Wide, fixed, paradoxical splitting of S2 - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 06-20-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 286 Times in 191 Posts
Reputation: 298
Stethoscope Wide, fixed, paradoxical splitting of S2

occurs in insp or expiration....what are dd? any ans is useful....
Reply With Quote Quick reply to this message



  #2  
Old 06-20-2011
USMLE Forums Addict
 
Steps History: Not yet
Posts: 192
Threads: 0
Thanked 47 Times in 40 Posts
Reputation: 57
Default

i if i understood right your question..
In healthy people we can finds s2 splitting during deep inspiration because it prolongs the systolic phase of the right ventricle

paradoxical splitting of s2 occurs in aortic stenosis where systolic phase of the left ventricle prolongs...so during deep inspiration both systolic phases of right and lef ventricle are prolonged leading to one s2

But during deep expiration systolic phase of the right ventricle accelerates (systolic phase of left ventricle still prolonged) so we have splitting of s2...that s wht it is called paradoxical..
Reply With Quote Quick reply to this message
The above post was thanked by:
Ace3 (06-20-2011)
  #3  
Old 06-20-2011
USMLE Forums Addict
 
Steps History: ---
Posts: 146
Threads: 27
Thanked 74 Times in 42 Posts
Reputation: 84
Post s2 paradoxical split

Quote:
Originally Posted by confident View Post
occurs in insp or expiration....what are dd? any ans is useful....

Paradoxical split S2 A paradoxical split S2 heart sound occurs when the splitting is heard during expiration and disappears during inspiration, the opposite of the physiologic split S2. A paradoxical split S2 occurs in any setting that delays the closure of the aortic valve, such as severe aortic stenosis, hypertrophic obstructive cardiomyopathy (HOCM) or in the setting of a left bundle branch block (LBBB )

ps:
Physiologic split S2
Normally, A2 occurs just before P2 and the combination of these sounds make up S2. A physiologic split S2 occurs when the A2 sound precedes P2 by a great enough distance to allow both sounds to be heard separately. This happens during inspiration when increased venous return to the right side of the heart delays the closure of the pulmonic valve (major effect) and decreased return to the left side of the heart hastens the closure of the aortic valve (minor effect), thus further separating A2 and P2. During expiration, the distance narrows and the split S2 is no longer audible.

http://www.learntheheart.com/PDF2-heartsounds.pdf

Reply With Quote Quick reply to this message
The above post was thanked by:
Ace3 (06-20-2011)
  #4  
Old 06-20-2011
Ace3's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 735
Threads: 89
Thanked 286 Times in 191 Posts
Reputation: 298
Default

Quote:
Originally Posted by MANIAKOS View Post
i if i understood right your question..
In healthy people we can finds s2 splitting during deep inspiration because it prolongs the systolic phase of the right ventricle

paradoxical splitting of s2 occurs in aortic stenosis where systolic phase of the left ventricle prolongs...so during deep inspiration both systolic phases of right and lef ventricle are prolonged leading to one s2

But during deep expiration systolic phase of the right ventricle accelerates (systolic phase of left ventricle still prolonged) so we have splitting of s2...that s wht it is called paradoxical..

i was trying to know respiratory phase with split i,e wide splitting of s2 occur in both insp and exp..due to delay closure of pul valve as seen in..ps,mr,rbbb

fixed splitting --> unaffected by resp seen in lft to rt shunting such as asd,vsd


paradoxical-->caused by anything which delay a2...seen in lbbb,as...here expiration (NOT INSPIRATION) prolongs lft ventricle ejection and dec rt vent ejection..

@samstar thanks for pdf..
Reply With Quote Quick reply to this message



Reply

Tags
Cardiology-, Clinical-Signs

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Fixed splitting of S2 in ASD but not VSD? dazzles USMLE Step 1 Forum 13 11-16-2015 09:27 AM
Splitting Versus Primitive Idealization insomnic USMLE Step 2 CK Forum 0 05-10-2011 01:23 AM
"Splitting" the Internships between US and India! AvinashSingh USCE & Clinical Rotations 8 04-21-2011 06:14 AM
Paradoxical Chest Wall Movement khushboo USMLE Step 1 Forum 4 06-01-2010 12:44 AM
Paradoxical embolism lemontea88 USMLE Step 1 Forum 2 11-30-2009 09:13 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)