Auscultation in Primary Care First and Second Heart Sounds - Reduced In 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. Listen The patient's position should be supine. VisualizeObserve LessonsFirst and Second Heart Sounds - Normal and Unsplit C31.✓First and Second Heart Sounds - Reduced Intensity C31.Second Heart Sound - Splitting C31.Third Heart Sound Gallop C31.Fourth Heart Sound Gallop C31.Third and Fourth Heart Sound Gallop C31.Summation Gallop at 120 beats per minute C31.Second Heart Sound - Fixed Splitting C31.Mid-Systolic Click C31.Mitral Valve Leaflet Prolapse C31.Aortic Stenosis (Diamond Shaped Systolic Murmur) C31.Aortic Regurgitation (Decrescendo Diastolic Murmur) C31.Mitral Regurgitation (pansystolic Murmur) C31.Mitral Stenosis (Diastolic Murmur) C31.Sign-in to enable progress reports and certificates.