When auscultating a patient’s heart at the pulmonic area,you hear a split S₂ with the louder A₂ component occurring slightly before the P₂ component during inspiration.You recognize that this finding most likely is

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There is a normal physiological splitting of S₂ that is heard best at the pulmonic area.The components of a split S₂ are A₂ (aortic)and P₂ (pulmonic).The aortic component occurs slightly before the pulmonic component during inspiration.The physiology of a split S₂ is that during inspiration,because of the more negative intrathoracic pressure,the venous return to the right side of the heart increases.Thus,pulmonic closure is delayed because of the extra time needed for the increased blood volume to pass through the valve.Normally,the A₂ component of the split S₂ is louder than the P₂ component because of the greater pressures in the left side of the heart.A fixed split is unaffected by respiration; the split is always there.

When Auscultating a Patient’s Heart at the Pulmonic Area,you Hear