If a patient presents with an increased apical first heart sound on auscultation, it is commonly seen in the following situations. First, the first heart sound increases when the heart is tachycardic or the myocardial contraction is increased. For example, patients may have an increased first heart sound if they consume large amounts of strong coffee or tea under physiological conditions, smoke, drink alcohol, are overly stressed, are under stress, or exercise vigorously. For certain pathological factors, such as fever and hyperthyroidism, the heart in this case may also experience tachycardia and increased myocardial contraction, resulting in an increased first heart sound. In addition, some common pathological causes, such as mitral stenosis in rheumatic heart disease, may also result in an increased first heart sound in the early stages. In addition, for some other conditions, such as the development of valvular disease and acute rheumatic heart disease, there may also be an increase in the first heart sound.