Cardiac Exam - Auscultation Apex

You are incorrect - our patient's acoustic events at the apex include a first heart sound, a second heart sound and a third heart sound (S3).

Your choice: S1 + ejection sound (ES) + S2

This is a graphic example of an S1, an ejection sound (ES) and an S2. Note that the ejection sound is high frequency, helping to distinguish this S1-ejection sound combination from that of a low frequency S4-S1 combination. The distribution of an ejection sound is also helpful, being well heard at the base, where an S4 is poorly heard. In this case, the finding is due to bicuspid aortic valve.