First Heart Sound (Markedly Split)

If the splitting of the first heart sound is large (about 50 milliseconds) it is an indication of an abnormal condition called Right Bundle Branch Block. The splitting is most clearly heard at the tricuspid area.

In the mitral valve area, the mitral component is louder.

At 50 milliseconds, the splitting of the first heart sound is clearly audible.

First Heart Sound (Markedly Split)
The recommended auscultation position for the stethoscope is the Tricuspid position. For this sound, use stethoscope's Diaphragm.


maneuver
The recommended patient position is Supine

Phonocardiogram

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

Heart Animation

Lessons
left button        right button



Listening Tips
A synopsis of important sound features and timing for this abnormality.
S1: Splitting..
Auscultate this sound over tricuspid and mitral areas.
CaseID40
CourseID23
CourseCaseOrder3
ID28