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Pulmonary closure is completely fused with aortic closure throughout the respiratory cycle only in Eisenmenger's syndrome with a large ventricular septal defect or in cases of single ventricle, where the durations of right and left ventricular systole are virtually equal. The second sound may also be single in a variety of congenital heart defects (e.g., truncus arteriosus, tricuspid atresia, hypoplastic left heart syndrome, transposition of the great arteries, and, occasionally, corrected transposition of the great arteries).

The loudness of each component of the second heart sound is proportional to the respective pressures in the aorta and pulmonary artery at the onset of diastole. Dilatation of the aorta or pulmonary artery may also cause accentuation of the aortic and pulmonic components, respectively. The aortic component is normally of greater intensity than the pulmonic component. The aortic component, therefore, radiates widely over the chest, whereas the pulmonic component is heard mainly in the second left ICS with some radiation down the left sternal border. The greater radiation of the aortic component is probably due to the higher pressure in the aorta compared to that in the pulmonary artery. At any given level of pressure, however, the pulmonic component will be proportionately louder than the aortic component because of the closer proximity of the pulmonic valve and the pulmonary artery to the chest wall. These considerations account for the relative loudness of P 2 in young patients in whom the pulmonary arteries are quite close to the chest wall. They also account for the decreased intensity of both components of the second sound in patients with emphysema in whom both arteries are displaced from the chest wall.

The pulmonic component is considered to be abnormally loud in a subject over age 20 if it is greater than the aortic component in the second left ICS or if it is audible at the cardiac apex. This may be due either to pulmonary artery hypertension or right ventricular dilatation, with part of the right ventricle assuming the position normally occupied by the left ventricle. A split second sound at the apex is, therefore, definitely abnormal. The loud P 2 commonly heard at the apex in patients with atrial septal defect is probably due to a dilated right ventricle encroaching upon the cardiac apex.

Decreased intensity of either component of the second sound may be due to a stiff semilunar valve, decreased pressure beyond the semilunar valve, or deformity of the chest wall or lung. A decreased intensity of P 2 is most common in patients with chronic obstructive lung disease or valvular pulmonic stenosis. A decreased intensity of A 2 is most common in patients with valvular aortic stenosis.

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(See also references for Chapter 22, The First Heart Sound .)

Adolph RJ, Fowler NO. The second heart sound: a screening test for heart disease. Mod Conc Cardiovasc Dis. 1970; 39 :91–96. [ Jenny by ara Peach 63314 SlipOn Womens Recommend Sale Online Free Shipping Cheap Online cxUrM
]
Boyer SH, Chisholm AW. Physiologic splitting of the second heart sound. Circulation. 1961; 24 :180–86.
Chandraratna PAN, Lopez JM, Cohen L. Echocardiographic observations on the mechanisms of the second heart sound. Circulation. 1975; 51 :292–96. [ Online Sale Online Robert Clergerie Clergerie Paris Embellished Slide Sandals Clearance Footaction Free Shipping Big Sale 7Ikpq6RdHN
]
Curtiss EL, Shaver JA, Reddy PS, et al. Newer concepts in physiologic splitting of the second heart sound. In: Leon DF, Shaver JA, eds. Physiologic principles of heart sounds and murmurs. New York: American Heart Association, 1975.
Harris A, Sutton G. The normal second heart sound. Br Heart J. 1968; 30 :739–42. [ Yves Saint Laurent Tribute Raffia Sandals Websites Cheap Price Professional Sale Online Cheap Sale Discounts Sale Low Price Fee Shipping xR0ZC
] [ PubMed : 5718983 ]
Leatham A. Splitting of the first and second heart sounds. Lancet. 1954; 267 :607–12. [ PubMed : 13202450 ]
Rouanet J. Analyse des bruits du coeur. Paris, Thesis No 252, 1832.
Shaver JA, Salemi R, Reddy PS. Normal and abnormal heart sounds in cardiac diagnosis. Part I: systolic sounds. In: O"Rourke RA, ed. Current problems in cardiology. Chicago: Year Book Medical Publishers, 1985;9–68. [ PubMed : 3996020 ]
Tavel ME. Clinical phonocardiography and external pulse recording, 2d ed. Chicago: Year Book Medical Publishers, 1972;38–41.
Copyright © 1990, Butterworth Publishers, a division of Reed Publishing.
Bookshelf ID: NBK341 PMID: 21250183
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Prep Wrestling

Tue., January 23, 2018
By Jenna Novak, Prairie senior

CEDAR RAPIDS — Kennedy senior Dylan Ironside has lived with high expectations since he stepped on a wrestling mat.

The name Ironside is familiar to many wrestling fans.

Uncle Mark Ironside won two NCAA titles for the University of Iowa and also captured the Hodge trophy as the nation’s top wrestler. Dylan’s father, Matt Ironside, was a two-time junior college All-American and won an NJCAA title at Iowa Central. Another uncle, Tim Ironside, was a state champ for Jefferson.

The Ironside side of the family is only part of Dylan’s wrestling heritage. Cedar Rapids Prairie state champ and former University of Iowa wrestler Rick Novak also is an uncle.

The day Dylan started wrestling, he knew there would be high expectations.

Ironside knew he wanted to wrestle after watching his dad coach high schoolers. He started going to practices in second grade, but got more serious about it in fourth grade.

When he was wrestling in youth tournaments, he not only had to deal with the pressure of his name but also from being placed in the “feature match.”

Most fourth- and fifth-graders don’t have to deal with that.

“Throughout my life and especially my high school career, people would talk about my name and expectations for me,” Ironside said. “I would get extremely nervous for a match and thought I had to be just like my family.”

As time progressed, Ironside has figured out how to deal with the pressure in a way that wouldn’t affect him on the mat.

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“I don’t care about any (of the expectations) anymore. I just block it out,” Ironside said.

It seems to be working. As his last season continues, Ironside keeps getting more confident. He has knocked off ranked opponents, which earned a spot in the rankings for the first time.

“It’s cool to see my name up there, but rankings don’t really mean much to me,” Ironside said. “I know when I wrestle to my potential, I can beat anyone in the state.”

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