<prompt> First heart sound is soft in all, exceptShort PR intervalVentricular septal defectMitral regurgitationCalcified valve  <response>: S1 is loud in short PR intervalS1 is heard due to closure of AV valvesTHE INTENSITY OF S1 DEPENDS UPON -1 Position of mitral leaflets at the onset of ventricular systole Mitral leaflets at greater distance than normal - S1 loud short PR intervarMitral leaflets at a lesser distance than normal - S1 soft long P-R intervals2 The rate of rise of left ventricular pressure Low rate of rise of pressureS1 soft VSD and MRQHigh rate of rise ofpressureS1 loud ASQ3 Presence or absence of structural disease of mitral valve Calcification of mitral leafierQ Soft S1Defective closure in MRQ Soft S1 4 Amount of tissue, air or fluid between heart and stethoscopePericardial effusionQ Soft S1ObesityQ Soft S1 EmphyseinaeQ Soft S1Explanation of the loud S1 in short PR intervalPR interval denotes the time interval between atrial and ventricular contraction.PR interval occurs due to delay at the A.V. node. This delay allows maximal time for atrial contraction and protects the ventricle from fast stimulation. What would be the implication of early ventricular contraction on first heart sound ??It has been already discussed that first heart sound occurs due to closure of the mitral valve at the start of ventricular systole or contraction.At this time increased intraventricular pressure exceeds the atrial pressure and the A.V. valves close, producing first heart sound.Keep in mind one important fact that just before the start of the ventricular systole, the atrial contraction stops. The atrial contraction occurs during late diastole, just before the start of ventricular systole.With reduced PR interval the ventricle starts contracting, while the atria is still in a state of contraction.Thus at the start of a ventricular contraction, the mitral valve leaflets are maximally separated because the atria is still contracting.That means that ventricular systole will now push the mitral leaflet from a greater distance than usual.This results in loud S imagine the sound produced when a door is closed form a short distance or from a widely opened position. When the door is forced to shut from a large distance, obviously more sound will be produced.The reverse happens in longer PR intervals -Larger PR interval means there is more time lag between atrial and ventricular contraction.Thus when ventricular systole begins the mitral leaflets have already begun to close due to atrial relaxation.Thus less force is applied to the mitral valve and its closing velocity is decreased resulting in soft S1 