A patient with new-onset syncope has a blood pressure of 110/95 mm Hg and a harsh systolic ejection murmur at the base, radiating to both carotids. Auscultation of the second heart sound at the base might reveal which of the following findings?: (A) it is accentuated, (B) it is diminished, (C) it is normal in character, (D) it is widely split due to delayed ventricular ejection
Answer is B. In aortic stenosis, the first sound is usually normal; the second sound is characteristically diminished because of the increased ventricular pressure and the stenotic valve is less mobile. There can be a single S2 either because A2 and P2 are superimposed or A2 is absent or very soft. Severe aortic stenosis may be accompanied by paradoxical splitting of S2.