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In the second left space, more frequently than in the case the aortic valve, in the one below, may heard the sound the closure the pulmonary valv The murmur an obstructive lesion at this point transmitted toward the interscapular region rather than upward, owing the course the pulmonary artery, while that regurgitation transmitted downward in much the same way as that aortic leakage. At a point just within and below the nipple, hear the normal first sound the heart, this being termed the mitral area, because here listen for either the murmurs produced at this valve. The stenotic murmur quite sharply localized as a rule, while the murmur regurgitation transmitted the left or into the back, or upward toward the pulmonary area in some paraphrasing essay cases. Near the lower end the sternum, perhaps most frequently upon the left side, but often the right, the area the tricuspid valve.

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Its murmurs, direct or regurgitant, are as a rule more limited in extent than those the mitral.

Heart Sounds. The umi thesis rhythm, quality, area maximum intensity and modifications the sounds various agencies in health and The first sound the heart, coinciding with the thrust the apex-beat, best heard at the mitral area, and following hear at the same point the second sound, coinciding dissertation writing services uk with the closure the basic valves. The first sound, commonly described as resembling that produced pronouncing the syllable lubb, presumably a composite sound produced the impact the apex against the chest wall, another sound due the contraction the muscle, and an other arising from the closure and tension the mitral and tricuspid valves and their auxiliary structures.

The second sound, dup, arises from the closure the basic valves.

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Then follows the diastolic interval, normally somewhat greater than that occupied the two heart sounds. Although the two sounds in health differ markedly as render differentiation sound alone online report writing help comparatively easy and certain, in disease the qualities change markedly as render necessary verify the location the first sound in the cardiac cycle palpation the apexbeat, or the carotid artery.

The heart weakened disease may have much the same rhythm as the fetal heart, and may then in doubt whether hear only the first sound, only the second sound, or the two, alternating but indistinguishable.

The first sound the predominating one in the mitral area, service learning reflection essay but at the base the heart the pulmonary or aortic sound assumes the leading place according as listen over the left or right second interspace.

It possible, however, for either basic sound accentuated in disease as dominate the whole basic area. The intensity the heart sounds modified the vigor or feebleness the cardiac action, and the thinness or thickness and elasticity or rigidity the chest walls.

In general, the sounds are clearer and sharper in children than in adults, and the valvular element in the first sound more pronounced than the duller muscular sound which gives the characteristic booming quality the adult The intervention lung or other tissue between the heart and the chest wall may markedly modify the intensity the sounds in accordance with the density the tissue in question.

The withdrawal the thin edge lung from over certain parts the heart permits the sounds propagated the surface the chest with more than normal force and distinctness. Increased Intensity First Sound. Causes tending increase the force the first sound the heart are in general those causing more vigorous action the organ, and especially exercise and excitement. The heart, the muscular walls which are hypertrophied athletic training, or stimulated increased action in the early stages fever, or the one whose cavities and walls are modified the dilatation and hypertrophy valvular disease, yields an accentuated first sound. When the vascular tension increased, as in interstitial nephritis, the first sound has more the booming quality associated with increased muscular work. The rapid and forcible heart action Graves disease, the other hand presents more best dissertation services the valvular element. The increase in force the first sound in well compensated mitral stenosis recognized more easily than explained. Increased Intensity Second Sound. The increased intensity the second sound due increased pressure in either the systemic or the pulmonic circulation, with correspondingly forcible closure the aortic or pulmonic valves, except that in rare instances the two causes may combined.

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