Persistently Split S2

A persistently split S2 describes the presence of a split S2 on expiration that widens further upon inspiration. The most common cause of a persistently split S2 is a right bundle branch block, but it can occur whenever there is prolonged right ventricular ejection, such as outflow obstruction, pulmonary hypertension, or increased RV output.

Card Tutorial

Patient 2

This is an older woman with severe pulmonary hypertension from lung disease and a right bundle branch block. The split S2 widens slightly during inspiration but remains split during expiration.

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