関: II音

概要

通常の心音はS1→A2→P2　だけど、widened splittingではS1→P2→→→A2となる。

原因

right bundle branch block(RBBB), pulmonic stenosis(PS)

IIPが遅れる：RBBB, PS, pulmonary hypertension

奇異性分裂の逆パターンと覚える！！

IIAが早まる：MR, VSD(YN.C-109)

僧帽弁閉鎖不全症 MR：左心室収縮駆出された血液は大動脈以外に左心房にも流れ込む。大動脈に駆出する血液量が減少するため、大動脈弁は早期閉鎖する。~~A弁を挟んだ圧較差を考えると、僧帽弁閉鎖不全症の場合、心房からの逆流により心室圧が早く上昇すると考えればよい。~~

心室中隔欠損症 VSD：欠損孔を通じて右心室に流れ込むために、大動脈に駆出する血液量が減少するため大動脈弁は早期閉鎖する。

WordNet

extend in scope or range or area; "The law was extended to all citizens"; "widen the range of applications"; "broaden your horizon"; "Extend your backyard" (同)broaden, extend
become broader or wider or more extensive; "The road widened"
make wider; "widen the road"

PrepTutorEJDIC

…‘を'広くする / 広くなる
(頭痛などが)割れるような

UpToDate Contents

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English Journal

Cascade wide-angle Y-junction 1 x 16 optical power splitter based on silicon wire waveguides on silicon-on-insulator.

Tao SH, Fang Q, Song JF, Yu MB, Lo GQ, Kwong DL.SourceInstitute of Microelectronics, A*STAR, 11 Science Park Road, Science Park II, Singapore 117685.
Optics express.Opt Express.2008 Dec 22;16(26):21456-61.
A 1 x 16 optical power splitter with wide splitting angle, uniform outputs, and low excess loss is demonstrated. The 1 x 16 splitter comprising cascaded 1 x 2 splitters with arc-shaped branching waveguides is fabricated on the silicon-on-insulator (SOI) substrate. The gap between the branching waveg
PMID 19104575

Midface augmentation using bony segments obtained from sagittal splitting angle ostectomy in asians.

Park H, Chun KW, Kye MS, Dhong ES, Yoon ES.SourcePark-Hyun Plastic Surgery Clinic, Korea.
Plastic and reconstructive surgery.Plast Reconstr Surg.2008 Feb;121(2):578-86.
BACKGROUND: Asians characteristically have flat or broad and round facial features. These characteristics are primarily attributable to enlarged and widened jawbones, impressive muscles associated with mastication, and a zygomatic arch involving the masseter. Their faces appear flat, with midface re
PMID 18300978

Symmetrical 1x2 digital photonic splitting switch with low electrical power consumption in SiGe waveguides.

Li B, Zhang Y, Teng L, Zhao Y, Chua SJ, Wang X.AbstractA symmetrical digital photonic splitting switch with a low insertion loss and a low driving voltage is developed using carrier injection in a silicon-germanium material for optical communication systems and networks at a wavelength of 1.55 mum. The switch structure has been improved based on a traditional 1x2 Y-shaped configuration by using two widened carrier injection regions. The switch has a threshold voltage of 1.0 V and a corresponding threshold current of 85 mA on one of the two output waveguide arms. The calculated driving current density is 5.7 kA/cm2 and the calculated power consumption is 85 mW at the 85 mA of threshold current. The measured insertion loss and the crosstalk are 5.2 dB and -9.6 dB, respectively, at driving voltage over 2 V.
Optics express.Opt Express.2005 Jan 24;13(2):654-9.
A symmetrical digital photonic splitting switch with a low insertion loss and a low driving voltage is developed using carrier injection in a silicon-germanium material for optical communication systems and networks at a wavelength of 1.55 mum. The switch structure has been improved based on a tradi
PMID 19488396

Japanese Journal

Splitting of Temporalis Muscle for Basal Exposure

GOEL Atul
Neurologia medico-chirurgica 37(1), 59-62, 1997-01-15
… Splitting of the temporalis muscle to increase the basal exposure in subtemporal approaches is discussed. … Zygomatic osteotomy could be avoided in selected patients and the exposure of the infratemporal fossa region could be widened by employing this technique. …
NAID 110002282618

Related Pictures

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★リンクテーブル★

リンク元	「II音」
関連記事	「widen」

「II音」

　　[★]

英: second heart sounds, S2
関: 心音

まとめ

II音亢進	II_A	高血圧	AR	動脈硬化
II音亢進	II_P	肺高血圧	PR	MS
II音減弱	II_A	低血圧	AS
II音減弱	II_P		PS

II音増大

MSとASとでは、同じstenosisでも心音の大きさに関与の仕方が違うんですね。

(体循環)高血圧症、肺動脈高血圧症。(PHD.35)

拡張期における大動脈圧、肺動脈圧が高い　→　弁に衝突する血液の流速が早い　→　弁の閉鎖音が大きい

動脈硬化の強いとき

大動脈弁が閉じるとき、拡張期早期 back pressureが高い？

大動脈弁閉鎖不全症 AR

拡張期に大動脈弁を挟んだback pressureが高いから？

肺動脈弁閉鎖不全症 PR

心室中隔欠損症

右室へのvolume load。PHで顕著

II音減弱

大動脈弁狭窄症(AS)、肺動脈弁狭窄症(PS)。(PHD.35)

駆出できる血液量がへるから？

分裂音

呼吸性分裂

PHD.33-35

生理的状態では、

		横隔膜の相対的位置	II音
呼気	expiration	￣	｜	single sound
吸気	inspiration	＿	｜　｜	splitting sound

(1)吸気時には、肺の血管抵抗性が低下　→　拡張期におけるP弁へのback pressureは呼気時と比べ比較的低下する　→P弁の開放時間が延長
(2)吸気時には、肺静脈が拡張　→　左房・左室への血液還流量が減少　→　左室を充満する血液量減少　→　一回拍出量減少　→　駆出時間の短縮　→　A弁の開放時間が短縮