Abstract
Changes of the second heart sound are caused by shifting in position and changes in magnitude of the aortic or pulmonary component, or both. Differences in the magnitude of each component are primarily related to changes in pressure but are also affected by structural changes of the vascular walls. Positional changes are influenced by the time of closure of the respective valve (in turn related to time of ventricular activation, duration of systole and pressure gradient across the valve) and by the interval between valve closure and vascular vibration at the time of rebound. Normal splitting is present during inspiration and decreases or disappears during expiration. Marked differences related to age are present. Three abnormalities may occur: wide splitting during inspiration that persists during expiration; single second sound; and reverse splitting, either occurring only during, or accentuated by, expiration (occasionally also occurring during inspiration).
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