Hello everyone, I'm Doctor Júlio Massao and welcome to my channel on Today's video we will learn the sound of normal heart sounds and also the sound of physiological unfolding of the second sound but before starting the video I'm asking for you let your like subscribe to the channel and follow me on social and personal networks just remembering i also have a secondary channel where i talk about healthy eating exercise routine physical and lifestyle changes go there and check it out so let's go on cardiac auscultation of a normal patient we can distinguish two sounds happening
during the cardiac cycle that we will call it B1 and B2 where B1 happens in systole and B2 happens in diastole the sound of the first sound we called B1 it originates from the closing of the valves atrioventricular, that is, the mitral and tricuspid valves And so we can say that B1 is composed of M1 and T1 and the sound of the second sound, we called it B2, it originates because of the closure of the semilunar valves, which are the pulmonary and aortic valves, so we can say that B2 is composed of P2 and A2
and to better understand that relationship we have with the cycle heart with heart sounds I'm going to suggest that you review that class we have here on the cardiac cycle channel and Wiggers diagram I'll leave the link here in the description of this video to reproduce the sound of the first sound, we use the onomatopoeic sound "Tum" and the second sound we use "Tá" to facilitate the visual understanding of these acoustic phenomena I'm going to draw here so phonocardiogram I'll place systole and diastole B1 and B2 now I'm Going suggest that you put headphones on
so you can listen to the performance sound of the first and second sounds at the same time you look here on the phonocardiogram at the beginning of our medical practice, it is sometimes difficult for us to distinguish the first of the second sound, so one way for us to try to make this distinction is to try to palpate the carotid pulse but very carefully because Remembering that you may unintentionally make a vagal maneuver and bradycardise this patient so if you palpate the carotid pulse and you locate the sound that happens with a pulse This will
be the first sound because the first sound happens in ventricular systole, that is, together with the arterial pulse. So this will be a way of you try to make this distinction especially in those more tachycardic patients but only reinforcing that cardiac auscultation is extremely practical over time with practice you will notice and your ear will be able to make this distinction easily and you will be able to perceive better the tone the timbre of each one of the sounds and in this way also be able to separate which it's the first of the second sound,
well now that we've already met How is the sound of the first one and from the second sound, we will then know a variation of normality, which is the unfolding physiological of the second sound this can happen on inspiration Why physiologically when the we inspire, we increase our venous return and this can cause a slight delay in the closure of the pulmonary component of the second heart sound in this way in inspiration the second sound can unfold and on expiration it can normalize and the onomatopoeic representation of this sound is a "Trá" another "Tlá" as
if we were trying to say two syllables "Tá" with a distance of milliseconds between them and to facilitate the visual understanding of these auditory phenomena I will draw here so the phonocardiogram will place the first here and the second sound, systole and diastole, and I'll also put the inspiration and expiration of this patient now I will suggest that you put the headphones on to that we can listen to the physiological unfolding of the second sound, they realize that with the inspiration happens the unfolding of the second sound and on the expiration it disappears Good so
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