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Wide split second (2nd) heart sound

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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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