Narrow pulse pressure Pulses should be easily palpable and equal in their intensity throughout the body. Generalized week pulses is suggestive of poor cardiac output either due to severe heart failure or severe aortic stenosis. Better pulses in the upper upper extremities than the lower extremities is suggestive of coarctation of the aorta. The precordium should be normally quiet. Prominent cardiac impulses or a thrill indicate pathology.
Heart sounds in innocent heart murmurs are normal.
First heart sound should be audible. Second heart sound should split in inspiration and become single in expiration. Single second heart sound, or variation in splitting such as fixed splitting or reverse splitting, i.e. split in expiration and single in inspiration indicate pathology. Added sounds such as S4 is pathological. S3 may be normal.