Tôi chấm dứt đột ngột của dòng chảy van hai lá và ba lá do đóng cửa van lớn trong hẹp van hai lá - mềm trong bất van hai lá, hẹp động mạch chủ, còn lại khối chi nhánh bó - biến trong khối tim | Auscultation 59 Normal heart sounds I Sudden cessation of mitral and tricuspid flow due to valve closure loud in mitral stenosis soft in mitral incompetence aortic stenosis left bundle-branch block variable in complete heart block and atrial fibrillation II Sudden cessation of aortic and pulmonary flow due to valve closure usually split see below loud in hypertension soft in aortic or pulmonary stenosis wide normal split right bundle-branch block wide fixed split atrial septal defect Added sounds III Rapid ventricular filling sound in early diastole. Often normal until about 30 years then probably means heart failure fibrosed ventricle or constrictive pericarditis. IV Atrial contraction inducing ventricular filling towards the end of the diastole. IV May be normal under age 20 and in athletes but suggests increased atrial load. Not as serious a prognosis as a third heart sound. Canter rhythm often termed gallop with tachycardia gives the following cadences 60 Chapter 3 Examination of the Cardiovascular System III Tum-----te tum or Ken-----------tucky k first heart sound IV te-Tum-----te or Tenne--------ssee n first heart sound Opening snap Mitral valve normally opens silently after second heart sound. In mitral stenosis sudden movement of rigid valve makes a click after second heart sound Fig. . Ejection click Aortic valve normally opens silently. In aortic stenosis or sclerosis can open with a click after first heart sound. Splitting of second heart sound Ask patients to take deep breaths in and out. Blood is drawn into the thorax during inspiration and then on to the right ventricle. There is temporarily more blood in the right ventricle than the left ventricle and the right ventricle takes fractionally longer to empty. Splitting is best heard during first two or three beats of inspiration. Do not ask patient to hold breath in or out when assessing splitting. Paradoxical splitting occurs in aortic stenosis and left bundle-branch block. In both these .
