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