Second Heart Sounds Second Heart Sound with Persistent Splitting This example shows persistent splitting of the second heart sound. Splittiing 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. play pause Position: Pulmonic Chestpiece: Diaphragm Maneuver: Supine Phonocardiogram Cardiac Animation 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 Practice Drill