[Cut-away] it is clear that our patient’s second sounds split in inspiration, so when you listen in inspiration you hear [sounds]; [sounds] in expiration. That is normal. In addition, the intensities of these sounds are also normal. So, we have normal findings at the upper left sternal edge.
Now, I have carefully listened at the upper right and at the lower left sternal edge, and in both situations the findings are entirely normal, but do that thorough examination, because you just may get clues. For example, in the situation where a patient has an acute inferior wall myocardial infarction, it can involve the right ventricle, and when it does, certain findings, at the lower left sternal edge especially, may be a clue to that involvement. For example, you may hear a fourth sound from the right side, so when you listen, you hear [sounds]. And that fourth sound increases with inspiration often when it is from the right side. In addition, you may hear just a whiff of regurgitation of the tricuspid valve due to papillary muscle dysfunction on that side from the ischemia or infarction, and so when you listen in systole, you will hear [sounds]. Again, it could increase with inspiration.
In sumary, while the findings in these three areas are normal in our patient, do that careful examination. You may get a clue to the extent and you may get a clue to the types of complications that are occurring in your patient with acute myocardial infarction.