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Describe Paradoxical and Reverse Split S in second heart sound?
Sequence of seminar valve closure reversed i.e. P, proceeds A. A reversed split is nearly always due to delayed A, as can occur in LBBB, severe AS Paradoxical splitting should be suspected when a split widens on expiration and narrows on inspiration. It can be confinned on auscultation by gradually moving the stethoscope from left sternal border toward the apex. The P, component S, becomes softer or I disappears at the apex. So if the first component of S, becomes softer or disappears at apex, then sequence is P,A.
Figure: Second heart sound (S,)
simpson''s index
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