Page 1 of 1: WIDE SPLIT S2..........

dr_nidhi · Credits: 13101 My Scrapbook My Reading List 5 Books

Q.WIDE SPLIT S2 IS SEEN IN-----
A.LUTEMBACHER SYNDROME
B.AS
C.LBBB
D.MS
E.EISSENMENGER WITH ASD

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WHEN U REALLY WANT SOMETHING THE WHOLE UNIVERSE CONSPIRES IN UR FAVOUR............

neelanjana · Credits: 2096 My Scrapbook

I GO WITH LUTEMBACHER(ASD).WIDE FIXED SPLIT ALSO IN SEVERE PS AND SEVERE RIGHT HEART FAILURE.

Bruno · Credits: 45660 My Scrapbook My Reading List 50 Books

Reference

neelanjana · Credits: 2096 My Scrapbook

refrnce is my undergraduate clinical medicine book by dr.rajendran and george mathew.i will give it here. ABNORMALITIES IN SPLITTING OF S2 (1) WIDE FIXED SPLIT -A2 AND P2 HEARD AS 2 SOUNDS WIDELY SEPARATED DURING INSPIRN AND EXPIRATION .CAUSES-ASD,SEVERE RIGHT VENTRICULAR FAILURE . (2) PARADOXICAL SPLIT (REVERSED SPLIT )- P2 FIRST FOLLOWED BY A2,SPLIT MAXIMUM IN XPIRATION.CAUSES-SEVERE AS,LBBB,SEVERE LVF, HYPERTENSION (3) ABSENCE OF SPLIT (SINGLE S2 )- S2 HEARD AS SINGLE SOUND IN XPIRN AND INSPIRN. CAUSES-TOF (P2 SOFT AND INAUDIBLE ,SO ONLY A2 HEARD ) EMPHYSEMA (P2 INAUDIBLE ) EISENMENGER VSD (A2 AND P2 FUSED TOGETHER )

alekhin · Credits: 2171 My Scrapbook

yup

so

WIDE FIXED SPLIT - ASD

REVERSED SPLIT - AS, syst. HT, LVH, LBBB

guest · Credits: 79189 My Scrapbook My Reading List 262569 Books

Split S2 or saplit (As our worthy PM Manmohan singh pronounced it during his speech in Oxford, London to emphasize the point that how indians have indegenized English) S2

Abnormal splitting of S2 (splitting other than that normally observed during inspiration) is associated with
1. delayed electrical activation of the right ventricle (as in complete right bundle branch block and premature ventricular beats, and with left ventricular pacemakers)
2. prolonged right ventricular or shortened left ventricular ejection time (as in valvular or infundibular pulmonic stenosis, mitral regurgitation, and ventricular septal defects)
3. altered impedance of the pulmonary vascular bed (massive pulmonary embolism).

Wide and fixed splitting of S2 (splitting of S2 that does not vary with respiration) is found in patients with large atrial septal defects, severe pulmonary stenosis, and right ventricular failure.

Paradoxical splitting of S2 (when splitting increases with expiration) is usually due to a delayed A2. This delay in A2 may be due to
1. electrical conduction disorders (complete left bundle branch block, right ventricle premature contractions, and ventricular tachycardia) or
2. mechanical disorders (severe valvular aortic stenosis, left ventricular outflow obstruction, hypertrophic cardiomyopathy, coronary artery disease, myocarditis, and congestive cardiomyopathy).

So the answer is lutembacher syndrome.

Regarding the fixed splitting, it is the splitting that does not vary with respiration. Normally splitting is more during inspiration when blood flow to the right heart increases due to negative intrathoracic pressure. In ASD this increase is compensated by left to right to shunt during expiration. So during whole cardiac cycle a fixed amount flows through pulmonic valve making the variation in split very small.

naseem · Credits: 1447 My Scrapbook

what about MS LATE STAGE WHEN PULMONARY HYPERTENSION IS ALSO THERE.

guest · Credits: 79189 My Scrapbook My Reading List 262569 Books

The main reason for split of S2 is more hangout time for pulmonary valve due to low pulmonary resistance as compared to aortic resistance. As the pulmonary hypertension develops the increase in pressure gradient decreases this hangover time, and hence reduces the split. But there are difference in opinions in cases of chronic increase in pulmonary pressures as in MS. This may cause some splitting to continue.

naseem · Credits: 1447 My Scrapbook

there occurs split from both sides as A2 also occurs early as there is reduced stroke volume from MS..... SO EARLY a2and late p2 flares the split///

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