What we heard at the upper left sternal edge was a very loud pulmonary second sound. When the patient breathed in and the sounds split it was the second, or pulmonary component, not the first, or aortic component, that was very loud. When the patient breathed in it was [sounds], and out [sounds], breathed [sounds], [sounds]. That very loud pulmonary second sound tells us something. It tells us that our patient has pulmonary hypertension, and it starts to fit together with the right ventricular impulse and the large, giant "a" wave in the neck. A loud pulmonary second sound at the upper left sternal edge. [Cut-away]