Second Heart Sounds Second Heart Sound and Late Systolic Click Lesson Waveform Anatomy play pause Table of Contents 1Second Heart Sound - Physiologically Split #2 2Second Heart Sound with Persistent Splitting 3Second Heart Sound with Fixed Splitting 4Second Heart Sound: Fixed Splitting, Increased Aortic Intensity 5Second Heart Sound: Fixed Splitting, Decreased Aortic Intensity 6Second Heart Sound and Late Systolic Click 7Second Heart Sound and a Tumor Plop 8Opening Snap and Second Heart Sound Quiz This video is an animation of Second Heart Sound and Late Systolic Click A#24 (lesson# 6) within course number 6. Certain heart sound configurations mimic a split second heart sound.One of these conditions is a late systolic click plus a single second heart sound (S2). Since the late systolic click occurs just before the S2 it is easy to confuse the two with a split S2.Listen carefully to the two sounds. If the first of the pair is of higher frequency and shorter duration than the second, it is a late systolic click followed by a single second heart sound. Another way of distinguishing a late systolic click from a split S2 is to move the stethoscope head to the pulmonic area. The late systolic click will disappear and you will only hear the single S2.A late systolic click is caused by degeneration of the mitral valve leaflets. This degeneration causes the closing of the leaflets to make a "clicking" sound during late systole.On the Anatomy tab you will see prolapse of the anterior lateral mitral valve leaflet which is the cause of the late systolic click.