The diagnostic value of an accented cardiac second sound / [J. Warburton Begbie].

  • James Warburton Begbie
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: The diagnostic value of an accented cardiac second sound / [J. Warburton Begbie]. Source: Wellcome Collection.

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    or rather naturally, soundless, become attended by sound—in other words, produce a second sound of their own; or it is equally conceivable—although perhaps not fully established— that certain diseased states in existence may determine a sound bearing a resemblance, more or less exact, to the normal diastolic sound of the heart. These few observations I have made by way of preface to the statement of great practical value which I now wish to consider, —That an accentuated condition of the heart’s second sound is heard in connection with one or other of two conditions of disease—aneurysm of the aorta, or dilatation of the aorta. It is hardly necessary to say, that no account is taken here of the by no means uncommon phenomenon of an accentuated pulmonaiy second sound. All careful auscultators know of how much value that phenomenon is in relation to the condition of mitral valve constriction. In describing the heart’s second sound as accentuated in the instances of aortic aneurysm and aortic dilatation upon which the present observations are based, it is perhaps necessary to explain that the expressions, inten- sified, or greatly pronounced, would equally well indicate the character of the sound which has been found to exist. When occurring under the circumstances referred to, the accentuation of the second sound is always well-marked. I have frequently observed that early auscultators have, unaided, noticed the peculiarity, while very rarely indeed has there been difficulty attending its recognition by such, when their attention has been called to the subject. In a case of aortic aneurysm under my care last summer, there existed so accentuated a second sound over the base of the heart as to arrest the notice of all who examined the patient by auscultation. Several students, merely tyros in the art, readily recognised the booming character of the sound. When the accentuated second sound occurs in connection with aortic aneurysm or aortic dilatation, it may be presumed that the semilunar valves are competent. Their insufficiency and the occurrence of an accentuated second sound are incon- sistent; if the former lesion be in existence, a diastolic murmur is the necessary result. The influence of valvular disease in the production of murmurs in cases of aortic aneurysm is a point of the greatest importance for consideration. There may
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