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Intensity of A2 and P2 Compare the intensity of the two components, A2 and P2. A2 is usually louder.

A loud P2 suggests pulmonary hypertension.

Extra Sounds in Systole

Such as ejection sounds or systolic clicks

Note their location, timing, intensity, and pitch, and the effects of respiration on the sounds.

The systolic click of mitral valve prolapse is the most common of these sounds. See Table 7-4, Extra Heart Sounds in Systole (p._).

Extra Sounds in Diastole

Such as S3, S4, or an opening snap

Note the location, timing, intensity, and pitch, and the effects of respiration on the sounds. (An S3 or S4 in athletes is a normal finding.)

See Table 7-5, Extra Heart Sounds in Diastole (p._).

Systolic and Diastolic Murmurs

Murmurs are differentiated from heart sounds by their longer duration.

See Table 7-6, Midsystolic Murmurs (pp. - ), Table 7-7, Pansystolic

Table 7-8, Diastolic Murmurs (p._).

ttributes of Heart Murmurs. If you detect a heart murmur, you ist learn to identify and describe its timing, shape, location of maximal intensity, radiation or transmission from this location, intensity, pitch, and quality.

5 Timing. First decide if you are hearing a systolic murmur, falling between S1 and S2, or a diastolic murmur, falling between S2 and S1. Palpating the ^ carotid pulse as you listen can help you with timing. Murmurs that coin-0 cide with the carotid upstroke are systolic.

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