305
4354147819011156112
•1205596012849
Insufficiency12895960128175245301370417464502565603665735797867
of2190596012876123
the2348596012845115178
mitral25655960128110146186233295334
or2935596012876123
tricuspid309359601284592130193262317386425495
valve3624596012874137175246309
–3968596012879
incomplete4082596012845115177246356424463526565628
closing4745596012868106176231269340409
of5190596012876123
the5348596012843114176
valves,851839012870133172242304358393
diastolic1279839012870109171225264334373412475
ventricular1787839012871133202242289327390460498561608
overload.2429839012870139202249287357420489525
•12051080012849
Aortic128910800128230299347386424487
valve18111080012883146185254317
insufficiency21631080012853124178248295342379442481543613676746
–29431080012885
more307710800128110178225287
blood33991080012884124193264334
enters37681080012877146185248293348
the41521080012851122184
left43711080012853116161200
ventricle46071080012883146215254301339402440502
during51441080012884154201240309379
diastole,8511321012870110172226264335373436471
reducing13571321012847109178249310349419489
the18811321012839109171
speed20861321012855125188249320
of24401321012870117
its2592132101283977132
contraction27601321012862131201240286349411449488558629
and34241321012863131201
blood36611321012870108179248318
flow4014132101284786155257
velocity.43061321012870132171241304342380451484
•12051563012849
Aortic128915630128230299347386424487
stenosis181115630128120159221290361415455509
–235515630128137
pronounced252815630128135182252322391462532594656726
hypertrophy328915630128136207275338385423470539610679750
of407215630128136183
the429015630128105175238
left456315630128105168214252
ventricular485115630128134197266305353391453522562624670
myocardium,85118050128109178247309372418489528599708741
reducing16271805012846109179250313352421491
the21531805012839109171
contraction23591805012863132202241288350413451489560629
speed30241805012854124186249318
due33771805012871140203
to36151805012839108
increased37591805012837108171216279341398461531
afterload.43251805012863108147209256295364427497533
Changes12052046012894164227296366428483
in17232046012847117
the18762046012848117180
Intensity20902046012856126165227296351390428499
of26222046012880127
S2:27842046012887157196
In30152046012856125
normal31762046012878148195304364403
conditions,36152046012871141211281320358398467537592628
the42782046012847117179
sound44922046012864134203274343
intensity48712046012848118156219288343382421492
of53962046012879125
S28512288012878148
is10352288012859114
the11842288012859129192
same14112288012874137246306
at17532288012883122
the19112288012860129191
second21372288012876139201270340411
and25822288012884154224
third28412288012859129168215284
auscultation31612288012883152208270339378417479518557627697
points.38932288012890160200269309363398
However,432622880128123191293355425488533568
if49292288012860108
there50712288012860129192239301
is54062288012861115
amplification8512529012862173241280319367404467530567606677746
of16332529012877124
S217912529012886155
at19812529012871109
these21252529012846117178233296
points,24552529012877147186256295349384
it2875252901284685
is29942529012847101
called31312529012870132169209272341
the35062529012847117180
accentuation37212529012869131194256325364434497535573644714
of44702529012877124
S2.46292529012887155191
This48632529012886154193247
can51462529012869131200
be53822529012883145
over8512771012870141203249
the11352771012839109172
aorta13422771012862131178217279
or16562771012870117
pulmonary18072771012870141179288356426489536606
artery.24482771012862109148210257327361
Accent120530120128101163225288358397
of16373012012870117
S217893012012879147
on19723012012870139
the21473012012839108171
Pulmonary23533012012878147186296364434497544614
Artery300030120128102148187249296366
•12053254012849
Physiological128932540128206277347400440510549618689727790852890
–22153254012877
in23283254012844115
children24783254012868139177217286333396465
and29783254012869138208
young32223254012877145216285356
people36133254012876139208278317380
up40273254012877146
to42093254012845114
2543593254012877146
years45413254012877137200246301
old.48783254012875114184219
This51393254012885155194249
is54223254012846100
due8513495012870141203
to10893495012841110
the12353495012841110173
more144534950128110177225287
superficial17673495012857126197259305351390453491554593
location23953495012840109172235272312382452
of28833495012871118
the30363495012840109172
pulmonary32433495012871142180290358428491538608
valve38853495012872135174243306
and42263495012864133204
higher44663495012871110180249312359
elasticity48603495012864102165218258296359398437507
of54013495012872119
the8513737012839110172
pulmonary10573737012881151189299367437500547617
artery,17073737012873120159222268339373
resulting21153737012857120174244283322360431501
in26513737012848119
lower28043737012850119221283330
pressure.31683737012880127189243298368415477512
With372537370128132170209280
age,40393737012873142205240
blood43143737012879119188259329
pressure46783737012880127189243297367414476
in51893737012848119
the53423737012850119181
pulmonary8513979012870141179289357427490537607
artery149239790128144191230293340410
increases,193539790128122192255302364427480543596632
and260239790128144215284
the292239790128121191254
pulmonary321039790128152223261371439509572619689
artery393239790128145192231294341411
moves437839790128192260331394448
backward,486239790128151214276345447509556626661
eliminating8514220012862101141250287358420458498567637
the15244220012839108171
accentuation17304220012862124187248318357427490528566637707
of24724220012870116
S226234220012878149
over28054220012871141203250
the30904220012839108171
pulmonary32954220012870140179289357427490537607
artery.39354220012863110149211258328362
•12054461012849
Pathological128944610128206269308377448487557627665728790828
–21534461012887
amplification22764461012879188256295335381420483545583622692762
of30734461012887134
S232424461012895164
over34414461012887156219266
the37424461012854124187
pulmonary39644461012886156195304372443505552622
artery46204461012879125164227274344
is50014461012856111
due51484461012885156218
to54014461012855125
increased8514702012839110172218280343396459528
pressure14154702012887135197250305375422485
in19344702012857127
the20964702012857127190
pulmonary23214702012888158197307374445508555625
circulation.29794702012881120168230299337400439478547618653
This366647020128105174214268
is39694702012857111
observed41154702012888159213276322391454523
in46744702012856127
mitral485447020128110146186233295334
heart52244702012888150213258296
defects,8514945012870133180242304342396432
chronic13184945012862132179248318358420
respiratory17734945012847108163232272318380419489536606
diseases,24134945012870109164227288343406459495
and29434945012862132202
primary31794945012870116155265325371443
pulmonary36554945012870140180290358428491538608
hypertension.42964945012870142212274321359422492546585655725760
Causes12055186012894156226280343398
of16375186012870117
Accentuation178951860128102163225288357395466529567605675745
of25685186012871118
S227215186012878147
over29035186012870140202249
the31875186012839109171
Aorta:339451860128101169216254317356
•12055427012849
Increased128954270128175245308355417479533596665
blood19885427012870110180250320
pressure.23425427012870117180233288358405467502
•12055669012849
Atherosclerosis1289566901282302683394024485175726346737357828529069451000
of23255669012877124
the24845669012846116177
aorta,26965669012871141188226289324
where306356690128101170232279341
the34405669012845115178
accentuation36535669012870133194256326365436497536575645715
of44045669012877124
S245635669012886155
occurs47535669012877140202272319373
due51615669012878148210
to54075669012845115
sclerotic8515911012855117156218265335374412475
thickening13615911012839108148210280342412450521591
of19865911012870116
the21375911012839109172
aortic23455911012862131178216255317
valve26975911012870133171240303
leaflets30355911012839102163210248311350404
and34745911012863131202
aortic37125911012862131178216255317
wall.406459110128101163202240276
Causes12056152012894156226280343398
of16376152012870117
Attenuation178961520128102140178241310381442481520591660
S2:24856152012878148186
•12056393012849
Over128963930128230299362409
the17336393012893162225
pulmonary199363930128124194233343411481544591660
artery:268763930128116163202265312382419
Insufficiency314263930128100170225295342389428490529591661722792
of396863930128124171
the41746393012893163226
pulmonary443563930128124194233343410481544591660
valve,512963930128124187226296358393
stenosis851663501285594157226296351389444
of13296635012870117
the14826635012837108171
pulmonary16866635012870140180289357428490537607
orifice.23276635012870117156203241304366401
•12056877012849
Over128968770128230299362409
the17336877012865135198
aorta:19666877012887157204242305343
Severe234468770128104167236299344406
arterial27866877012888135174236282321383422
hypotension,32446877012895165234304344405476530568638708744
aortic40236877012888157204242282344
valve44026877012896158197266329
insufficiency47666877012864135189258304351390453491554623686756
(where8517118012847148218281327390
the12767118012885155218
aortic152971180128109178225264302365
valve192971180128117179218288350
leaflets23147118012886148211257296358396451
do280171180128115186
not302271180128117186225
close),328171180128109148219273336382417
stenosis373471180128100139202272341395435489
of425971180128116163
the44567118012886156219
aortic471071180128109179225264303365
orifice511171180128116163201249286349410
(reducing851736001284794156226296359396467537
blood14237360012870109178249319
flow1777736001284784155257
velocity20677360012870133172241304342381451
through25527360012839109156226296367436
the30247360012839108171
narrowed32297360012870132179226295397459529
opening37927360012870140203273311381452
of42787360012870117
the44307360012838108171
aortic46367360012861131179217256318
valve).49897360012870132171240303350385
Splitting12057601012878148188226265304343413483
and17237601012863131202
Doubling196176010128101169240309348387457527
of25237601012871118
Heart267776010128101162225272310
Sounds:30227601012878147217287357412450