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Old 07-01-2011
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Stethoscope Splitting of s2

a 50y old man with occasional palpitation and exertion.cvs examination reveals splitting of s2 both in inspiration and expiration? what is diagnosis and why?
1.rbbb
2.lbbb
3.aortic stenosis
4.asd
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Old 07-01-2011
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paradoxical splitting of s2 occurs in aortic stenosis(expiration only) so no as..

RBBB can cause s2 splitting so i m with 1
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Old 07-01-2011
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We Have first A2 and then P2 in a normal subject. When you have delayed closure of P2 you will have wide splitting. When you have delayed activation of right ventricle by RBBB, you have delayed closure of P2 and wide splitting
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Old 07-01-2011
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splitting of s2 in inspiration and expiration means wide fixed spiltting s2(regardless to breathing ) and cause in old exercise intolerance
so the answer is 4 -ASD

and aortic stenosis & LBBB (LV emptying delay )cause paradoxial or single spilt so not the answer

wide spilt in RV emptying delay (PS & RBBB ) regardles the breathing so also maybe the answer

Last edited by USMLE-Syndrome; 07-01-2011 at 10:41 AM.
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Old 07-01-2011
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Quote:
Originally Posted by confident View Post
a 50y old man with occasional palpitation and exertion.cvs examination reveals splitting of s2 both in inspiration and expiration? what is diagnosis and why?
1.rbbb
2.lbbb
3.aortic stenosis
4.asd
answer is1.rbbb.....

s2 splitting both in insp and exp is wide splitting s2...that is a2.....p2
delayed closure of pulmonic valve results it like ps,rbbb,mr


2 and 3 prolong lft ventricular ejection so delay a2 so seen in paradoxical splitting(expiration only)

4.asd,vsd left to rt shunt,uneffected by respiration so seen in fixed split
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USMLE-Syndrome (07-01-2011), yarasara77 (08-04-2012)



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