Wide splitting of S2 with maintained inspiratory delay of P2 |
Delayed activation and completion of right ventricular ejection |
Complete right bundle branch block |
Artificial left ventricular pacing |
Pre-excitation of the left ventricle (Wolff-Parkinson-White syndrome) |
Premature beats and idioventricular rhythm originating from the left ventricle |
Prolonged right ventricular ejection time |
Pulmonary hypertension with right heart failure |
Right ventricular outflow obstruction (eg, pulmonic stenosis, acute massive pulmonary embolus) |
Increased pulmonary hangout time |
Idiopathic dilatation of the pulmonary artery |
Mild pulmonic stenosis |
Postoperative atrial septal defect |
Decreased left ventricular ejection time (early A2) |
Mitral regurgitation |
Ventricular septal defect with low pulmonary vascular resistance |
Constrictive pericarditis |
Fixed splitting of S2 |
Unchanged right ventricular stroke volume during respiration; severe right ventricular failure due to any cause |
Interatrial communication; atrial septal defect; common atrium |
Reversed splitting of S2 |
Delayed left ventricular activation and completion of ejection |
Left bundle branch block |
Artificial right ventricular pacing |
Pre-excitation of the right ventricle (Wolff-Parkinson-White syndrome) |
Premature beats of right ventricular origin |
Prolonged left ventricular ejection time |
Increased resistance to left ventricular ejection (aortic stenosis, obstructive hypertrophic cardiomyopathy, hypertension) |
Isolated increase in left ventricular forward stroke volume (aortic regurgitation, patent ductus arteriosus) |
Myocardial dysfunction (mild to moderate left ventricular failure, myocardial ischemia or infarction) |
Increased aortic hangout time (not the sole cause) |
Aortic regurgitation |
Patent ductus arteriosus |
Aortic stenosis |
Single S2 |
Apparent: obesity, emphysema, pericardial effusion |
Absent A2: severe aortic stenosis, severe aortic regurgitation |
Absent P2: absent pulmonary valve, pulmonary atresia, tetralogy of Fallot, truncus arteriosus |
Fusion of A2 and P2: Eisenmenger ventricular septal defect, common ventricle |
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