The Sounds of the Diseased Heart.

Raymond Pietras, MD
Arch Intern Med. 1974;134(3):597-598. doi:10.1001/archinte.1974.00320210207040.
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This book is the companion to an earlier volume—The Sound of the Nor-mal Heart. The author attempted to produce a comprehensive text on auscultation and phonocardiography directed to the clinical cardiologist. Mechanisms for the production of the heart sounds are espoused that differ from those currently accepted and thereby diminish the usefulness of this book for the less affluent student. The classical explanation of the first heart sound is abandoned and its vibrations are attributed to acceleration and deceleration of the blood-filled ventriculoaortic system. The first heart sound is divided into three components. The first coincides with the rapid rise of pressure within the ventricle after closure of the atrioventricular valves, the second with the dynamic changes associated with the opening of the aortic valve, and the third with the end of rapid distension of the aorta. The second heart sound is ascribed to vibrations of the closed


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