Failure bivalve and aortic valves

With this combination in the apex of the heart are heard and long systolic murmur, usually covering the first tone. Such noise characteristic of organic mitral insufficiency. In addition, at the apex of the heart are heard and diastolic murmur. In contrast diastolic noise mitral stenosis this noise is well defined in 5-th point and higher in the second intercostal space on the left and right of the sternum. The specific nature of this noise inherent failure of the aortic valve, localization of this noise, and lack clapping I tones, splitting II tone pulmonary artery allow to suspect the presence combination with aortic insufficiency. Borders of heart, as a rule, extended to the left and down the apical jerk is strengthened, pulse type celer et alius, pulse pressure is increased.
On electrocardiogram define the characteristics of hypertrophy of left atrial - P-mitrale due to mitral insufficiency, and in I standard lead, aVL, V5 and u define the signs of left ventricular hypertrophy. It should be noted that the P wave-mitrale may be observed in patients with a clean aortic insufficiency in the case of advanced blemish, accompanied by the merger of maraliseca".
Phonocardiography diagnosis of this combination is sometimes difficult due to the fact that diastolic aortic noise is not always clearly written on the phonocardiograms, especially in the initial phases. However, in severe aortic insufficiency at Botkin clearly registered prettiesiski the noise, typical for aortic insufficiency. Unlike stenosis of the left venous mouth in aortic insufficiency is not observed elongation phase transformation (Q-I tone), the opposite effect of increasing the blood supply to the left ventricle interval Q-I tone can be reduced (Fig. 26).
The data of x-ray studies indicate an increase in left atrial and sometimes the right ventricle. The increase of the left ventricle is determined always. The increase of the left atrium and the right ventricle in the absence of stenosis of the left atrioventricular holes allows you to confirm the combination of the failure of the mitral and aortic valves (Fig. 27, a, b, C).