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The S2 heart sound can exhibit persistent (widened) splitting, fixed splitting, paradoxical (reversed) splitting or the absence of splitting. Both of these abnormalities cause a delay in the aortic valve closure until after the pulmonic valve closure, reversing the normal sequence of events. S2 is physiologically split in about 90 of people. S2 is normally split because the aortic valve (A2) closes before the pulmonary valve (P2). The second heart sound (S2) represents closure of the semilunar (aortic and pulmonary) valves (point d).
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Paradoxical splitting can occur with aortic stenosis and left bundle-branch block. S1 is normally a single sound because mitral and tricuspid valve closure occurs almost simultaneously. In paradoxical splitting the maximum separation occurs at peak expiration.
Split second heart sound manual#
Methods proposed in the past to measure the split noninvasively are limited either by prior signal modeling assumptions or by reliance on manual processing in key steps. The second heart sound may be closely split in healthy dogs as resting heart rates, 7 but this is not commonly detected. The time separation between A2 and P2 is known as the A2- P2 split and it has very important diagnostic potential. Some cardiac sounds can be heard with the unaided ear (e.g. Remember these areas do not correspond to the location of heart valves, but the areas where the cardiac sounds are best heard. In physiologic splitting the maximum separation between aortic and pulmonic components of the second heart sound occurs at peak inspiration. Closure of the aortic valve (A2) and the pulmonary valve (P2) generates the second heart sound (S2). Auscultation for heart sounds is mainly done in 4 areas, namely Mitral, Tricuspid, Aortic & Pulmonic. The variation in splitting is a function of the respiratory cycle. The second heart sound (S2) is caused by the closure of the aortic and pulmonic valves, which causes vibration of the valve leaflets and the adjacent structures.During expiration, the pulmonic valve closes at nearly the same time as the aortic, and splitting of S2 cannot be heard. In this recording, the splitting varies between zero and eighty milliseconds. The second heart sound's splitting and intensity can indicate several types of cardiac abnormalities. These valves can close at slightly different times. Essential Heart Sounds Split Second Heart Sound This lesson covers physiologic and paradoxical splitting of the second heart sound.Īs described earlier, the second heart sound is produced by the closing of the aortic valve and the closing of the pulmonic valve.