I have a size 30 St Jude Valve...the largest. Meaning I have a very loud tick.
I was once pulled over for speeding while on business in Oklahoma. I was in a rental car so the officer had me sit in the front seat of his car while he wrote the ticket. He paused and asked if that was my watch ticking (something I've been asked many times). I smiled and told him I don't wear a watch then showed him my medical alert bracelet.