Persistently Split S2

A persistently split S2 describes the presence of a split S2 on expiration that widens further upon inspiration. The most common cause of a persistently split S2 is a right bundle branch block, but it can occur whenever there is prolonged right ventricular ejection, such as outflow obstruction, pulmonary hypertension, or increased RV output.

 

Patient 1:

This is an older man with severe pulmonary hypertension and a right bundle branch block. Note the persistently split S2 as well as a split S1.

Persistently Split S2

Annotated

Patient 2:

This is an older woman with severe pulmonary hypertension from lung disease and a right bundle branch block. The split S2 widens slightly during inspiration but remains split during expiration.

done

Patient 3:

This is a middle-aged woman with severe primary pulmonary hypertension. The split S2 widens slightly during inspiration but remains split during expiration.

Persistently Split S2

Annotated

Patient 4:

This patient has a persistently split S2.

Persistently Split S2

Annotated

Patient 5:

This is a young patient who was admitted to the hospital for tricuspid valve endocarditis related to intravenous drug use. Notice that the S2 is split during inspiration and expiration and the heart sounds become louder during expiration. An EKG did not demonstrate either a left or right bundle branch block. The cause of the persistently split S2 remained unknown.

Persistently Split S2

Patient 6:

This patient has

Persistently Split S2

Annotated