About Video

This recording is taken from a 52-year-old postmenopausal woman who is a chronic smoker with history of exertional chest pain being evaluated for possible coronary artery disease. She appeared to be of normal body build for her age with normal BP and heart rate. The arterial pulse was normal. Her jugular venous pressure and contour were normal. The apical impulse was normal and formed by the left ventricle with a definite area of medial retraction. This recording is taken from the apex area of the patient. Note hear the S2 is no longer seen to be split. The only component heard is most likely to be A2. This can also be easily confirmed at the bedside by listening over the left sternal border area where the S2 is clearly split and slowly moving to the apex area keeping the rhythm of the S1 and S2 mentally (the inching method in rhythm) and determining which component becomes soft or inaudible when moving from the left sternal border area to the apex. Normally, it is the P2 that would become soft or inaudible at the apex. If the sequence is normal with A2 followed by P2, then it will be the second component that should drop out at the apex. If one quickly switches from the previous clip to this clip back and forth, one can also easily tell that the second component is the one that becomes soft and inaudible at the apex. This makes again a normal sequence in this patient.