It is a well-known fact, frequently mentioned in the literature, that a gas-containing cavity in proximity to the heart may act as a resonating chamber and greatly increase the intensity of the heart sounds as heard on auscultation or even render them audible at a short distance from the chest. The conditions producing such cavities are (1) pneumothorax, (2) pulmonary vomicæ, (3) tympanites, (4) gastric dilatation. The former two require to be properly placed with relation to the heart in order to act in this way. Air or gas may increase the loudness of the heart sounds in two additional conditions, differing mechanically from the preceding; that is to say, in pneumopericardium and in subcutaneous emphysema. These obviously do not present the same favorable conditions for resonating action. In fact, pneumopericardium does not truly intensify the normal heart sounds, but produces abnormal sounds quite pathognomonic of the condition; these sounds
PEPPER OHP. MAGNIFIED HEART SOUNDS DUE TO EXTRACARDIAC CONDITIONS: WITH REPORT OF AN UNUSUAL CASE. JAMA. 1912;LVIII(5):340–342. doi:10.1001/jama.1912.04260020024011
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