According to The Hollywood Reporter, the four voice actors who make up the Family Guy cast -- Alex Borstein, Mila Kunis, Seth Green and Mike Henry -- has collectively negotiated a new salary between $175,000 and $225,000 per episode.
Hence, a patient with first degree heart block will typically have a soft first heart sound. For the same reasons a patient with variable PR interval (Mobitz I second degree AV block or third degree heart block) can have changing intensity of the first heart sound. Lyme carditis, anatomically corrected transposition and maternal lupus can all cause complete heart block.
The closing of the mitral and tricuspid valves (known together as the atrioventricular valves) at the beginning of ventricular systole cause the first part (the lubb) of the lubb-dubb sound made by the heart as it beats. Formally, this sound is known as the first heart sound, or S 1.