Second Heart Sounds Second Heart Sound with Fixed Splitting This example shows fixed splitting of the second heart sound. The second heart sound remains unchanged through inspiration and expiration at sixty milliseconds.Fixed splitting of the second heart sound (along with murmurs) indicates the presence of an Atrial Septal Defect, a congenital heart defect in which the intra-atrial septum is incomplete resulting in a hole between the left and right atria.The murmurs have been eliminated in this lesson so that you can concentrate on the fixed splitting of the second heart sound. In a later lesson you will hear the fixed splitting of S2 along with the murmurs of Atrial Septal Defect. 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