When auscultating a patient's heart at the pulmonic area, you hear a split S2 with the louder A2 component occurring slightly before the P2 component during inspiration. You recognize that this finding most likely is
a. normal physiological splitting. c. paradoxical splitting.
b. fixed splitting. d. S3.
A
There is a normal physiological splitting of S2 that is heard best at the pulmonic area. The components of a split S2 are A2 (aortic) and P2 (pulmonic). The aortic component occurs slightly before the pulmonic component during inspiration. The physiology of a split S2 is that during inspiration, because of the more negative intrathoracic pressure, the venous return to the right side of the heart increases. Thus, pulmonic closure is delayed because of the extra time needed for the increased blood volume to pass through the valve. Normally, the A2 component of the split S2 is louder than the P2 component because of the greater pressures in the left side of the heart. A fixed split is unaffected by respiration; the split is always there.
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