Fixed Split Second Heart Sound

This is a video that describes the fixed split second heart sound. We also show you a real patient with this.
The Stanford Medicine 25 program for bedside medicine at the Stanford School of Medicine aims to promote the culture of bedside medicine to make current and future physicians and other healthcare provides better at the art of physical diagnosis.
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[@moo3oo3oo3]

FINALLY! A video that actually plays the audio of a split S2 instead of only describing the physiology

[@dkzerify]

Sick beats Stanford

[@amoghavarshanrupatunga1914]

Take away points
1) To hear Splitting of S2, Auscultate in "PULMONARY AREA"
(Because in other areas normally only A2 will be heard)
2) Normal Physiological Splitting can be appreciated during - "INSPIRATION"
d/t increased venous return to Right side of heart leading to delayed closure of Pulmonary Valve
3) Pathological FIXED SPLIT S2 heard in
-Pulmonary Hypertension
-RV Failure
-ASD
4) Heard as "Lub daa dub"

[@jrperezdo]

Pulmonary hypertension will give you persistent splitting which varies with respiration, only an ASD will give you truly FIXED splitting

[@hadeelelfatih6090]

true !!

[@Nightraven26]

joseph perez I thought fixed split S2 was due to higher volume in the right ventricle in pulmonary hypertension and the left-right shunt in ASD, in turn causing right ventricle hypertrophy and the higher volume causes the pulmonary valve to close after the aortic valve.

[@aatifmirza9891]

Pulmonary htn with Rt heart failure gives fixed split s2 !
In Mild pulmonary htn we cant deferentiate split so well
In moderate to severe pulmonary htn with intact Rt ventricle will gives variable split s2

[@Uzairkhan-sc7is]

Aatif mirza said it correctly. Dont look at a particular heart pathology ( example Pulmonary HTN ) from a strict sense, but rather see its spectrum of natural history of disease from a mild to severe perspective.

[@metbumana4644]

How do you record heart sounds?That’s so great

[@Yasmeensm]

Thank you

[@ramilchow620]

Real helpful!!!

[@asnfhtmlzxsje274]

very nice video. thanks stanford

[@marshalldavidcolin4430]

Very cool! Keep these videos coming.

[@scaleindependent]

Thank you!

[@freedomwriter4523]

Thanks a bunch!!!

[@lisastarlove7429]

1:09 Okay take a listen

[@mohitjaiswal7450]

Also in TAPVC fixed split is seen with cyanosis

[@ahmedabouelkassem3804]

Great Vid

[@lisastarlove7429]

1:29 Let's listen with a more

[@sirranhaal3099]

These Stanford med videos are very useful but that damn fiddle is unsufferable

[@wholeNwon]

insufferable.

[@marebearzzz027]

LOL

[@Shimyshimya]

😂😂

[@hudaibrahimmohammed2443]

great!

[@drsimratsingh2352]

very useful

[@akhildc9560]

Thank you very much ;)

[@MOHAME74]

if Any one has a video about normal heart sounds give me the link please

[@nswetenham]

Nice explanation, but the heart sounds are a poor quality recording - all I hear is machine-like noise, I can't distinguish S1 from S2, let alone hear the splitting

[@sravanthimagi3]

me too, i cant distinguish

[@BobelVago]

maybe open your ears lmao

[@franknstein5376]

To me it almost sounds like an S3... there's a lot of time between aortic valve and pulmonary valve closure.

[@enevy3165]

If you turn the volume up and listen carefully, you could hear the faint "bum" then "dudun"
Bum dudun Bum dudun Bum dudun

[@StanfordMedicine25]

they are there. use a better audio if needed but pretty clear on the computer used to create this video. It can be a challenge with real sounds! :-)

[@xyz4380]

How to differentiate with s3 or opening snap

[@Rasha.Ishtar]

How can we differentiate a fixed splitting of S2 from S3

[@t_guitar8200]

In my opinion s3 (the last sound will have the lowest volume compare with s1 and s2) but in fix split s2 will have the same volume of A2 and P2 or P2 a bit lounder than A2

[@kaustavdutta8659]

My book says S2 can also be found in VSD and this isn't wrong
Then you didn't mentioned about VSD in your video.. may I know why ?

[@wholeNwon]

Though one might expect otherwise, an uncomplicated VSD does not usually affect S2 splitting. Of course, if pulmonary hypertension is present, the timing is affected.

[@majadbassam1032]

why not conseder s3???

[@srinivasaraosirasapalli5104]

excellent

[@rumit9946]

can this finding help in diagnosing a PE?

[@eezekiel07]

yes i would say so

[@nsindisomkhize9121]

Aortic and pulmonary valves dnt normally close at the same time, reason being the effect of systemic Bp o
ver the oartic.

[@lisastarlove7429]

1:56

[@wholeNwon]

Listen carefully: To my ears, the split of S2 is not really fixed but is persistent. So, let's see the phono.

[@Elixir01.k]

Fixed and persistent is the same

[@wholeNwon]

@@Elixir01.k No, they are not. A fixed split remains the same (usually in milliseconds) throughout the respiratory cycle. A persistent split is one that remains throughout the respiratory cycle but varies during the cycle.

[@Elixir01.k]

@@wholeNwonthanks

[@Yasmeensm]

🙏🏻😍😍💜

[@Dragon-Slay3r]

Truly is heart breaking to see how evil people are, not realising that I need to be in love to open portals. ( a safety mechanism to make sure the world is in a good place before we evolve) 🤣 dumb bastards

[@TOONIVERSEWITHYTN]

LETSGO

[@No-yk1th]

01:10

[@souhrdyasarkar5056]

Heart

[@SOLDbyYOU]

"What you should be hearing" .... is " A GODDAMN ....N...O...R...M...A...L..... pulse sound compared back to back with an abnormal heart sound"

[@rodrigobustillos1280]

Mmmm rico

[@BalrajSingh-gg3qm]

Thank you

[@souhrdyasarkar5056]

Heart