widened splitting

出典: meddic

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。


UpToDate Contents

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英文文献

  • 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

和文文献

  • 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

関連リンク

CLINICAL PEARL: A RBBB causes a widened split S1 while a LBBB results in the absence of a split S1. ... (widened) splitting, fixed splitting, paradoxical ( reversed) splitting, or the absence of splitting. ...
This forces the tricuspid valve closed earlier resulting in complete overlap ...

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★リンクテーブル★
リンク元II音
関連記事widen」「splitting

II音」

  [★]

second heart sounds, S2
心音

まとめ

II音亢進 IIA 高血圧 AR 動脈硬化
IIP 肺高血圧 PR MS
II音減弱 IIA 低血圧 AS  
IIP   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。
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?
  • 拡張期に大動脈弁を挟んだback pressureが高いから?
  • 右室へのvolume load。PHで顕著

II音減弱

  • 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

widened splitting

  • right bundle branch block(RBBB), pulmonic stenosis(PS)
IIAが早まる:MR, VSD
IIPが遅れる:RBBB, PS, pulmonary hypertension

固定性分裂 fixed splitting

奇異性分裂 paradoxical splitting

単一II音 single S2



widen」

  [★]

WordNet   license 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"」
broaden, extend

WordNet   license wordnet

「become broader or wider or more extensive; "The road widened"」

WordNet   license wordnet

「make wider; "widen the road"」

PrepTutorEJDIC   license prepejdic

「…‘を'広くする / 広くなる」

splitting」

  [★]

PrepTutorEJDIC   license prepejdic

「(頭痛などが)割れるような」




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