Auscultation in Primary Care First and Second Heart Sounds - Reduced Intensity Description Waveform Anatomy This is a simulation of a first heart sound and a second heart sound with greatly reduced intensity. This can be seen in an obese patient or a patient with emphysema. It is a challenge to your ability to hear these reduced intensity sounds. play pause Maneuver:Supine Chestpiece Position:Mitral Chestpiece:Diaphragm Table of Contents Introduction First and Second Heart Sounds - Normal and Unsplit First and Second Heart Sounds - Reduced Intensity Second Heart Sound - Splitting Third Heart Sound Gallop Fourth Heart Sound Gallop Third and Fourth Heart Sound Gallop Summation Gallop at 120 beats per minute Second Heart Sound - Fixed Splitting Mid-Systolic Click Mitral Valve Leaflet Prolapse Aortic Stenosis (Diamond Shaped Systolic Murmur) Aortic Regurgitation (Decrescendo Diastolic Murmur) Mitral Regurgitation (pansystolic Murmur) Mitral Stenosis (Diastolic Murmur)