Simultaneous phonocardiograms are recorded with the mitral valve echocardiograms in three patients: mitral stenosis (MS) (left), left atrial myxoma (center), and prolapse of the mitral valve (right). In each condition, a loud mitral first sound (M1) is present and coincident with the closing point of the mitral valve echocardiogram. Common to each condition is wide separation of the mitral leaflets at the onset of left ventricular (LV) systole, with high-velocity closure occurring over a large excursion. In the left panel, a mobile stenotic valve is demonstrated, and a loud opening snap (OS) is coincident with the E point. In the center panel, an early diastolic tumor plop (TP) is coincident with the maximal excursion of the tumor during its rapid descent into the ventricle. Note the presystolic crescendo murmur (PSM) occurring during the rapid closure of the mitral valve in both MS and left atrial myxoma. In the right panel, a pansystolic murmur (PSM) with late systolic accentuation is secondary to the prolapse of the mitral valve with late systolic hammocking. A2, aortic second sound; P2, pulmonic second heart sound; S1, first heart sound. Shaver JA. Current uses of phonocardiography in clinical practice. In: Rapaport E, ed. Cardiology Update: Reviews for Physicians. New York, NY: Elsevier, 1981:370. Reproduced in part (center panel) with permission from the publisher and author. Copyright 1981 by Elsevier Science Publishing Co., Inc. Source: Chapter 14. The History, Physical Examination, and Cardiac Auscultation, Hurst's The Heart, 13e Citation: Fuster V, Walsh RA, Harrington RA. Hurst's The Heart, 13e; 2011 Available at: http://accesscardiology.mhmedical.com/DownloadImage.aspx?image=/data/books/hurs13/hurs13_c014f061.jpg&sec=40282034&BookID=376&ChapterSecID=40279740&imagename= Accessed: November 14, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved