Let us begin auscultation together by listening with the diaphragm of the stethoscope at the upper right sternal edge while timing the vents we will hear with the movement of the cotton swab on the carotid, so that we can identify systole. Let's listen and observe together. [Cut-away]
What we heard at the upper right sternal edge with firm pressure on the diaphragm was the typical cadence of the first and second heart sounds [sounds]. But, what was important is the intensity of the second heart sound. Now, normally at the upper right sternal edge, the second sound is louder than the first. But his was even louder than normal. The second heart sound was enhanced. What we heard was [sounds].
And why should we hear that? because this is a patient with hypertension and, because of the high cloding pressure in the aortic root, those valves are pushed back under that high pressure and the second heart sound is enhanced. It's subtle, but if you tune in and listen, you can appreciate the increase in the intensity of the second heart sound due to enhanced aortic valve closure at the upper right sternal edge. Let's listen together, we'll use the cotton swab again to time the acoustic events, so that we can recognize systole. Everybody listen again. [Cut-away]
Chronic hypertension
In patients with dilated aortas, a frequent finding with chronic hypertension, the aortic component of the second sound may have a tambour or kettle-drum-like acoustic quality.