195
4554147819011156112
Causes851596012894156226280343398
include1283596012840110172210281350413
mitral17315960128109146185232295334
valve2099596012871134172242304
defects,2438596012871133180242305343397432
primary2905596012871118156266326372443
pulmonary3382596012870141180290357428491538608
hypertension,4024596012870141209272319358421490545583653723759
emphysema,4818596012868177245316386439502611671706
and851839012862133202
other1089839012893133203265312
chronic1435839012887157204274343382445
respiratory1915839012871134187258296343406444514560631
diseases.2579839012895134189251314367430484520
Usually,31338390128126180250313351390460493
accent3662839012886149211273344383
of4080839012894141
S242568390128103172
on4462839012895165
the4662839012863134195
pulmonary4892839012894165203313381451514561631
artery8511080012862109148211258328
is1212108001283994
accompanied13421080012862125187256365433496566606668737
by21141080012870141
splitting22881080012855125165203242281320390460
or27821080012870117
doubling29341080012870140209280319358428498
of34661080012870118
S236191080012878146
on38011080012870140
the39761080012839108171
pulmonary41811080012870141179288356426489536606
artery.48221080012862109148210257327361
Pathological12051321012878140179249320358429498537600662700
Third19401321012886156194241311
(S3)22871321012847125194241
and25631321012862131202
Fourth28001321012878147217264303372
(S4)32081321012847125193240
Heart348413210128101162225272311
Sounds:38301321012878147218287357412450
Decrease120515630128101163225272335397452514
of175415630128122169
the19591563012891161223
myocardial221715630128162231299362424471541581644682
tone29341563012892161232294
("flabby32631563012899159205244307376446517
myocardium")381315630128163232300363425472542582651761816863
may471115630128163224295
lead50401563012891154216286
to53621563012891162
appearance8511805012862133202265327374436506568631
of15151805012871118
pathologic16661805012871133172242312351421491530593
third22941805012837108146194263
or25921805012870117
forth27441805012847116163201272
heart30501805012870133194241280
sound33651805012855124194265334
(gallop37351805012846115178217255325396
rhythm).41661805012847116186224294404448483
•12052046012849
S3:128920460128206277316
A165320460128102
pathological17892046012882145183253323361432502540603665703
sound25282046012867137207277347
that29102046012852122184222
occurs31682046012881144207276323377
0.12-0.1835812046012882117186255306377412481551
seconds41682046012867129191262331401456
after46602046012873120159221268
S2,49632046012889160195
at51932046012875113
the53422046012851121184
beginning8512288012870133202241311382420490560
of144622880128127174
diastole165522880128126165228282320391429492
during218222880128126196243282352421
the26392288012895166228
rapid290122880128104166236274345
ventricular328022880128128190259298345384447516554617664
filling397822880128104143181221259329399
phase441222880128126197259313376
(Fig.482622880128105183220291326
14a).518622880128127197260307341
Diagnostic85125290128101140203273343412467506545608
significance1494252901285392162232271318357419481551613675
of22042529012870117
S3:23562529012878147187
severe25782529012853116185248295357
myocarditis,297025290128109178246309371418488527566605659694
myocardial370025290128109178247309372418489527590629
dystrophies.43632529012870140193232279349420490528591646681
•12052771012849
S4:128927710128206277316
A164927710128101
pathological17852771012878141178248319357427497536599661699
sound25192771012863133203273343
occurring28972771012878141203272320366404474545
just34772771012847117171210
before37232771012877138185255303365
S141232771012886155
at43142771012870109
the44592771012845116179
end46732771012870139209
of49172771012879125
diastole50772771012878118180234273343381444
during8513012012870141188226296366
the12523012012853122185
atrial14713012012876115161200263301
systole18083012012867138190230300339402
phase22443012012883153216270332
(Fig.26133012012861139178248283
14b).29313012012883153223270306
Conditions327130120128107178247317356395434504573628
for39343012012861131177
its4146301201285291145
occurrence43273012012883145207277325371433503566627
include49893012012852122184223293363425
a54493012012875
sharp8513254012855125188234304
decrease11903254012871134196243305367422483
in17093254012841110
ventricular18553254012872134204242290329390462501563610
tone25003254012840111180243
and27783254012864134203
presence30173254012872119180235297367430492
of35443254012871118
overfilled36973254012872142205251297336375413476546
atria.42793254012863102149187249284
Rapid46003254012893156226264335
stretching4970325401285695142204243305375413483552
of8513495012870117
the10033495012880151213
walls125134950128143205243282337
of162334950128111158
ventricles181634950128110173242281328367429468531584
that24363495012879150212250
have272234950128110173242305
lost30623495012879150204242
tone33403495012881150220283
during365834950128110181228266336406
atrial410034950128102142189227289327
systole44623495012896167219259329368431
results49283495012888150204274313351407
in53693495012881150
vibrations8513737012870110179226289327366436505560
and14473737012862131201
the16833737012839109171
appearance18893737012863132201264326373435505567629
of25533737012870117
S4.27053737012878147182
a)52805092014380134
b)52806546014389142
Figure8516824012878117188257305367
14.12526824012870139175
Gallop146168240128102164203242312382
rhythm:18786824012847117187225296405443
a)23566824012862109
protodiastolic;25006824012870117187226296366405467521560630669708771809
b)33446824012870117
presystolic.34966824012870118180233304357396467505545607642
S312057307012878148
and13897307012883154223
S416487307012899168
are18517307012884131193
better20797307012892154192231294340
heard24537307012892154217264333
at28217307012884123
the29797307012861130193
apex32077307012884153215285
of35277307012891138
the37007307012860131193
heart,39287307012891154216263301336
on42997307012891161
the44967307012860129192
left47237307012861122169208
side.49677307012876114184246282
The528473070128106176238
appearance8517548012862133202265327374436506568631
of15157548012871118
S316687548012878147
and18507548012862133202
S420877548012878148
is2270754801283993
associated23987548012863117171241303343404443506575
with300975480128101139178248
the32927548012839109172
emergence34997548012863172231278348411482543606
of41407548012870116
the42917548012839108171
gallop44967548012870133172211280351
rhythm.48827548012847116186224294404437