313
4454147819011156112
In1205596012847117
healthy1358596012873136198236276345416
individuals1807596012843114184223293331402471534572626
asynchrony2469596012866120191259322392439508579650
in3152596012843114
the3300596012844113176
work35145960128102171219289
of3838596012874121
the3993596012843113176
right420459601285189159229268
and4507596012867136206
left4747596012844106153191
ventricles4973596012874137206245292330393431494547
not851839012870141179
exceeding1066839012870139202264326396434504574
0.021675839012878114182253
seconds.1963839012862124186256326397451486
This2492839012886156194248
difference2776839012877116163210271318380450511574
is3385839012847101
insensible3522839012845116170233302357395465504567
to4123839012847117
the4275839012846117179
ear,4489839012870132179214
and4738839012870140209
audible4983839012870139210248318357419
it543783901284685
as8511080012862117
a10041080012863
single1102108001285493163233271334
sound.14711080012855125195265335371
When187710800128133201263333
the22461080012839109171
asynchrony24531080012862116186255318388435504575645
time3132108001283979188249
increases34161080012840110173220282343398460514
within396710800128101138178247287357
0.03-0.0443591080012870104175245297366401471541
seconds,49351080012855117180249319390444479
it5449108001283977
is851132101283994
called9811321012863124163201264333
splitting.13501321012855125163203241281319389459495
If1880132101284793
the20081321012840109172
asynchrony22151321012863117187256319389436505576646
time2895132101283979189248
is3179132101283994
0.0533081321012871106177246
seconds35901321012854116179248319388442
or40681321012871118
more,422113210128109177224286321
it4577132101284080
is4692132101283993
doubling—a48201321012871141210281320359429498646707
more85115630128109177224287
noticeable11731563012870140180218281343406475515576
duplication17841563012871140210249287349412451489560629
of24491563012870116
the26001563012839108171
sound.28061563012855124194265334370
Physiological12051805012878148219272311382420490560599662724762
Causes20021805012894156225280343396
of24331805012870117
Splitting25851805012878148187226265303343412483
and31031805012861131201
Doubling334018050128101170240310349387458528
of39021805012870117
S1:40541805012878148186
•12052046012849
Can128920460128222284355
be167920460128113176
heard188920460128114177238285355
at227920460128106144
the24582046012882153215
end270820460128106176246
of298920460128113161
exhalation318420460128106176246309346409447487556626
when384420460128146215278347
intrathoracic42272046012882152191238300338409478525588649688751
pressure501220460128114161223277331402449515
increases,8512288012839110172218280343396459514549
leading14352288012852115177246285355425
to18952288012852123
increased20532288012852123186231294356410472541
blood26302288012884122192263332
flow2998228801286198169271
from33022288012861108178288
the36222288012853124187
pulmonary38442288012883153192301369440503549619
vessels44972288012884147200255318356410
to49432288012852122
the51012288012851122184
left53202288012853116161199
atrium.8512529012862101149186257367399
This128625290128125195234289
increases16112529012879150212258321383437499553
the22002529012879149212
pressure244725290128110157219273327397444506
on298925290128110180
the32042529012879149212
atrial345125290128103141188226289328
surface38142529012894165211257320382445
of429425290128109156
the44842529012880150213
mitral473225290128150187226273335375
valve,514225290128110172211281344379
delaying8512771012870133172234304341412483
its1369277101283877131
closure,15362771012862101170224295341404439
resulting20102771012846107162233271310349419488
in25342771012839108
the26782771012839108171
perception28842771012870131178240303372411450520590
of35082771012870118
splitting.36612771012853124162201240278318387458494
Pathological12053012012878140179249320358429498537600662700
Causes19403012012894156225280343396
of23703012012871118
Splitting25233012012878148186225264302344413483
and30423012012862132201
Doubling327930120128101171240310348388458528
of38413012012870117
S1:39943012012878146186
1.12053254012870106
Blockade134632540128165204275336407468539602
of19823254012894142
one21583254012894164227
of24193254012895142
the25953254012863133196
legs28253254012864125196250
of31103254012894141
the32863254012863134195
bundle35163254012894165234305344406
of39573254012894141
His,413332540128127165219255
leading44233254012862125187256296365435
to48943254012862133
delayed50613254012895158196259329390460
contraction8513495012862133202242289351412451490559630
of15153495012870117
one16683495012870139202
ventricle.19043495012870133202241288326389427490525
2.12053737012870106
Ventricular134637370128173235305344392429492561601662709
extrasystole,209037370128115184224270332387458510550620659722757
where288137370128153223286332394
the33103737012891161224
ventricle356737370128123186255293340379441479542
in41443737012890161
which434037370128153223261324394
the47693737012891161224
impulse50283737012890200268338378433494
originated8513979012870117156226265335397436499568
contracts14543979012863131202241288350412450504
more199239790128110177225287
quickly.23143979012870141180243312352422456
3.12054220012870106
Marked134642200128196259305376438507
hypertrophy188942200128108179247310357396443512582652723
of264542200128110157
the28374220012879149211
myocardium,308342200128149218286349411458528568637747781
often389942200128109156195257327
the42614220012878148210
left45074220012877139186224
ventricle476742200128108170239279325364427465528
(in53304220012886124193
arterial8514461012862109148211258296358396
hypertension,12834461012883153222285331370433502557596666736772
aortic20884461012876147194232271333
stenosis).24564461012868107170239309364402456503538
The302944610128100170232
hypertrophied32954461012884155223286333372419488558629667730799
ventricle41294461012883146215255302340402441503
contracts46674461012876146215255301363426464519
more523444610128110177225287
slowly.851470201285594164265304375408
Splitting12054945012878148188226265304343413483
and17234945012863131202
Doubling196149450128101169240309348387457527
of25234945012870117
S2.26754945012878147184
Doubling120551860128101171242311351389459529
and17705186012866136205
splitting20115186012858127167205245283323392462
of25085186012874121
S226645186012883152
are,28515186012867113175210
as30965186012866120
a32515186012867
rule,33535186012851120159222257
associated36435186012867122176246308347410448511580
with426251860128102140179248
increase45465186012842113176221284345399462
of50435186012874121
blood51995186012874112183252322
ejection8515427012862101163225265304374443
time1330542701283978188248
of16135427012871118
the17665427012839110173
right1973542701284786156227265
ventricle22745427012870132201241288326389427489
and/or27985427012864133202242311359
decrease31925427012870131194241303365419482
of37095427012870117
blood38615427012870110179249320
ejection42155427012863102164226265304374444
time4695542701283978188248
of49785427012871118
the51315427012839109172
left53385427012839101147185
ventricle8515669012870133202241289327389427490
that13765669012871141204241
leads,16535669012871134196265320356
respectively,20445669012877139194264326389427466536599636707740
to28195669012871142
later29965669012871134173236283
appearance33125669012895165236299360407469538601663
of401056690128103149
pulmonary419456690128102173211320388458521568638
component48675669012894164275343414484546615654
and/or8515911012862133202242311358
earlier12455911012862124171209247310357
appearance16375911012862131202264326372435504567629
of23005911012870117
aortic24525911012863133179218256319
component28065911012862131241309379450512582621
of34615911012871118
S2.36145911012878147182
Functional12056152012878148219281320358429498561599
splitting18406152012863133171211249289327397468
or23436152012878124
doubling25036152012879150219289328367437507
of30466152012878125
S232066152012887158
is33996152012847102
more354561520128109177224286
common38706152012871142253361428499
than44046152012849119182251
the46916152012848117180
first4906615201285695142196235
and51766152012872142211
is54236152012847101
observed8516393012870141195258304373436505
in13926393012853122
young15506393012884152223293363
people19496393012883145215284324387
at23716393012875114
the25206393012852123185
end27406393012876145216
of29916393012883130
inhalation31576393012851121192253292355393432502572
or37646393012883130
the39306393012853122185
beginning41506393012883146215254324395433503573
of47596393012883130
exhalation49246393012877146215278317379418456526596
during8516635012870141188226296366
physical12526635012881151222274314377439477
exertion.17646635012874143206253291329400470505
The23046635012897167229
cause25686635012874136205259322
is29256635012849104
the30646635012851120183
asynchronous32816635012874128199268330400448517586657727781
end40976635012874143214
of43456635012882128
systole45076635012866137190229300338401
of49436635012881128
the51056635012851120183
left53236635012849112159197
and8516877012862133202
right1089687701284685155225264
ventricles.13886877012871132202241288326389428489544580
Pathological12057118012878140179249320358429498537600662700
splitting194071180128100170208248286326364434503
or247971180128115162
doubling267671180128115185254325363403473542
of325471180128114161
S2345071180128123192
is36807118012885139
more385471180128155222270332
often422171180128115163200263332
noted458971180128115185223286356
over498071180128115185248294
the53097118012884153216
pulmonary8517360012870141179289357427490537607
artery.149273600128100147186248295365399
The192673600128123194257
mechanism221873600128147207269340402473511566676
is29277360012876132
related30947360012885147185248287349419
to35487360012876147
increased37307360012876146209255318380434496565
pressure433173600128108154217271325396443504
in48707360012877147
the50537360012877146209
left52977360012876139185223
ventricle8517601012870133202241289327389427490
and13767601012888157227
delayed16397601012895157195258328389459
closure21347601012888126197251320367430
of25997601012895142
the27757601012865135197
mitral300876010128135171211257319358
valve34027601012895158196266328
compared37657601012888158267335398445507577
to43787601012863133
the45477601012863134197
aortic47787601012888157204243282345
valve.51577601012896158196266329364