After auscultating the aortic area, you determine that a patient has a diminished A2 and an ejection click. The most likely cause of these two findings is
a. arterial hypertension.
b. aortic stenosis.
c. the presence of an artificial aortic valve.
d. ruptured chordae tendineae of the aortic valve.
B
The second heart sound (S2) is associated with the closure of the semilunar valves. You can hear it with the diaphragm on the aortic landmark. The components of S2 are A2 (aortic) and P2 (pulmonic). A greatly intensified or diminished A2 is considered abnormal. A diminished A2 can be caused by aortic stenosis where the aortic valve is calcified or thickened. The ejection click occurs early in systole at the start of ejection because it results from the opening of the semilunar valves. Normally, the semilunar valves open silently, but in the presence of aortic stenosis their openings make a sound. It is short and high pitched, with a click quality. A greatly intensified A2 can be the result of arterial hypertension that increases the pressure in the aorta.
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