Diseases of the chest and the principles of physical diagnosis . rtery. The sound is due not to the mechanical act of valvu-lar closure, but to sudden increase in tension and subsequent vibrationof the valves. The pulmonic second sound is normally louder up to twenty-five orthirty years of age, after which the aortic tends to become louder. Whenauscultation is practised (experimentally) directly over the vessels, sound is the louder. In 90 per cent, of all children under ten yearsof age, the pulmonic sound is the louder (the artery is more superficial),and in about 10 per cent, of t
Diseases of the chest and the principles of physical diagnosis . rtery. The sound is due not to the mechanical act of valvu-lar closure, but to sudden increase in tension and subsequent vibrationof the valves. The pulmonic second sound is normally louder up to twenty-five orthirty years of age, after which the aortic tends to become louder. Whenauscultation is practised (experimentally) directly over the vessels, sound is the louder. In 90 per cent, of all children under ten yearsof age, the pulmonic sound is the louder (the artery is more superficial),and in about 10 per cent, of the cases a splitting of the second sound canbe recognized. 222 THE EXAMINATION OF CIRCLLATORY SYSTEM The second jmlmonic sound is louder in the reciimhent posture, and inconditions which increase the pressure in the lesser circulation—pulmo-nary consolidation, pleural effusion, mitral disease, emphysema—providedthe right heart is sufficiently strong to maintain the increased tension,, the tricuspid valve remains competent. When, therefore, ice say that. Fig. 181.—Left vextricular htpertropht. Extreme hypertrophy of the heart,especially of the left ventricle, occurs most characteristically in aortic valvular disease, or as aresult of long-standing arterial hypertension. It is clinically characterized by 1. a forcible,heaving cardiac impulse; 2. displacement of the apex impulse downward and to the left; 3. along, low-pitched, booming first sound; and 4. unless the aortic valves are insufficient, ormyocardial weakness pronounced, a clear, high-pitched, ringing accentuation of the secondsound both at the apex and at the aortic area. the second sound is accentuated ive mean that it is relatively louder than itshould be in relation to age and posture. This phenomenon indicates in-creased pressure in the lesser circulation. The aortic second sound is increased in arterial hypertension, providedthe ventricular strength be sufficient. This occurs especiallj- in glomerulo- AUSC
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