The first heart sound consists of two components: mitral  and tricuspid.  These two components are separated by a short interval which creates an audible narrow splitting of S1.  Here, you can find more information and a good example of the normal splitting of S1.

A lot of information is enciphered in heart sound.  There are two main problems:  it is difficult to perceive this sound because it is too faint, and it is not simple to interpret reaped information.  The later is some kind of understanding a foreign language.  Let us continue our talk about the language of the heart.

I am going to publish a series of posts about issential heart sound and murmurs. I will try to be explicit and breaf. And I will try to give information relevant to clinical use.
The first heart sound will be the first. This is natural, isn't it?

In patients with lung emphysema, heart sound is faint and sometimes is almost absent while performing auscultation on precordial area. In fact, among many of such patients heart auscultation is useless. Is there any solution?

Many cardiologists are not able to perform effective cardiac auscultation and helpless without ultrasound. Sad but true. But some simple skills can significantly improve the situation. In the nearest future, I hope to publish my book which will simplify the development of these skills, one of which I called 'chronological localisation'. This skill is vital. Heart auscultation just does not exist without it.
Fortunately, you need to memorise very little logical information. Later, practice this skill. More in the slideshow.
This is a part of my book which will appear soon.

So, here you are with stethoscope in your hands facing your first patient. Or maybe not the first?
Auscultation has to be performed quickly but without any omissions. One more time: quickly and comprehensively.
The rest is in the slideshow.

We gave some advice how to choose a stethoscope earlier. Now, let's talk about how to use it.