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in which MV = mitral valve, TV = tricuspid valve, PV = pulmonic valve, AV = aortic valve, c = closing, and o = opening.

Figure 14-4 Surface topography of the heart. 5ICS-MCL, fifth intercostal space at the midclavicular line.

The mitral component of S1 occurs as a result of the closure of the mitral valve when the left ventricular pressure rises above the left atrial pressure;it is written Mx. The tricuspid component of S1 occurs as a result of closure of the tricuspid valve when right ventricular pressure rises above right atrial pressure;it is written Tj.

The time between the closure of the atrioventricular valves and the opening of the semilunar valves is the period of isovolumetric contraction. When the pressure in the right ventricle exceeds the diastolic pressure in the pulmonary artery, the pulmonic valve opens. A pulmonic

Figure 14-5 Auscultatory areas.

Aorta

Left atrium Left ventricle

Pulmonary artery

Right atrium Right ventricle

Valve motion/sounds

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