First Heart Sound plus Aortic Ejection Click

A single first heart sound (S1) followed by an aortic ejection click (AEC) can also mimic a split first heart sound. An AEC follows S1 by 50 milliseconds. An aortic ejection click is caused by thickened aortic valve leaflets. This is commonly seen in a bicuspid aortic valve, a congenital abnormality where someone is born with two aortic valve leaflets instead of the normal three. Listen carefully to the second sound of the pair. If it is an AEC it will have a shorter duration and a higher pitch than the first sound of the pair (S1). The AEC is best heard at the Aortic valve area where splitting of S1 is not heard.

First Heart Sound plus Aortic Ejection Click Audio

First Heart Sound plus Aortic Ejection Click auscultation sound from lesson

Patient Sounds

First Heart Sound plus Aortic Ejection Click patient recording

Half Speed Patient Sounds

First Heart Sound plus Aortic Ejection Click half speed

Technique

The patient's position should be sitting.

Auscultation Tips

Systole:high-pitched sound, early in systole, short duration

Sound Wave

Observe Cardiac Animation

An aortic ejection click is caused by thickened aortic valve leaflets. This is commonly seen in a bicuspid aortic valve, a congenital abnormality where someone is born with two aortic valve leaflets instead of the normal three.

Authors and Sources

Authors and Reviewers

ECG heart rhythm modules: Thomas O'Brien.
ECG monitor simulation developer: Steve Collmann
12 Lead Course: Dr. Michael Mazzini, MD.
Spanish language ECG: Breena R. Taira, MD, MPH
Medical review: Dr. Jonathan Keroes, MD
Medical review: Dr. Pedro Azevedo, MD, Cardiology
Last Update: 11/8/2021

Sources

Electrocardiography for Healthcare Professionals, 6th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1265013470, ISBN13: 9781265013479
McGraw Hill, 2023
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
EKG Reference Guide
EKG.Academy
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH
ECG Reference Guide
PracticalClinicalSkills.com

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