Introduction
- Normal splitting
- physiology
- inspiration creates a negative intrathoracic pressure
- this pulls more blood from the systemic venous circulation into the right heart
- this also holds more blood in the lungs as well leading to less blood going to the left heart
- this causes A2 to close earlier (less blood) and P2 to close later (more blood flow) increasing the splitting
- inspiration creates a negative intrathoracic pressure
- physiology
- Wide splitting
- physiology
- a decreased ability of the RV to empty blood into the pulmonary circulation resulting in an exaggerated delay in pulmonic valve closure
- associated conditions
- states of delayed RV emptying
- physiology
- Fixed splitting
- physiology
- shunting of blood from left to right that results in increased right heart volume resulting in a consistent delay in pulmonic valve closure
- can lead to pulmonary hypertension if large
- associated conditions
- ASD
- physiology
- Paradoxical splitting
- physiology
- a decreased ability of the LV to empty blood into the systemic circulation resulting in a delayed closure of the aortic valve
- the left heart fills more during expiration so splitting occurs during expiration and P2/A2 move closer during inspiration
- a decreased ability of the LV to empty blood into the systemic circulation resulting in a delayed closure of the aortic valve
- associated conditions
- states of delayed LV emptying (e.g., aortic stenosis or left bundle branch block)
- physiology