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Systolic sounds - early systole

Aortic ejection sound

• Occurs when bicuspid aortic valve reaches fully open position.
• Also occurs in aortic root dilation
• Similar in pitch to A2 and P2.
• Position change (e.g. standing) does not affect timing.

Pulmonic ejection sound

• Decreases with inspiration.
• Occur when stenotic pulmonic valve reaches fully open position.
• Also occurs in pulmonary artery dilation.
• Similar in pitch to A2 and P2.
• Position change does not affect timing.

Mechanical aortic valve prostheses

• Ball valves, especially, generate early systolic sounds.
• Bioprosthetic valves do not.