This example shows a second heart sound (S2) with fixed splitting and an aortic component with increased intensity.

This pattern is seen in the presence of long-standing severe hypertension where the pressure in the aorta is markedly increased.

Once again, we are using fixed splitting of S2 to make it easier to concentrate on the relative intensities of the aortic and pulmonic component of S2.

This condition is caused by essential hypertension. Note the increased thickness of the left ventricular wall.