Essential Heart Sounds Patients who are obese or have emphysema will often have diminished heart sounds. Hearing these greatly reduced intensity sounds can take practice. Listen The patient was supine during auscultation. Visualize Observe LessonsNormal First and Second Heart Sounds - No Splitting✓Reduced Intensity First and Second Heart SoundsSplit Second Heart SoundThird Heart Sound (S3) GallopFourth Heart Sound (S4) GallopThird and Fourth Heart Sound Gallop 303Summation Gallop at 120 beats per minute 304Fixed Splitting of Second Heart SoundMid-Systolic Click 308Systolic Murmur - Aortic StenosisDiastolic Murmur - Aortic RegurgitationMitral Valve Leaflet Prolapse 309Pansystolic Murmur - Mitral RegurgitationDiastolic Murmur - Mitral StenosisSign-in to enable progress reports and certificates.