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Upper left. Sound and pressure correlates of the second heart sound (S2) in a 45-year-old woman with a normotensive atrial septal defect (shunt 2:1).
Wide, fixed splitting of S2 is demonstrated; pulmonic second heart sound (P2) and aortic second sound (A2) are coincident with their respective incisurae,
and the duration of the hangout interval is nearly equal to the A2–P2 interval. Upper right. Simultaneous right ventricular (RV) and left ventricular (LV)
pressures clearly show that the duration of RV and LV systole is equal. Lower left. Sound and pressure correlates of a patient with idiopathic dilatation of
the pulmonary artery. P2 is coincident with the incisura of the pulmonary artery and separated from the RV pressure tracing by a hangout interval of 90 ms
(almost identical to the splitting interval). Lower right. Similar sound and pressure correlates in a patient with mild valvular pulmonic stenosis and
Source: Chapter 14. The History, Physical Examination, and Cardiac Auscultation, Hurst's The Heart, 13e
aneurysmal dilatation of the pulmonary artery. Most of the delay in P2 is caused by a wide hangout interval of 56 ms. In each patient all pressures are
Fuster V,
Walsh RA, Harrington
RA. Hurst'sartery;
The Heart,
13e; 2011
Available
at: http://mhmedical.com/
May
11,O'2017
recorded by Citation:
catheter-tipped
micromanometers.
PA, pulmonary
SM, systolic
murmur.
Reproduced
with permission Accessed:
from Shaver
JA,
Toole JD.
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©
2017
McGraw-Hill
Education.
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Second heart sound: the role of altered greater and lesser circulation. In: Leon DF, Shaver JA, eds. Physiologic Principles of Heart Sounds and Murmurs
(Monograph 46). New York, NY: American Heart Association, 1975:63. Reproduced originally in part (top panel) with permission from the publisher and
the authors; and from Shaver JA. The second heart sound: hemodynamic determinants. Acta Cardiol. 1985;40:12.