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Preface to the Second Edition 9

Ⅰ．Historical Aspects of Auscultation of the Heart 11

Ⅱ．Importance of Cardiac Auscultation；Audio-Visual Equipment 14

Ⅲ．The Physical Principles of Sound 19

Ⅳ．The Perception and Recording of Heart Sounds and Murmurs 24

Transmission Through the Tissues 24

The Stethoscope 24

Human Hearing Mechanism 26

Major Frequency Ranges of Heart Sounds and Murmurs 27

The Stethogram 28

Ⅴ．Origin of Heart Sounds and Variations in Health and Disease 30

First Heart Sound 30

Splitting of the First Heart Sound 30

Ejection Sounds 32

Second Heart Sound 33

Changes in Intensity of Heart Sounds 35

Opening of the Mitral and Tricuspid Valves 36

Physiologic Third Heart Sound 37

Fourth Heart Sound 37

Gallop Rhythms－The Role of the Third and Fourth Heart Sounds 39

Systolic Click 40

Diastolic Sound in Constrictive Pericarditis 41

Air Sounds 42

Ⅵ．Routine of Auscultation of the Heart 43

Ⅶ．On the Nature and Properties of Murmurs 46

Mechanism of Production of Murmurs 46

Classification of Murmurs for Clinical Usage 48

Timing 49

Duration 49

Intensity 49

Pitch and Quality 50

Constancy 50

Location 50

Etiologic History 50

Pathologic Murmurs 51

Nonpathologic Murmurs 52

Ⅷ．Disorders of Heart Rhythm and Conduction 53

Temporal Variation of the Cardiac Cycles 53

Variation in the Intensity of the First and Second Heart Sounds 53

Abnormal Splitting of Sounds 54

Audible Atrial Sounds 56

Ⅸ．The Auscultatory Findings in Acquired Heart Disease Systolic Murmurs 57

Mitral Insufficiency 57

Mitral Incompetence 60

Tricuspid Insufficiency 61

Tricuspid Incompetence 61

Aortic Stenosis 62

Dilatation of the Ascending Aorta 63

Dilatation of the Pulmonary Artery 64

Evaluation of Systolic Murmurs 65

Diastolic Murmurs 66

Mitral Stenosis 66

Tricuspid Stenosis 75

Aortic Insufficiency 76

Aortic Incompetence 77

The Austin Flint Murmur 77

Pulmonic Insufficiency 77

Pulmonic Incompetence (Graham Steell Murmur) 78

Combined Lesions 78

Arteriovenous Fistula or Anastomosis 79

The Venous Hum 80

Pericardial Rubs 81

Ⅹ．Auscultatory Findings in Congenital Heart Disease 83

Atrial Septal Defect 85

Partial Anomalous Pulmonary Venous Drainage 87

Ventricular Septal Defect 87

Eisenmenger＇s Complex 89

Patent Ductus Arteriosus 89

Arteriovenous Fistula 92

Idopathic Pulmonary Hypertension 92

Pulmonic Stenosis with Intact Ventricular Septum 92

Tetralogy of Fallot 94

Aortic Stenosis 97

Coarctation fo the Aorta 97

References 99

Index 101