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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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Chandraratna PAN, Lopez JM, Cohen L. Echocardiographic observations on the mechanisms of the second heart sound. Circulation. 1975; 51 :292–96. [ With Credit Card Free Shipping Sanayi 313 Ragno Embroidered Mules Recommend Cheap Online Low Shipping Fee Online rDwTk
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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.
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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. [ Christian Louboutin Leather Semi PointedToe Booties Fashionable C5ctPYw
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Tavel ME. Clinical phonocardiography and external pulse recording, 2d ed. Chicago: Year Book Medical Publishers, 1972;38–41.
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AP June 1, 2018, 4:45 PM

Houston Texans cheerleaders wear pink boots for cancer awareness before an NFL football game between the Houston Texans and the Kansas City Chiefs, Sunday, Oct. 8, 2017, in Houston.

David J. Phillip/AP

HOUSTON -- Five former NFL cheerleaders sued the Houston Texans on Friday, alleging the team failed to fully compensate them as required by law and subjected them to a hostile work environment in which they were harassed, intimidated and forced to live in fear. The lawsuit, filed in Houston federal court, accuses the franchise of paying the women less than the $7.25 per hour they were promised, not compensating them for making public appearances or performing other tasks related to their jobs and creating a workplace where the women were threatened with being fired for voicing any complaints.

"I and my fellow cheerleaders were treated as the lowest of the low," Hannah Turnbow said at a news conference. "The Houston Texans were paid thousands of dollars to have us show up at appearances at locations all over Texas with no security, no transportation and where our safety was not guaranteed."

Turnbow said that after she was left with abrasions on her shoulder when she was attacked by a fan at one game, the team told her "to just suck it up."

"We were harassed, bullied and body shamed for $7.25 an hour," said ex-cheerleader Ainsley Parish.

Texans spokeswoman Amy Palcic said the team is constantly evaluating its cheerleader program and makes changes "as needed to make the program enjoyable for everyone."

"We are proud of the cheerleader program and have had hundreds of women participate and enjoy their experience while making a positive impact in the local community," Palcic said in a brief statement.

Prominent women's rights attorney Gloria Allred, who's representing the cheerleaders, alleged the women were paid "so little or not paid at all" for much of the work they did because of their gender.

"Surely (Texans owner Bob) McNair and the Houston Texans can find it in their budget of hundreds of millions of dollars to pay these women a fair wage, not minimum wage," Allred said. "I say, stop penny pinching. Pay these women what they deserve and make sure you pay them for every minute that they work."

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that included male spectators and were asked to be escorts for sponsors at a nightclub.

Former cheerleaders with the Miami Dolphins and the New Orleans Saints also have filed recent discriminatory complaints and lawsuits against their ex-teams.

Last year, a federal judge in California dismissed a lawsuit that had been filed by a former San Francisco 49ers cheerleader who had accused the NFL and team owners of conspiring to suppress wages for cheerleaders.

Allred said she planned next week to present a letter to NFL Commissioner Roger Goodell asking him to review the complaints being made by her clients and other cheerleaders about their working conditions.

© 2018 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.

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The search is over for a missing high school cheerleader after her remains were discovered Thursday morning in the woods behind her home.

Ke’Asia Adkins, 17, was last seen on Monday, leaving her home in Dinwiddle.

Her body was found during an early morning ground search. A 21-year-old man is in custody, charged with abduction.

An autopsy is being performed on the Dinwiddie High School varsity cheerleader to determine a cause of death.

View photos
Ke’Asia Adkins

On Tuesday, authorities in Dinwiddie announced that Adkins was missing and asked for any information concerning her whereabouts.

“According to her family, this is the first time Ke’Asia has left home and not kept in touch with her family,” the Dinwiddle County Sheriff’s Office said in a Tuesday release.

Adkins was reported missing after she failed to return home after not showing up for cheerleading practice.

Investigators apprehended Anton Deonte Coleman within hours of Thursday’s grisly finding.

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Coleman is being held without bond. He has not entered a plea to the charge he faces, but will be asked to do so when he stands before a judge for his arraignment on Monday.

Coleman does not have an attorney of record who could comment on the allegations.

Authorities have not said what led them to arrest Coleman, or what relationship, if any, he may have had to the victim.

A motive also remains unclear.

Adkins’ body was found hours after a prayer vigil was held for her.

View photos
Anton Deonte Coleman

A statement from Dinwiddie High School, obtained by PEOPLE, says Adkins — who was a junior — “was a beautiful young lady” who “will be greatly missed by the entire Dinwiddie High School family, especially her friends, teammates, teachers and staff said the school community.”

“It is a very sad day for Dinwiddie High School,” the statement reads. “The thoughts and prayers of the entire Dinwiddie County Public Schools’ community go out to her family.”

Anyone with any information on Ke’Asia Adkins’ killing should contact the Dinwiddie County Sheriff’s Office at (804) 469-3755.

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