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Old 07-01-2011
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Stethoscope split s2 present on inspiration that disappears on expiration

a 48 y old women with split s2 present on inspiration and disappear on expiration.which of these likely cause of this physical examination?

a. decreased stroke volume
b. decreased pulmonary vasculature compliance
c. decreased thoracic pressure
d. shortened right ventricular ejection period
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Old 07-03-2011
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split s2 in inspiration means normal split.mechanism for it is :inspiration increase venous return and decrease thoracic pressure,delay closing ejection and prolonging p2 closure and also increase compliance of pulmonary vasculature ..so a2 early followed by p2...so answer here is c.
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Old 04-07-2012
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My answer would be C.
the S2 in this question splits on inspiration, hence it means that it is associated with an increased venous return. inspiration causes a normal increase in venous return and at that time also decreases the intrathoracic pressure, ie causes negative intrathoracic pressure.
B- decreased pulmonary compliance cannot be the answer, because decrease in the pulmonary compliance would actually decrease the amount of blood entering during inspiration and hence would not cause a split.
D-shortened rv ejection time, would make P2 come earlier and causes a single S2
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