What is a physiological split S2?

A split S2 is a finding upon auscultation of the S2 heart sound. It is caused when the closure of the aortic valve (A2) and the closure of the pulmonary valve (P2) are not synchronized during inspiration.

Where is split S2 best heard?

Exam Technique in Second Heart Sounds

• Splitting best heard in the 2nd left intercostal space, close to the sternal border.
• Use the diaphragm of your stethoscope.
• Second heart sounds are best heard when patients are semi-recumbent (30-40 degrees upright) and in quiet inspiration.

Why does ASD cause fixed split S2?

The authors suggested that fixed S2 splitting in ASD was “a manifestation of right-sided diastolic hypervolemia” due to left to right shunting. They hypothesized that the persistence of S2 splitting in the other cases may have been due to persistent shunting between the pulmonary vasculature.

Is S2 always split?

The S2 heart sound can exhibit persistent (widened) splitting, fixed splitting, paradoxical (reversed) splitting or the absence of splitting. The S2 heart sound intensity decreases with worsening aortic stenosis due to immobile leaflets. In severe aortic stenosis, the A2 component may not be audible at all.

How can I tell if my S2 is split or S3?

A S3 heart sound should disappear when the diaphragm of the stethoscope is used and should be present while using the bell; the opposite is true for a split S2. Also, the S3 sound is heard best at the cardiac apex, whereas a split S2 is best heard at the pulmonic listening post (left upper sternal border).

Is S1 systole or diastole?

S1 and the 2nd heart sound (S2, a diastolic heart sound) are normal components of the cardiac cycle, the familiar “lub-dub” sounds. S1 occurs just after the beginning of systole and is predominantly due to mitral closure but may also include tricuspid closure components. It is often split and has a high pitch.

What does a loud S2 indicate?

The second heart sound (S2) represents closure of the semilunar (aortic and pulmonary) valves (point d). S2 is normally split because the aortic valve (A2) closes before the pulmonary valve (P2).

Does VSD cause split S2?

The precordium may be hyper-dynamic and the cardiac apex may be displaced inferiorly and to the left. The auscultatory findings are also variable and may include a systolic ejection murmur due to increased flow through the pulmonary valve with wide and fixed splitting of S2 as in ASD.

Where is S1 and S2 best heard?

apex
You’ll hear S1 best at the apex of the heart, the left lower sternal border, or the mid-left sternal border. The second heart sound (S2) occurs when the aortic and pulmonic valves, also known as the semilunar valves, close. The closing of the aortic valve, called A2, is loud.

Is S1 louder than S2?

Normally, S1 is louder than S2 at the apex, and softer than S2 at the base of the heart. Pathologic changes in the intensity of S1 relative to S2 may be seen in certain disease states. When evaluating the intensity of S2, note the relative intensity of the aortic component (A2) and the pulmonic component (P2).

Where is the S1 sound heard the loudest?

The 1st heart sound, S1 (lub), marks the beginning of systole (end of systole). Related to the closure of the mitral and tricuspid valves. Loudest at the apex.

What causes a split S2 in the heart?

Wiggers diagram of various events of a cardiac cycle, with 2nd heart sound at bottom. A split S2 is a finding upon auscultation of the S2 heart sound. It is caused when the closure of the aortic valve (A2) and the closure of the pulmonary valve (P2) are not synchronized during inspiration.

What kind of sound is a split S2?

When these sounds are distinguishable from each other a split S2 can be heard. The patterns of splitting of the S2 heart sound include physiologic splitting, paradoxical splitting, widened splitting and fixed splitting.

Why does my S2 split during deep inspiration?

In this case, the splitting is due to a normal physiologic cause: respiration. In most healthy adults, a splitting of S2 can be heard during deep inspiration. The reason for this relates to the fact mentioned in the murmur overview discussion that the second heart sound is actually a blending of the closing sounds of two distinct heart valves.

Can a supine position cause a split S2 sound?

The supine position in young patients, for example, may yield an erroneous impression of abnormally wide S2 splitting, which can be avoided by reexamining the patient in the sitting or standing position. The Valsalva maneuver may also be used to exaggerate splitting of the second sound.