305
5054147819011156112
2.1205596012870106
Diastolic13465960128173211274329367438476515577
murmur19715960128110177224334402449
in2455596012852122
the2612596012850121184
second2830596012866129191260331400
intercostal3266596012850120159222268330399454493555593
space3895596012866137198261323
to4253596012851121
the4409596012851121183
left4627596012851114160198
is4861596012850105
a5001596012874
sign5110596012867106175246
of5391596012883129
left851839012839102149186
atrioventricular1073839012863102149187258327390459498545584647716754817864
valve1972839012871133172242304
insufficiency.2311839012840110165234282328366429467530600662732765
Organic31128390128101147219281350390453
defects3600839012870132179242304342396
in4032839012839109
this4177839012839109148202
valve4415839012871133172242304
are4754839012863110172
extremely4961839012864134172220282391451490561
rare.8511080012847109156218253
Diastolic120513210128101140203257296366405444506
stenotic1746132101285594156225296335374436
murmurs221713210128109177225335403450505
occur27581321012870131194264310
with:310313210128102140179249288
1.12051563012870106
Mitral134615630128196235275321383422
stenosis.18041563012894132195265335389428482518
The235715630128126195258
murmur264915630128151219266376444491
is31751563012880135
accompanied334515630128103164227296405473537607647709779
by416015630128109180
an437315630128102173
increase45811563012880149212259321382437499
in51151563012879150
S1,530115630128117187221
accentuation8511805012862125187249319358428490528568637708
and15941805012863133202
splitting18321805012855125164202241280319389460
or23261805012871118
doubling24791805012870140210280319358428497
of30121805012871118
S231651805012878147
over33471805012871141203250
the36321805012839109171
PA,38391805012878180214
and40881805012863132203
the43261805012839109170
appearance45321805012863133203265328374436506569630
of51971805012871117
the53501805012839109172
opening8512046012870141203273311382452
snap13382046012855125188257
of16302046012871118
the17842046012839109171
mitral199120460128109146185232295334
valve23602046012871134172242305
(quail's27002046012848117187249288327353406
melody).314220460128109170210280351421466501
The36792046012886156218
murmur393420460128110177225335403450
occurs44192046012871134196265312367
immediately48222046012844154262323393433496535596635706
after8512288012862109148211258
the11442288012841111173
opening13532288012872142204274313382453
snap18422288012856126189258
of21352288012872119
the22902288012842111174
mitral250122880128110146186233295334
valve.28712288012872135173243306341
The32492288012886155218
mechanism350622880128109169231301364434473528638
is4176228801284298
related43092288012850112150212251314383
to47272288012843112
blood48752288012872110181251320
entry52312288012865135174221291
into8512529012839110148219
the11052529012889159222
left13622529012889152198237
ventricle163525290128120183252290338377438476539
through22092529012891160207276346417486
the27312529012890160222
narrowed298825290128121183230277346448510580
mitral360425290128160197236283345383
orifice402325290128121168206253291354416
during447325290128122192240277347418
the49262529012889159222
rapid51832529012898160229268337
ventricular8512771012870133202241289327389458498560606
filling14922771012864102141179218289358
phase.18862771012885155217271334369
This229027710128102171210264
is25902771012854108
a27332771012879
mesodiastolic286327710128109169223294365403465520559629667707769
murmur.368327710128109177224334402449485
The420327710128102171234
second44722771012870133195264335404
murmur492727710128109177224335403450
is54122771012855109
associated8513012012862117172242305342405443506575
with146130120128127165204274
an17713012012887157
increase19643012012862132195241304366420482
in24813012012863134
the26503012012864134196
blood28813012012894134203273344
flow32593012012872111181283
rate35773012012871133172234
through38463012012864134181251321390461
the43433012012862132195
narrowed45733012012895158203250320422484553
mitral516130120128134171210258320359
valve8513254012870133172242304
orifice119032540128100147185233272334396
during162132540128101170218255326396
the20513254012870141203
atrial22903254012893131178216279318
systole26433254012884155208247318356419
phase309732540128100170232287349
–348132540128105
it36213254012869109
is37653254012869124
a39243254012893
presystolic405232540128100147210263334388427497537575638
murmur.472532540128140208255365433480515
The527532540128117186249
murmur85134950128109177224335402450
is1336349501283993
best14653495012870133187226
heard17263495012871132195241311
at20723495012861100
the22083495012839108171
apex24143495012862131194263
of27123495012870117
the28643495012838109171
heart30703495012870132194239278
in33843495012839108
the35283495012839108171
vertical37323495012870133180218257320381420
position.41863495012871141195235273312382452487
2.12053737012870106
Diastolic134637370128173211274329367438476515577
murmur196237370128109177224334402449
at24463737012866105
the25873737012842111174
base27963737012872137192254
of30853737012873120
the32403737012841111174
xiphoid34493737012873112181252322360430
process39143737012874121190253314369423
is4372373701284297
a45043737012866
sign4605373701285696165235
of48763737012873120
tricuspid5031373701284188127189259313384423492
valve8513979012870133172242304
stenosis.1190397901285493155225295350388442478
Functional12054220012878148219281320358429498561599
Murmurs.184042200128124193240349417464519556
Functional12054461012878148219281320358429498561599
murmurs184044610128149217264374442489544
are241944610128102149211
heard266544610128111174236282352
in30534461012878149
pathological323744610128110172210281350389460529569630693731
conditions400344610128103173243312352390430499569624
not466244610128110180219
related49164461012888150188251288351420
to53724461012879149
anatomical8514702012862133195233304414450513575614
changes15014702012896166229298367430484
in20204702012872143
the21984702012873142205
valve243847020128104166205275338
apparatus.28114702012895166235298345406445515570605
Sometimes,345147020128113181291351390430539599654689
they41764702012873143206276
may448647020128144204276
be479547020128105167
heard499747020128105168229276346
in53794702012872141
normal8514945012870141188297357396
conditions.12834945012862132202271311349389458528583618
Causes:12055186012894156226280343398436
1.12055427012870106
Disturbance134654270128173211266305375423492554623686749
of21295427012884131
hemodynamics22945427012884146255323395465534596707743806861
leading31905427012852115177246286355425
to36515427012851122
increased38085427012851122185230293355409471541
blood43845427012884123192263333
flow4752542701286199168270
velocity50575427012884146184255317356394465
(physiological8515669012847117188258311351420459529599638700763802
and16885669012871140209
emotional19335669012870179247287326397467529568
stress,25375669012862101148210264319354
fever).29265669012855117186249296341377
Murmurs334556690128125195243352420467521
heard39025669012878141203250319
in42575669012847117
adolescents,44105669012869139209248311364427490559597652688
known51335669012878147217319387
as8515911012862117
physiological10045911012874144214267307377416486556594657720757
adolescent17975911012867137207246308362425488557596
murmurs,243359110128109177224335402450504540
occur30085911012874137199268315
when336359110128101171234303
there37015911012844113176223285
is4021591101284498
a41545911012867
mismatch426059110128110146203312372411474544
between48405911012874137175277339401471
the53475911012842112174
growth8516152012870117188290327397
of12826152012871118
vessels14336152012871133188242305343398
in18666152012838108
length2012615201283799169239279348
and23966152012862132202
width.263361520128102140209248318354
2.12056393012870106
Disturbance134663930128173211266305375423492554623686749
of212963930128169216
rheological237963930128146215277347387456526565627689728
properties314263930128169215286355418465503542604659
of383563930128169217
blood408663930128169207277348417
–453963930128171
in474663930128137207
anemia,498763930128162232295404441504539
polycythemia8516635012870141179250310382419490552662698761
(decreased16476635012847117179242289351412466529599
blood22806635012870109179249319
viscosity,26346635012870108164226295349389427498531
appearance32006635012862133204266328375437506569632
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turbulent40186635012839108155224295333396465504
flows).4557663501284786155257311358394
3.12056877012870106
Attenuation134668770128173211251313383453515554592663733
of21146877012881128
the22776877012851120183
tone24956877012851121190253
of27836877012882129
papillary29476877012881144213252291330392439509
and34896877012874144215
circular37396877012874112159222291330393439
muscles422668770128109177232294332395450
–47116877012886
in48336877012850120
this49886877012851121160214
case,52386877012873136189252287
the8517118012839110172
leaflets10597118012841103166212250313351406
of15017118012872119
the16557118012842112175
mitral186871180128109146185233297336
and22407118012865134205
tricuspid2481711801284188127189259313383422491
valves30087118012873136174245306361
sag34057118012857120189
into36307118012842112150221
the38867118012841112175
atrium,40967118012865103150188259369401
and45327118012866136207
the47747118012842112175
valves49847118012872135174243306360
do53797118012872142
not8517360012870141179
completely10667360012881151261329368431469532571641
close17417360012881120190244307
the20827360012858129191
AV230873600128121221
openings.25647360012889160222291331401470525561
During316073600128119188235274344415
systole,36107360012872143196235306344407442
blood40877360012889127198268337
from44607360012865112182292
the47857360012858128191
ventricle50117360012889152221260308346408446509
enters8517601012862133172234281335
the12227601012837108170
atrium,14277601012862101148186256366398
leading18607601012839102164234274343413
to23097601012839108
the24527601012839109171
audibility26597601012862131201240309349387427465536
of32297601012870117
functional33817601012847117187249287327396466529567
murmurs.398376010128109177224334402449504540