262
4054147819011156112
When12058390128133201264334
analyzing1575839012881151214252322383422493562
heart2173839012889152214260299
sounds,2507839012873143214283353408444
it's298683901285796121176
crucial3197839012882128197260298361399
to3630839012858129
differentiate3794839012889128175222284331392462501539602641703
between4532839012889152190290352415485
the5052839012858128191
first5278839012865104151205243
and8511080012862133202
second10891080012854117179248318389
heart15121080012870133195242280
sounds.18271080012855124194263334388425
Differentiating120513210128101140187234296343405474514552615653692762832
S120721321012878149
and22561321012862131201
S2:24921321012878148186
•12051563012849
S1128915630128206277
occurs16011563012870133195264312366
after20021563012863110147210257
a22941563012863
longer23911563012840110180250312358
pause,27841563012872134203257320355
i.e.,3174156301283974137172206
diastole,34151563012871110172227265335374436470
while392415630128101171210248311
S242711563012878147
occurs44541563012870132195264311366
after48541563012863110148211256
a51451563012864
short52441563012855125194242281
pause,8511805012870133202257320355
i.e.,1241180501283773135170205
systole.14811805012854125177217288326389424
•12052046012849
S1128920460128206277
is1601204601284094
louder17302046012840110180250313360
than21252046012839108171241
S224022046012879147
at25852046012862101
the27212046012841110173
apex29292046012863132195264
and32292046012863133203
the34672046012840109172
4th36742046012871110180
auscultation38892046012863134188250319359397460498537607677
point46012046012871141180250288
(where49252046012847148217280327389
the53492046012840110173
projection8512288012870117188227289351389428498568
of14542288012881127
the16162288012850119182
mitral184422880128109146185232294333
and22132288012873142213
tricuspid2461228801284895134196266320391430499
valves,29962288012880143181251312367403
whose344422880128101171241296358
closure38372288012873111181236305353415
forms42872288012857126174282334
S1,46562288012889159195
is48862288012849104
located).50252288012850120182245284345416463497
S18512529012878148
is10352529012847101
more117925290128110177225287
prolonged15012529012878125195233304373443506576
and21112529012871141211
lower.23572529012847117219280327362
S227542529012886155
is29452529012845100
louder30812529012846115186256318368
than34852529012845116178248
S137692529012886155
at39592529012870108
the41032529012846116178
base43162529012878140194256
of46072529012878125
the47672529012847116179
heart49812529012877140201248287
–53042529012880
at54192529012870108
the8512771012839110172
2nd10572771012870140211
and13032771012862131201
3rd15392771012871117187
auscultation17612771012863133187249318358396459497536606676
points24722771012870140179249288342
(points28502771012847115186225294334388
of32732771012870117
projection34242771012870117188227289351389428498568
of40282771012870117
the41802771012838108170
semilunar43852771012855117226263303373443506552
valves),49732771012870131170240303356403438
it5447277101283775
is851301201283994
shorter9813012012853123193240278341388
and14043012012862131202
higher.16393012012871110180249312359394
•12053254012849
During128932540128230299347386455526
tachycardia,18503254012846109171240311371434481551590652687
especially25723254012870125196259320359422459498569
in31743254012847117
children,33273254012870141180219288335398467502
when387132540128101171234304
systole42113254012862133186225295334396
equals46423254012870141210273311366
diastole,50433254012877117180233271342381443478
distinguishing8513495012870110164203242311382452490545615654724793
S1168034950128123192
and190834950128107176247
S2218934950128124194
can241734950128108170239
be269234950128114179
aided290534950128107146216279348
by328834950128114185
auscultation350634950128108178233296365404443506544582653722
in42643495012883153
combination445234950128108177286354394464527565604674744
with523134950128147184222292
palpation8513737012870133172242304342381451521
of14083737012873120
the15633737012843112175
pulse17733737012873143182237299
on21063737012874144
the22863737012842112175
carotid24963737012865128174244283321392
artery;29243737012865112150213259330367
the33263737012843113176
sound35373737012858128198268338
that39103737012842113175214
coincides41593737012866135174244307345414477532
with473037370128101139178247
the50133737012842113175
pulse52233737012873144182236298
on8513979012870141
the10273979012838108170
carotid12323979012863125172241280319388
artery16563979012862109148210256326
is2016397901283994
S1.21453979012878149184
Physiological12054220012878148219272311382420490560599662724762
third20024220012851121160207276
and23144220012873142212
fourth25624220012857126197243282352
sounds.29494220012865135205275345400437
The34214220012896166228
emergence36844220012873183243290360423493556617
of43364220012881128
the44994220012849119182
third47164220012849119158206275
(S3)50264220012857135204251
and53134220012872141211
fourth8514461012847117188234273343
(S4)122944610128110188258304
physiological156944610128133203274326366436475545615654716779817
sounds242144610128118188258328398453
is290944610128101156
associated310144610128125179234303366404467506568638
with377444610128165203242312
the412144610128102173235
oscillation439044610128133188251289328367429467507576646
of507244610128133180
the528744610128102172235
ventricular8514702012870133202241289327389458498560606
myocardium150047020128110179247310372419489529598708
under22414702012878149219282329
the26044702012847116179
influence28184702012846116163202272334403465527
of33814702012878125
blood35404702012878117186257327
moving391047020128109177248287357427
from43724702012855100171280
the46854702012847118181
atria49014702012870108155193256
to51924702012846116
the53444702012846115177
ventricles8514945012870133202241289327389427490545
during14304945012870140187226295365
ventricular18314945012870132201240286325388457496559605
diastole24714945012870108171226264334373436
(Fig.29444945012847124163232268
13).32474945012870141188223
S312055186012878148
(protodiastolic13895186012846117163233271342412450513566606675715753816
sound):22405186012853124194264334381419
•12055427012849
appears128954270128191261331393456502556
at18815427012862101
the20175427012838109170
beginning22225427012871133202241311381421490561
of28175427012870117
diastole,29695427012870109171225264336374437472
0.14-0.2034765427012870105174245291362396466537
seconds40485427012854116179248318388442
after45265427012862109148209256
S2;48185427012878148186
•12055669012849
occurs128956690128199261324393440495
due181956690128105174237
to20915669012875145
myocardial227156690128145214282345408455525564627666
oscillation297256690128105160222261299339400439478548618
during362656690128104175221260331400
the40625669012874144207
rapid43045669012882145214252323
passive466256690128105168221276315384447
filling51445669012883122160199238308377
phase8515911012870141203257320
of12055911012870117
the13575911012839109171
ventricles,15625911012870133202242289327389427490544579
resulting21765911012846109163233272311349420490
from2701591101284794162272
blood30065911012870109180251320
flow;3362591101284786155257298
•12056152012849
it128961520128167207
is1531615201283893
a16596152012863
weak,175661520128102163226295330
low-pitched,21226152012838108209257327366404467536599668703
and28606152012862132202
short30976152012855124195241280
sound.34136152012853123193263333369
S412056393012878148
(Presystolic13896393012847125171234287358410450520559598660
Sound):20846393012878148218287357404443
•12056635012849
appears128966350128191261331393456502556
at18816635012862101
the20176635012838109170
end22226635012863133202
of24606635012870116
diastole,26116635012870109172226264336375437472
preceding31186635012870116179241303373412482551
S1;37056635012878147187
•12056877012849
very128968770128199261308378
quiet17016877012870140180242281
and20176877012863131201
brief;22536877012871117156218265304
•12057118012849
heard128971180128199261324370440
in176471180128128197
individuals199771180128126197266306375414484554617655710
with274271180128190228267336
high311471180128159197268337
ventricular348771180128157220289328375414476545585648693
tone421571180128128198268330
and458071180128151221291
increased490671180128126196259306368430484547616
sympathetic8517360012855125234302364404474537576614677
nervous15627360012870133180249319389443
system20407360012855125178218281390
tone;24637360012839109180242284