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Abstract
Changes in both the first and second heart sounds may be audible on auscultation in older persons whose hearts are “normal.” A common phenomenon in aged persons with aortic atherosclerosis is an ejection murmur. Bundle-branch block and atrial fibrillation also change the heart sounds. Previous myocardial infarct alters the first and second sounds, causes a third or fourth sound, and sometimes results in mitral insufficiency.