Second Heart Sound: Fixed Splitting, Decreased Aortic Intensity
The patient's position should be sitting.
This example shows a second heart sound (S2) with fixed splitting and an aortic component with decreased intensity. Once again, we are using fixed splitting to help you hear the difference in intensity between the aortic and pulmonic components of S2.
This pattern is seen in the presence of long-standing severe pulmonary hypertension where the pressure in the pulmonary artery is markedly increased.
Note the increased thickness of the right ventricular free wall.