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Left. Wide physiologic splitting of the second heart sound (S2) is seen in a patient with complete right bundle-branch block (RBBB). Audible expiratory
splitting, which widens normally with inspiration, is present. Note also the wide splitting of the first heart sound into its mitral (M1) and tricuspid (T1) sound
components, as recorded at the apex. Right. The base phonocardiogram is recorded simultaneously with high-fidelity catheters in the right ventricle (RV)
and pulmonary artery during cardiac catheterization. There is marked prolongation of the Q to the onset of the right ventricular (RV) pressure rise of 96 ms,
resulting in wide physiologic splitting of S2. The delayed pulmonic second heart sound (P2) is secondary to delayed activation of the right ventricle.
Reprinted from Shaver JA. Current uses of phonocardiography in clinical practice. In: Rapaport E, ed. Cardiology Update: Reviews for Physicians. New
Source: Chapter 14. The History, Physical Examination, and Cardiac Auscultation, Hurst's The Heart, 13e
York, NY: Elsevier, 1981:337; Shaver JA, Salerni R, Reddy PS. Normal and abnormal heart sounds in cardiac diagnosis: I. Systolic sounds. CurrProbl
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Harrington RA. Hurst's The Heart, 13e; 2011 Available at: http://mhmedical.com/ Accessed: May 10, 2017
Cardiol. 1985;10:48,
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