266
4154147819011156112
•1205596012849
сaused12895960128191253323377440509
by18345960128115186
myocardial20535960128156225293356418465535575637676
oscillations27655960128115169232271310348411450488558629683
when34835960128147216279348
blood38665960128115155225295365
enters42665960128108178216279326379
the4681596012884154216
ventricles49335960128115177247286333372434472535589
during851839012870141188226296366
the1253839012850121184
atrial1472839012875113160198261300
systole1807839012866137190229299338401
–2243839012885
the2364839012851121184
active2583839012875137175215284347
filling296583901286099137176215285355
phase3355839012884154217271333
of3723839012883130
the3888839012852122185
ventricles4108839012883144215253300338400439502555
(similar4699839012859114152262299338401448
to5182839012852122
the5340839012852121184
4th8511080012870110179
component10661080012862131241308379450512581621
of17211080012870117
S1).18731080012878147194228
•12051321012849
often128913210128199246285347417
heard17421321012871133196241311
in20891321012840109
the22341321012841111173
vertical24421321012872134181219258321382421
position28991321012871140196234273312382452
in33871321012839109
athletes35321321012864103173211274313375429
and39971321012864133204
after42361321012863110149211258
emotional45291321012864174241281320390460522560
stress5125132101285695142204258313
-54791321012848
this8511563012839110148203
is10901563012849104
because12301563012880143205268337391454
the17191563012851120183
atria19371563012874112158197260
are22321563012874121183
sensitive24501563012865128198252291330369439501
to29861563012851121
sympathetic31421563012866136245312375414485548587626688
influences,38651563012851120167207276339408471533587622
resulting45221563012858121175245284323361432501
in50591563012850120
some52151563012866135245305
advancement8511805012862133202265335397459568629699738
of162518050128104152
atrial18121805012898136183221283322
contractions21691805012899168238278324386448486526596666720
over292518050128104174237284
ventricular324218050128106169238277324363425495533596643
contractions,39191805012898168237276323385448486524595664719756
therefore,47101805012875144207254315362432478541576
the53211805012873144205
fourth8512046012847117188234273343
component12292046012872141250318389459522591630
of18942046012879126
S120552046012886156
starts22472046012862102164210249303
to25862046012848117
be27392046012878141
heard29152046012878141202249319
separately32692046012862125195257304366404467506577
from38792046012856103173283
S141942046012888158
and43872046012872141211
is46332046012848102
called47712046012871133171210273343
the51482046012849118181
S453642046012887156
sound.8512288012855125195265335371
In12052529012847117
clinical13582529012862101139209248311372411
practice18032529012870118180242280319382444
the22822529012839108170
following24872529012847117156195265366405475545
changes30682529012862131194263332395450
of35522529012870117
heart37042529012870132194241280
sounds40202529012853122193263332387
may444325290128109169240
be47172529012870133
met:488525290128109169208248
1.12052771012870106
Volume134527710128102171211280390450
change18302771012862133195265335398
of22632771012870116
the24142771012839109173
main262227710128109169208278
sounds29362771012854124193264333387
(S133592771012848127197
and35912771012861131201
S2);38272771012878149195233
2.12053012012870106
Splitting13453012012878149187226265304343412483
(doubling)18633012012847116186256326364404473544590
of24883012012871117
the26403012012839109172
main284730120128109169208279
sounds;31613012012855124195264334389427
3.12053254012870106
Appearing134532540128102171242304366413451521591
of19723254012870116
additional21233254012862132202241280318389458521559
sounds:27183254012854123194264333388427
S331803254012878147
and33633254012862132201
S4,35983254012878149184
mitral381732540128109146185232295334
valve41863254012870133171241303
opening45243254012871140203272310381451
snap50103254012855124187256
(OS).12053495012847148226272307
Changes12053737012894164227296366428483
in17233737012838108
the18673737012837108170
Intensity20723737012847117155218287342380420491
of25963737012870117
Heart274837370128101163225272311
Sounds.30953737012878147217287356411450
Simultaneous12053979012878117227295334373436505568637708762
amplification20023979012877186254293333379418480542581619690760
or27973979012883130
attenuation29613979012877116154217286356418457496565636
of36323979012883130
the37973979012852122184
first4016397901286199146199239
(S1)42893979012861139209256
and45803979012876145215
second48303979012868130193262332402
(S2)52683979012859137207254
heart8514220012870133196242280
sounds11674220012854124193264333388
is1591422001283793
primarily17184220012870117155264324372411451521
due22734220012870140203
to25114220012838108
extracardiac26554220012862131170217279341404450520558620682
factors.33724220012847109172211280328381417
Causes12054461012894156226280343398
of16374461012870117
Amplification178944610128102210278317357404443505567606644715785
Both26094461012894163202272
Sounds29164461012878148218287358412
(S133644461012846124193
and35934461012860130200
S2)38294461012878148195
in40594461012838108
Normal420344610128101169216326385425
Conditions:46634461012894164234304342382420491561615654
1.12054702012870106
Thin134647020128157227266336
chest17174702012863133194249288
wall.204047020128101163202240276
2.12054945012870106
Physical134649450128149220290343383445508546
and19274945012873142211
emotional21744945012873182250289329398469531570
stress,27794945012864103151212266321356
leading31704945012848111173242282351421
to36264945012849119
increased37804945012849119182228291353407469538
heart43544945012879142204250289
rate,46794945012855118157219254
shortened49684945012865134205252290353422484553
diastole,8515186012870110172226264335373436471
and13575186012897166236
decreased162851860128103166229275338399452515585
diastolic224851860128105143206259299368407446509
filling27915186012881120161200239308379
of320551860128103150
the33905186012873143206
ventricles.363051860128104166236275322360423462524578614
Increased42795186012881150212258321383438500570
ventricular488451860128104167236274321360422492531594640
contraction8515427012862133202242289351412451490559630
force15175427012846115162225287
and18395427012862131201
blood20745427012870110179249320
flow2429542701284784155257
speed27205427012853124187248318
result30745427012847108162232271310
in34195427012839109
intensified35635427012839108147210280334372419459520590
heart41885427012870133195242280
sounds.45035427012855124195264334389425
Pathological12055669012878140179249320358429498537600662700
Causes19405669012894156225280343396
of23705669012871118
Amplification252356690128101210277317356403442505566605644715784
Both33435669012893162201271
Sounds:36505669012878148217287357411451
1.12055911012870106
Decreased134659110128173235297344406468523585655
airiness20375911012882120167205276338392446
of25195911012889135
lung26895911012859130199269
tissue2994591101285897151206276338
in33685911012857128
the35325911012857127190
heart's37575911012889152214261299324379
projection41725911012889136205244306368407446516586
on47945911012889158
the49875911012859130192
chest52135911012883153215269308
wall85161520128101163202242
–11276152012870
pneumosclerosis,12336152012870139202271381449504566605668715784838877932967
inflammatory22356152012839108156193256365474533573643690761
infiltration.30296152012839109157196235274321383421460530601636
2.12056393012870106
Air-filled134663930128173211258305352391430468531601
resonating19826393012860123176247316379417456526596
space26136393012868138201262325
in29736393012852122
the31316393012852121184
lung33506393012852123192262
adjacent36476393012877146185247309372442481
to41636393012852122
the43216393012852121184
heart45406393012883146208255293
–48696393012887
amplifies49926393012875186254293332380417480534
sound.8516635012855125195265335371
3.12056877012870106
Tumor134668770128157227336404451
in18336877012855126
the19946877012856126188
posterior22176877012887156211250313359397467514
mediastinum,278368770128109169239279341396434474544613723756
causing35746877012879141212267305376446
the40556877012856125188
heart42786877012887148211258296
to46096877012856125
approach47706877012878149218266335397460529
the53346877012856125188
chest8517118012862133195249288
wall.117571180128101163201240276
•12057360012849
Cardiac128973600128222284331401440503565
causes:18897360012897159228282345399438
Increased23637360012881150213259321383437500569
heart296873600128105166229275313
rate33177360012881144183245
during359873600128103173220258328401
fever,40347360012881144213275322357
hyperthyroidism442673600128105175244306353391462532577647687757796850960
–541973600128106
leading8517601012839102164233273342412
to12987601012839109
decreased14427601012870133194241303366419482551
diastolic20297601012870109172225264335373412474
ventricular25387601012871133202241288327389459497560607
filling.3180760101284784124162202271341377