Second Heart Sounds

Opening Snap and Second Heart Sound Sounds

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An opening snap occurring early in diastole along with a single second heart sound can mimic a split second heart sound.

An opening snap is caused by thickened valve leaflets. When they open it produces a snapping sound.

The more severe the thickening the earlier in diastole the opening snap occurs. In this example you are hearing an opening snap which occurs 75 milliseconds after the start of the second heart sound.

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The recommended auscultation position for the stethoscope is the Mitral 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.
Diastole: Snap early in diastole, higher pitch than S2.

CaseID	52
CourseID	24
CourseCaseOrder	8
ID	40