By Donald N. Ross B.Sc., M.B., Ch.B., F.R.C.S. (auth.)
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Additional info for A Surgeons’Guide to Cardiac Diagnosis: Part 1: The Diagnostic Approach
Aneurysmal dilatation of the left atrium in the presence of mitral valve disease favours a diagnosis of mitral regurgitation. The Ventricles. It is worth re-emphasizing that there can be considerable concentric hypertrophy of the obstructed right or left ventricle without evidence of enlargement of the ventricular silhouette. Where these chambers are grossly hypertrophied or dilated, they have a characteristic contour. The right ventricle is adjacent to the central tendon of the diaphragm, and enlargement of this chamber tends to elevate the heart and "round off" the apex.
When this falls below the right atrial pressure the tricuspid valve opens and there is a rapid fall of right atrial pressure as blood pours from atrium to ventricle. This fall of pressure produces the y descent. In the presence of tricuspid stenosis, the right atrial pressure will be high and there will be a high pressure throughout the venous system. Also, with normal rhythm, there will be an increased force of right atrial contraction producing large a waves. In addition, the rate of the y descent will be slow since the blood can escape only slowly across the narrow valve orifice into the right ventricle during diastole.
42). Similarly, in severe pulmonary valve stenosis, the pulmonary component of the second sound can hardly be heard owing to the involvement of its commissures and the low diastolic elosing pressure transmitted from the pulmonary artery. The second sound at the base is, therefore, apparently single, only the aortic elosure being heard. Alternatively, when one listens over the "pulmonary area" the aortic valve component may be lost in the pulmonary systolic murmur and with the faint elosing sound of the pulmonary valve there is an apparent "absence of the second sound", as in aortic stenosis.
A Surgeons’Guide to Cardiac Diagnosis: Part 1: The Diagnostic Approach by Donald N. Ross B.Sc., M.B., Ch.B., F.R.C.S. (auth.)