doubling being often audible at the apex. It has been explained as being due premature closure the pulmonary valve because earlier attainment a sufficient intraventricular pressure cause systole in the right ventricle, with its embarrassed pulmonary circulation carry, than occurs upon the left side.

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