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Hmm...I don't really know and I'm stuck between 2 possibilities:
1) either the extra blood from previous cycle would delay A2 sound making A2 and P2 closer together in inspiration and get a split of A2 and P2 during expiration (like that presented in the question)
2) Because theres more blood coming in LV, rapid decrease in pressure will cause A2 to occur before P2 and so there will be a wider split during inspiration and less during expiration.
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or I could be wrong about both - possibility number 3.... LOL
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Hi Sarim
What is your opinion for MR?
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sorry for the late.
In "Mitral regurgitation"......
.it is the Early Aortic Valve Closure (A2) due to more rapid LV emptying (Blood flowing forward and Backward) and that will widens the split.
Q. so why it is that we see split S2 in Bundle Branch Block ?
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Bundle branch blocks - defect in ventricular depolrization and is prolonged emptying of the ventricle.
A left bundle branch block -prolongs emptying of LV.
During inspiration, the physiologic split of S2 is decreased because now A2 is catching up with P2 b/c its taking time to empty into aorta whereas P2 was already prolonged due to the decreased intrathorasic pressure.
During expiration, normally A2 and P2 close around same time but since the LV is taking time to empty to the block P2 will close before A2 -> paradoxical splitting.
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wide physiological block....RBBB
wide paradoxical block.....LBBB
