Cardiac Exam - Auscultation ULSE

Second heart sounds

The second heart sounds are normally split in inspiration due to asynchronous aortic and pulmonary valve closure. The first, or aortic, component is normally more intense than the second, or pulmonary, component, because the aortic valve normally closes at a higher pressure. The normal intensity of the pulmonary component suggests that there is no significant pulmonary hypertension.


Let us analyze the acoustic events at the upper left sternal edge using the diaphragm of the stethoscope and watching respiration.

What we hear is normal splitting of the second heart sound – lub didup, lub didup, with inspiration; lub dub with expiration and, in addition, we hear that the intensity of the individual components is also normal – no enhancement of one component, such as the pulmonary component suggesting pulmonary hypertension. No, this is normal splitting, normal intensity.