Second Heart Sounds

Second Heart Sound with Persistent Splitting Sounds

This example shows persistent splitting of the second heart sound. Splitting varies between thirty milliseconds at peak expiration and sixty milliseconds at peak inspiration.

With normal physiologic splitting the second heart sound is not split at peak expiration. With persistent splitting, the second heart sound is split in both inspiration and expiration although the degree of splitting is reduced in expiration.

This type of splitting is associated with Right Bundle Branch Block a condition in which the electrical signal which causes contraction of the right ventricle is blocked.

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The recommended auscultation position for the stethoscope is the Pulmonic position. For this sound, use stethoscope's Diaphragm.

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The recommended patient position is Supine

Phonocardiogram

This waveform plots sound amplitude on the vertical axis against time on the horizontal axis.

Heart Animation

Lessons

1	Second Heart Sound - Physiologically Split #2
2	Second Heart Sound with Persistent Splitting
3	Second Heart Sound with Fixed Splitting
4	Second Heart Sound: Fixed Splitting, Increased Aortic Intensity
5	Second Heart Sound: Fixed Splitting, Decreased Aortic Intensity
6	Second Heart Sound and Late Systolic Click
7	Second Heart Sound and a Tumor Plop
8	Opening Snap and Second Heart Sound

Practice Drill

Listening Tips
A synopsis of important sound features and timing for this abnormality.
S2: Splitting varies with respiration.

CaseID	45
CourseID	24
CourseCaseOrder	2
ID	33