339
3854147819011156112
Ventricular12055960128101163233273320358421490529591638
ejection1878596012881120182244283322391462
starts2376596012872111174220259313
when27245960128120190253322
ventricular3081596012889151221260307345408478516578625
pressures3741596012889136202255310380427489543
exceed4319596012881151213276338407
the4762596012856126189
pressures4986596012889135197252306376423485539
within8518390128101140179249288358
the1245839012856126189
aorta1469839012880150196235298
and1802839012880149220
pulmonary2057839012887157196306373444507553624
artery;2714839012880127166229275346383
the3133839012856127188
aortic3357839012880150197236275337
and3729839012881150220
pulmonic3985839012886157195305373444483545
valves4565839012888151190259322375
open4976839012888157220289
and5301839012880150219
blood8511080012870110179249320
is12061080012885139
ejected138110800128109148209272311373443
out185910800128116187225
of212010800128116163
the23181080012886155218
ventricles.257110800128117179249287335373435474536591626
This323110800128132202241296
is35631080012885139
the37381080012885155217
rapid39901080012894156225265334
ejection436010800128107146208270309349419488
phase.488410800128116186249303365400
As531910800128148202
ventricular8511321012870133202241289327389458498560606
repolarization,14921321012877139208279317380427465528589628667737807842
reflected23691321012876138185223286348386449519
by29241321012898169
the31261321012869140202
T-wave,336313210128116166267329399462497
begins,38951321012898161230270339393429
ventricular43591321012899162231271318356419488527589638
pressure50321321012899147208262316387433495
starts851156301285594157202241296
to11821563012847118
fall13351563012855117156195
and15651563012872141211
the18111563012847118180
force20251563012855125173235297
of23571563012879126
ejection25171563012871110172235274312382452
is30041563012848102
reduced.31421563012856118187258319382452488
When367315630128133202264333
ventricular40421563012878141210249297334397466506568614
pressures46911563012878126188243297366413476529
drop52561563012878125194264
below8511805012870133172242343
aortic12291805012864133181218258320
and15841805012864133204
pulmonary18221805012872142182290358429491538608
pressures,24641805012872119181236291361408470524559
the30591805012840110172
semilunar32661805012856119228265304375445507554
valves38541805012872135173243305359
close,42481805012865103172227290325
marking460918050128109169216286326396466
the51101805012840111173
end53171805012865134203
of8512046012870117
systole10032046012881152204244315353416
and14542046012888158228
beginning17182046012896158228267337406446515585
of23392046012896143
diastole.25172046012896136197252290361400462497
Closure305020460128119158227281352399460
of35462046012896143
semilunar37242046012881143253289329399469532578
valves43382046012896159197267330383
produces47572046012896143212282353415477531
the53232046012866136197
second8512288012855117180249319389
heart12742288012870133195242280
sound,15902288012854123194264333369
S2.19932288012878147183
The12052529012886155218
first1458252901285190138191230
part17232529012875137183222
of19812529012873120
diastole21362529012874113176229268338377440
is,2611252901284296132
again,27782529012866136199237307342
isovolumetric,3155252901284498168238307347417525586625673712774809
as40002529012866119
the41552529012843113176
ventricles43662529012873136205245292330392430492547
relax49482529012851114152214284
with527125290128102140180249
all8512771012862101141
valves102727710128101164202273334389
closed.14522771012894132203257319388424
Ventricular191127710128133195265305351390453522560623670
pressure261627710128102148210265319389436498
drops314927710128101148218289343
rapidly35272771012879141210250319358429
but398927710128102173212
their42372771012869140203241288
volumes456027710128102172211281391450505
remain51012771012879141250310349420
unchanged.8513012012870141203273336405474537606642
Meanwhile,154630120128125187250319421490529567630665
the22463012012858127190
atria24713012012881119166204267
are27733012012881128189
being29973012012889151190260330
filled33623012012866105143182244313
with371130120128120159197268
blood40143012012888126197267336
and43863012012881150221
atrial46423012012880119166204267305
pressures49873012012888135198252306376423485539
rise851325401284786141203
slowly.10893254012866105175277315386419
Ventricular155532540128101163233272320359420491529592639
filling2229325401285897136174214283354
starts26183254012865105168213252306
when297132540128102171234303
ventricular33103254012881144213253299338401470508571618
pressures39633254012882129190245299368416477531
drop45303254012882129198268
below48333254012882145183253355
atrial52223254012874112159198260298
pressures,8513495012870117180233288358405467521556
causin14433495012862125194249287357
the18353495012840110172
AV204334950128101201
valve22793495012871134173242305
to26193495012840110
open,27643495012870141203273308
allowing31073495012864101140210311350419490
blood36333495012870108179248318
to39863495012840110
flow4131349501284886156258
down44243495012870140242310
the47703495012840109172
ventricles49773495012870133202242289327389427490544
passively.8513737012870133188242280351412452522555
The14413737012886155218
atria16943737012863102148188249
contract19793737012862131201240287349412450
to24643737012839108
finish2608373701284784155193247318
the29623737012837108171
filling3168373701284684122162200271341
phase35433737012870140203257319
and38983737012862131200
the41343737012839108171
cycle43403737012862132193232295
repeats46703737012846109178241303345400
itself.5106373701283777131194231279314
There12053979012886155218265327
are15673979012863109172
two17743979012838139209
phases20173979012870141203257320374
of24253979012870117
the25773979012839108171
cardiac27833979012863125170241279342404
cycle:32223979012863133193232295334
systole35923979012853122175214285325387
and40143979012863132201
diastole.42513979012870108171224264333373435470
First12054220012878117164219257
Heart149842200128101163225272310
Sound18434220012878149218288358
(S1)22374220012846124193239
occurs25124220012870133196265312366
at29144220012862100
the30494220012839109171
beginning32544220012870133202242311381419490560
of38494220012870116
systole40004220012855125178218288327390
and44254220012862131201
consists46614220012862133202257296351389443
of51404220012870117
four52924220012846115186232
components8514461012862133242310381451514583622677
(Fig.15644461012847125162233269
12):18664461012870141188225
1.12054702012870106
Valvular155947020128101163202273342382444490
component208547020128113182292360430501564633672
-27924702012899
created292647020128114161223286325387457
by341847020128121191
the36434702012890160223
closure390147020128113152222276346393455
of439247020128120167
the45944702012890160223
mitral485247020128160197237284345384
and527147020128114183253
tricuspid851494501283986125187257311382420490
valve137749450128102165204274336
at17484945012895134
the19174945012871141203
onset215549450128103173228290329
of251949450128103150
systole.27044945012886157210249320358421456
The319549450128118188250
mitral348049450128143180219266329368
valve388349450128102165203274336
closes42544945012895133203258321374
first,46644945012879117165218257293
followed49924945012878149187227296398460529
shortly8515186012855125195242280319390
by12745186012881152
the14595186012849120183
tricuspid1677518601284996134197267321391429500
valve,22125186012880143180251314349
with260651860128102140178248
a28905186012872
time2997518601285088198258
interval32915186012850120159221268337400439
of37665186012879126
0.0239275186012880115185255
seconds,42175186012865128189259329400454489
imperceptible47415186012849159227290336399461530570608679717779
to8515427012839110
the9965427012838108170
ear12015427012862125172
–14085427012870
this15145427012837107146200
is1750542701283993
the18785427012839108171
time2083542701283978188248
of23665427012870117
physiological25185427012870141212264304374413483552592655716755
asynchrony.33075427012863117187256319389437506576647680
2.12055669012870106
Muscular155956690128125195249312382420483530
component21235669012888157267335405476539608647
-28055669012874
caused29145669012889150220275337406
by33565669012895165
the35555669012865135198
oscillations37875669012895150212251292330393431471540610665
of44865669012897143
the46645669012864134196
ventricular48955669012895158227267313352415484523585630
myocardium85159110128109178247309372418489528599708
during15925911012870141188227297366
the19945911012839108171
isometric2200591101283993162272332371418457520
contraction27555911012862133202241288350412450490559630
phase.34195911012870141203257319354
3.12056152012870106
Vascular155961520128101163218281351389452499
component209361520128122191301368439510572642680
-280861520128107
caused295061520128123185255310373442
by342861520128129200
the36616152012899170232
oscillations392861520128129184247285323363425463502572642696
of466061520128129176
the48726152012898168231
initial51386152012897168206246284347385
segments8516393012855117188297357428467521
of14086393012897143
the15866393012867136199
aorta18206393012890159206244306
and21616393012889159229
pulmonary24266393012897167205315382453516563633
artery30926393012890136175238285355
under34816393012897168238301348
the38646393012865135197
influence40966393012865136183221291354423485548
of46796393012896143
blood48576393012897136206275346
flow52396393012873111181283
moving85166350128109177248287358428
from1315663501284792162272
the16206635012839109172
ventricles18276635012870132202240287326388426489544
to24066635012838108
the25506635012837108170
major275766350128109169208278325
vessels31176635012870133187243305343397
during35506635012870139187226295365
rapid39506635012847109178218287
ejection.42736635012862101163224263302372442477
4.12056877012870106
Atrial155968770128101140187226289327
component192168770128110180290358429498561630670
-26266877012896
caused275668770128110172243298360430
by322168770128117188
the34426877012886157220
oscillations369768770128118172235272312350413451490560631685
of441768770128118164
the46166877012887157219
ventricular487168770128117179249288335374436506544607653
myocardium85171180128109178247309372418489528599708
during159271180128148218266304374444
atrial207071180128140179226264327365
systole.247171180128132202255294364403465500
This300771180128163232271326
component336871180128139209319387458527590660699
precedes410271180128147194256317379449512565
the470371180128115186249
valvular498571180128148210249319388428490536
component8517360012862133242310381451514583622
of150873600128102149
the16927360012871140203
first19307360012879117163218257
heart222373600128101163225271310
sound.25697360012885155226295365400
The300573600128117187249
onset328873600128103173227290328
of365173600128101149
the38357360012869140203
first40727360012879118165218257
heart436473600128102164227273312
sound47127360012885155226295365
on511273600128103172
the53207360012870139201
phonocardiogram8517601012870141210280351412475522591630700771817879988
is1872760101283994
projected20017601012871117187226288350389451521
0.0325577601012870105176245
seconds28377601012855116179249319388443
from3315760101284793164273
the36217601012839109172
beginning38287601012870133202242311381420490560
of44237601012870116
the45747601012839109173
Q478276010128101
wave.491776010128102163233295330