S2 VARIATIONS

Question 1

Listen for in 2nd and 3rd left interspace

• Normally accentuated by inspiration and disappears on expiration

Answer 1

Physiological Splitting

Question 2

what are the pathological splitting types?

Answer 2

wide physiological splitting
fixed splitting
paradoxical/reversed splitting

Question 3

name this type of pathological splitting?

• Delayed closure of pulmonic valves (pulmonic stenosis or right bundle branch block)
• Early closure of aortic valve (mitral regurgitation)

Answer 3

Wide physiological

splitting

Question 4

name this type of pathological splitting?

Wide and unvarying with respiration

• Atrial septal defect
• Right ventricular failure

Answer 4

Fixed splitting

Question 5

name this type of pathological splitting?

Appears with expiration and disappears with inspiration

• Aortic valve closure is abnormally delayed so A2 follows P2 in normal respiration
• Normal inspiratory delay of P2 makes splitting disappear in expiration
• Common with left bundle branch block

Answer 5

Paradoxical/reversed

splitting

Question 6

what are the types of A2 sounds?

Answer 6

increased intensity

decreased intensity

Question 7

what are the types of P2 sounds?

Answer 7

increased intensity

decreased intensity

Question 8

name this type of A2?

Can usually only be heard in right 2nd interspace

• Systemic hypertension (increased pressure load)
• Aortic root dilated (increased proximity of aortic valve to chest wall)

Answer 8

A2 (increased intensity)

Question 9

name this type of A2?

Calcified aortic stenosis (valve is immobile)

Answer 9

A2 (decreased intensity)

Question 10

name this type of P2?

• Pulmonary hypertension
• Dilated pulmonary artery
• Atrial septal defect

Answer 10

P2 (increased Intensity)

Question 11

name this type of P2?

• Increased AP diameter of chest (common with aging)
• Pulmonic stenosis (stenoses decrease intensity)

Answer 11

P2 (decreased intensity)