S1 is not a click; it is a symphony of tension. It begins with the high-velocity arrest of the mitral valve (M1), is quickly joined by the tricuspid valve (T1), and is rounded out by the turbulence of blood rushing into the aorta. It is the sound of the heart locking its doors to build pressure, preparing to push life forward.

: Similarly, the tricuspid valve, situated between the right atrium and the right ventricle, closes to prevent backflow into the right atrium when the right ventricle contracts. The closure of the tricuspid valve also contributes to the S1 heart sound.

: A loud S1 sound may indicate a short interval between atrial and ventricular contraction (such as in mitral stenosis) or increased force of ventricular contraction. A soft S1 sound might suggest a longer interval between atrial and ventricular contraction or problems with valve closure.

The loudness of S1 varies with the :