Second Heart Sounds Second Heart Sound with Fixed Splitting Description Waveform Anatomy This example shows fixed splitting of the second heart sound. The second heart sound remains unchanged through inspiration and expiration at sixty milliseconds.Fixed splitting of the second heart sound (along with murmurs) indicates the presence of an Atrial Septal Defect, a congenital heart defect in which the intra-atrial septum is incomplete resulting in a hole between the left and right atria.The murmurs have been eliminated in this lesson so that you can concentrate on the fixed splitting of the second heart sound. In a later lesson you will hear the fixed splitting of S2 along with the murmurs of Atrial Septal Defect. play pause Maneuver:Supine Chestpiece Position:Pulmonic Chestpiece:Diaphragm Table of Contents Introduction Second Heart Sound - Physiologically Split #2 Second Heart Sound with Persistent Splitting Second Heart Sound with Fixed Splitting Second Heart Sound: Fixed Splitting, Increased Aortic Intensity Second Heart Sound: Fixed Splitting, Decreased Aortic Intensity Second Heart Sound and Late Systolic Click Second Heart Sound and a Tumor Plop Opening Snap and Second Heart Sound