Audible atrial flutter sound creates a strange impression of two simultaneously beating hearts in one chest cavity. It is a rare and subtle sign. Here I will show you two cases.

A tragic case when a definite diagnosis was made by the Echo after a patient's death.

It is great to achieve the best result of treatment with minimum cost and risk. This is such story. Watch the video:

It is more likely to make a correct diagnosis of unfrequent disease when you remember this disease. 


A middle aged woman, apex of the heart: ...

Asymptomatic middle aged woman with some severe heart problem. Soon she had cardiac surgery. Can you make a diagnosis from this audio fragment of her heart sound:

It is simpler to make a correct diagnosis when you have an appropriate experience. If you have extensive experience, you can make the diagnosis almost automatically without any mental strain.
It 's hard to make a diagnosis when you meet some disease for the first time, especially when this disease is rare. That is why it is useful to read good descriptions of clinical cases. Here is another one challenging case.

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.