![]() Poet and rapper Omekongo Dibinga teaches a course on global hip-hop at American University. And in Tunisia, hip-hop even helped launch the Arab Spring. The genre has been the voice of various generations demanding social change and even revolution: Rappers in Tibet are using hip-hop to preserve the traditional language. Hip-hop, though a uniquely American art form, has spread across the world as a tool for social change. Being a low pitched sound, it is better heard with the bell of the stethoscope.Facebook Email Afghan rapper and activist Sonita Alizadeh performs. It can occur in acute ischemia of the myocardium when the relaxation of the left ventricle is impaired. S4 is designated as an atrial sound, though it possibly originates in the ventricle. Fourth heart sound: Fourth heart sound occurs when there is a forceful atrial contraction and is common in the elderly with a stiff left ventricle.A right ventricular S3 may be heard medial to the apex beat in the tricuspid area in right ventricular failure. S3 in mitral regurgitation need not imply left ventricular failure while an S3 in aortic regurgitation implies left ventricular failure. Left ventricular S3 is usually a feature of left ventricular failure and best heard at the apex. Third heart sound: Third heart sound is a low pitched sound and hence better heard with the bell of the stethoscope.But it is often difficult to appreciate in the latter condition due to the preceding loud murmur. ![]() Paradoxical split can occur in left bundle branch block and aortic stenosis. Wide variable split may be heard in right bundle branch block due to delayed closure of the pulmonary valve. Wide fixed split of S2 is a feature of atrial septal defect. P2 is loud in pulmonary hypertension and soft in pulmonary stenosis. A2 is loud in systemic hypertension and soft in aortic stenosis. Second heart sound: Second heart sound is also a high pitched sound, better heard with the diaphragm of the stethoscope.In the latter condition, the loud tricuspid component (T1) is known as sail sound and it is due to the closure of the large anterior tricuspid leaflet. Split of S1 is not audible usually, but may be heard in right bundle branch block and Ebstein’s anomaly of the tricuspid valve. Intensity of S1 increases in tachycardia when the diastolic period is shortened. In severe calcific mitral stenosis, when the valve becomes very stiff, intensity of S1 may decrease. Intensity of S1 decreases with decreasing left ventricular systolic function. A loud S1 is heard in mitral stenosis while a soft S1 is heard in mitral regurgitation. Interval between the first and second heart sounds constitutes the clinical systole and that from second heart sound to the next S1 the clinical diastole. First heart sound is timed in relation to the carotid pulse as it occurs at the onset of systole. First heart sound: First heart sound is a high pitched sound and is heard best with the diaphragm of the stethoscope.In tachycardia, S3 may fuse with S4 and produce a summation gallop (sometimes called S7 gallop!). S4 gallop is otherwise known as presystolic gallop. S3 gallop is also known as protodiastolic gallop. When S3 or S4 is associated with tachycardia, it is called a gallop rhythm ( S3 or S4 gallop). But an S3 may be heard in normal children and in pregnancy. Third (S3) and fourth (S4) heart sounds are usually heard in pathological conditions. Wide fixed split is audible in both inspiration and expiration, without any change in the A2-P2 interval. If the split increases in expiration and closes in inspiration, it is paradoxical split. If it is audible in both inspiration and expiration, it is called wide split. Normal split of second heart sound closes in expiration and is audible only in inspiration. If it is heard at the apex, it can be considered as loud P2. Normal A2 is heard in all auscultatory areas while normal P2 is heard only in the pulmonary area. Second heart sound has two components – aortic (A2) and pulmonary (P2). ![]() Two normally heard heart sounds are the first heart sound (S1) and second heart sound (S2).
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