Essential Heart Sounds Reduced Intensity First and Second Heart Sounds - Auscultation Lesson Patients who are obese or have emphysema will often have diminished heart sounds. Hearing these greatly reduced intensity sounds can take practice. Listen The patient's position is supine. Visualize Observe LessonsNormal First and Second Heart Sounds - No Splitting.✓Reduced Intensity First and Second Heart Sounds.Split Second Heart Sound.Third Heart Sound (S3) Gallop.Fourth Heart Sound (S4) Gallop.Third and Fourth Heart Sound Gallop.Summation Gallop at 120 beats per minute.Fixed Splitting of Second Heart Sound.Mid-Systolic Click.Systolic Murmur - Aortic Stenosis.Diastolic Murmur - Aortic Regurgitation.Mitral Valve Leaflet Prolapse.Pansystolic Murmur - Mitral Regurgitation.Diastolic Murmur - Mitral Stenosis.Sign-in to enable progress reports and certificates.