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Split second heart sound(widened)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The second heart sound is widely split if there is an early A2 or if the P2 is delayed.

  • Early A2 can occur in mitral regurgitation or ventricular septal defect. There is a shortening of left ventricular systole because of diminished resistance to left ventricular ejection.
  • Delayed P2 - possible causes include :-
    • right bundle branch block, where there is delay in the activation of the right ventricle
    • pulmonary stenosis - the P2 is soft and delayed;
    • atrial septal defect with left to right shunt - there is an increase in right ventricular stroke volume which causes a delayed P2
    • prolonged right ventricular contraction as a result of right ventricular failure.

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