Physiologically Split S2
Normally the higher pressure left -sided valves close first (mitral before tricuspid, aortic before pulmonic). This discordance is exaggerated by inspiration, allowing the human ear to perceive two distinct sounds. During inspiration, intrathoracic pressure drops and augments RV filling. As a result, more time is required for the RV to pump the higher volume of blood into the pulmonary artery, thus delaying pulmonic valve closure.
Patient 1:
This young patient was admitted to the hospital with sepsis related to intravenous drug use. She was noted to have a physiologically split S2. Notice how the second heart splits into two distinct sounds when she breaths in.
Physiologically Split S2
Annotated
Patient 2:
A young man was admitted to the hospital with pancytopenia and was found to have acute lymphocytic leukemia. He was noted to have a physiologically split S2.
Physiologically Split S2
Annotated
Patient 3:
This patient has a physiologically split S2. (**This video has an extra sound in it and will need be re-rendered)
Patient 4:
This is a young woman who was admitted to the hospital with soft tissue infections related to intravenous drug abuse; she was found to have a physiologically split S2.
Patient 5
This is a young woman who was admitted to the hospital with an acute pulmonary embolism. There is a physiologically split S2.
Patient 6:
This is a young woman with a physiologically split S2.