288
5154147819011156112
4.1205596012870106
Stretching13465960128149188236298336399468507577647
of2029596012883130
the2194596012852123184
valve2414596012884146185254317
opening2766596012883154216286324395464
during3266596012883153201238308379
dilatation3680596012883122160223266328367405476545
of4261596012883130
the4426596012853123186
heart4647596012883145208253292
chambers4975596012875145208317385448495549
or851839012870117
vessels10038390128154216271325387425480
(aorta,15198390128130191262309347410445
left19978390128123186232270
atrium).23038390128146185231270340449494529
The28678390128169239301
cause32038390128146209279333396
may36348390128193253324
be39918390128154217
myocarditis,42438390128193262330393455502572612651690745780
dilated50598390128152191230292330393462
cardiomyopathies.85110800128621251712422803514615295986687317698408789419941030
The12051321012886155218
majority145813210128137197236305353392431502
of19931321012897144
functional21721321012874145214276315355424494557595
murmurs280213210128136204251362430477531
are33691321012889136198
systolic.36011321012882153206245316354394455490
Exceptions412713210128112182245307376416454524594648
include48101321012866137198237307378440
two52851321012866168236
functional8511563012847117188249289327397467530568
diastolic14541563012873112174228267338376414477
murmurs197015630128109178225334402449504
–25091563012876
Graham-Steel262415630128101147208279342451495574613675737776
murmur343815630128110177225335403450
(relative3923156301285097159198260299337408470
insufficiency44281563012842112167237284332370433471533604665736
of51971563012873121
the53531563012842112173
left8511805012839102149186
atrioventricular10731805012891130177215284355418487525573612673744782845892
valves)20001805012897160199268331385432
and24671805012891160230
Flint273318050128106144183253292
murmur306018050128138207254363431478
–357318050128103
a37111805012891
murmur383718050128138206253363431478
of435018050128100147
functional45321805012876146215278316355425495558595
mitral516318050128138174214261323361
stenosis851204601285594157226296351389444
with133320460128101138178247
organic16162046012872118188251320359422
aortic20732046012863133180218258320
insufficiency.24292046012839110164234281328366428467529599662732766
The32322046012885155218
mechanism348720460128109169231302364435474528638
is4158204601284196
related42892046012849111150212251314383
to47082046012841110
the48542046012841110173
fact50622046012849111174212
that53092046012841111174211
during8512288012870141188226296366
diastole,12532288012880120182236275345384446482
the17702288012850120182
blood19882288012880119189259328
flow2352228801285897167269
returning26552288012859121160230277346385455526
from32162288012858104174284
the35332288012850121184
aorta37522288012874144191229292
through40792288012851120167237307377446
the45612288012850120183
incompletely47792288012851120183252362430475538577640677748
covered8512529012862133202265312374443
aortic133025290128106176224261300363
valve172825290128114177215285347
opening210925290128114185248317356426495
strikes26402529012899138184223293356409
the30852529012883153215
anterior333425290128106176216279326363433480
leaflet38492529012883146208254293356394
of427825290128114162
the44752529012882152215
mitral472525290128153190229277339378
valve,513925290128113175214284347382
resulting8512771012847109164233273311351420490
in13772771012880150
the15622771012880149212
narrowing180927710128111173220267336438476546617
of246127710128111158
the26542771012879149212
mitral290127710128151187227274336375
valve331127710128112174212283345
opening369127710128112181244313353422492
–421827710128116
a436927710128104
functional45072771012889159228291330369438509571610
mitral515227710128151188227274336373
stenosis.851301201285594157226296351389444480
Unlike136630120128139208247285356419
organic182030120128107154223285355395456
murmurs231130120128148216263373441488543
in28893012012877148
mitral307230120128147184224271333371
stenosis,34783012012893132194264334388428482517
the40303012012877147209
Flint427430120128116156194263303
murmur461230120128148215263373441488
is51353012012877132
not530330120128108177216
accompanied8513254012862125187257367435498568606669738
by16253254012887158
the18163254012857128191
appearance20423254012878149218281343390453522584647
of27233254012888135
the28923254012856126189
opening31163254012886156218288328397467
tone36183254012856126196259
of39123254012887134
the40813254012855125188
mitral432232540128109145185232294332
valve,46903254012888149188258321356
and50813254012880149218
the53353254012855126188
rhythm8513495012847117188225296405
of12893495012870117
a14413495012862
quail's15383495012871141204242281307360
song19343495012855124193264
is2234349501283792
not23603495012870141179
heard.25733495012870133196242312347
Differences120537370128101140187234296343405474537600653
between18943737012870131170272334396465
functional23953737012845115186248287325395465528566
murmurs299737370128109176224334402449504
and35363737012862131202
organic37723737012870117186249318358420
murmurs:422737370128110177224335402450504544
1.12053979012870106
Functional134639790128149220290352391430500570633670
murmurs205239790128109177224334402449504
are25913979012863110172
more279839790128109177224286
often31193979012870117156219288
heard34433979012870132194241311
in37893979012838109
systole.39333979012853124177216287325388423
2.12054220012870106
They134642200128157227290360
are17394220012863109172
more194642200128110177225287
often22684220012870117156219288
heard25904220012870133195242311
over29374220012870139202249
the32214220012838108170
apex34264220012864134196266
and37284220012862131202
left39654220012838101147185
atrium.41864220012862101148186256365398
3.12054461012870106
They134644610128157227290360
are173944610128120166229
characterized200344610128119190253299362424462525572609671734804
by284244610128127197
variability,307344610128127190236275338407447485525563634667
appearing377544610128121191261323386432470541611
and442144610128120189259
disappearing,471644610128126166220282352422484546593632702771807
occurring8514702012870133195264312358396467536
in14234702012839108
one15654702012870141204
position18024702012871140195234273312382452
and22904702012862131201
disappearing25254702012870110164227296366428491537575646716
in32764702012838108
another.34204702012862131201240310372419454
4.12054945012870106
They134649450128157227290360
never17394945012875138208271317
occupy20914945012874137198268338408
the25334945012843114176
entire27444945012867136176214261324
systole;31024945012859129182221291331393431
they35694945012842113174243
are38464945012866113176
often40574945012874122161223292
heard43854945012873136198245314
in47354945012842113
the48834945012843112175
middle,509749450128110146217288326389424
not8515186012870141179
associated10665186012862115170240303341403442504574
with167651860128101140178248
heart19595186012871132194241280
sounds.22755186012853123193263333387425
5.12055427012870106
They134654270128157227290360
are17395427012873120182
not19565427012881151190
accompanied21815427012873134197267377445507578617679749
by29665427012879150
changes31495427012873143206275345407462
in36475427012848117
the38005427012849119182
volume40175427012879150188258368428
of44805427012880127
tones,46435427012849120189252305341
splitting,50195427012864134173212251289328398469503
or8515669012870117
other10035669012871109179241288
signs1326566901285593163233287
of16495669012870117
heart18005669012870133195241279
defects.21145669012870133179241303342396432
6.12055911012870106
They134659110128157227290360
do17395911012870141
not19155911012871140179
have21285911012871133202265
characteristic24285911012863133194240302365404467512551605645683746
radiation.32095911012847109178217279318357426497533
7.12056152012870106
In134661520128118188
terms15706152012839101147257309
of19146152012870117
volume20666152012871141180250360420
and25216152012862133203
timbre,2760615201283777186254301364399
they31946152012838109171241
are34686152012863109172
softer,36756152012854125171210273319355
gentler,40646152012870132202241280342389424
blowing.45236152012870108179281318389458494
Extracardiac12056393012886155195242304366428475544583646707
Murmurs.194763930128125195242351420467520557
These12056635012886155218273336
are15756635012878125188
murmurs181566350128109177224333401448503
that23536635012856126188227
occur26156635012887148211281327
synchronously29776635012871142210273342389460529599668723762833
with385966350128102140180250
the41456635012854124186
activity43666635012879140179218288327365436
of48376635012886133
the50056635012855125187
heart52276635012887149211258296
but8516877012870141179
are106668770128101147209
not131068770128109179218
associated156368770128100155209280342381443481543613
with221268770128140178217287
damage253468770128108171280340411473
to30436877012878147
the32266877012877147210
valve347068770128110171210280343
apparatus384868770128100170240303350411450519574
or445768770128109157
disturbance464968770128108146201240310357427489559622683
of536768770128108155
intracardiac8517118012839110148195258320381428498537600662
hemodynamics.1548711801282152783874555265966657278388749379921027
They261071180128232302364434
include307971180128185256318357427497560
pericardial367471180128216279324363426487534604643706743
friction445271180128193240279341380419490559
noise,504771180128216286324379442476
pleuropericardial8517360012870110172241289358427490537575638700747816855917956
noise,18417360012870141179234296331
and22077360012862132203
cardiopulmonary24467360012862123170240278348419488527637704775838884955
noise.34347360012870140180238301336
Pericardial12057601012878140187226289351397467506568606
Friction18477601012878125164225264302373443
Noise:232576010128102170209263326364
It2724760101284786
occurs28447601012870133195265312365
with:324576010128101139179248287