How do you hear a split S2 in kids??

[cardsurgguy]

I switched to working on a PICU a bit ago and have been reading many peds cardiology notes and studies since I'm interested in peds CT surg.

I always take my scope and listen to the kids to hear their murmurs and what not.

I think I can hear murmurs pretty well. Large VSD murmurs, PDA murmurs, shunt murmurs, etc...

(disclaimer: at least I think I hear the murmurs...the advice I was given was to listen for a while and "factor out" the heartbeat and breath sounds; so at this point, any whishing sounds that aren't the heartbeat or breath sounds I'm interpretting as the murmur...)
so if anybody has any tips on murmurs, I'd welcome them too


My question relates to something else...split S2 sounds, A2 P2 and so on

On patients that the defect would indicate and the peds cardio note said that the patient has a split S2, I tried to listen and I only hear what I think is one S2 sound

Any tips on hearing a split S2??? What should A2 and P2 sound like?? What site is good to hear the split S2? LLSB, ULSB, URSB, apex? somewhere else??

I've tried to hear more than a few times and I keep getting what I think is 1 S2 sound...

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[Krazykritter]

Disclaimer: I am not a cardiologist

I have heard numerous split S2's on healthy kids while performing school physicals. As you will remember (or maybe not if you haven't started med school), physiologic splitting of S2 occurs on inhalation. Therefore, while listening to heart sounds watch for breathing. As the pt. inhales, you will often hear the splitting of S2 b/c of the difference in pressure causing the pulmonic semilunar valves to delay slightly.

B/c it is the difference in the sounds of the semilunar valves, you should listen in those areas. I have always heard these the best in the Pulmonic area (2nd Intercostal space on the Left).

Hope that helps...

 

[DR.IBN-JIZAN]

Disclaimer: I am not a cardiologist

I have heard numerous split S2's on healthy kids while performing school physicals. As you will remember (or maybe not if you haven't started med school), physiologic splitting of S2 occurs on inhalation. Therefore, while listening to heart sounds watch for breathing. As the pt. inhales, you will often hear the splitting of S2 b/c of the difference in pressure causing the pulmonic semilunar valves to delay slightly.

B/c it is the difference in the sounds of the semilunar valves, you should listen in those areas. I have always heard these the best in the Pulmonic area (2nd Intercostal space on the Left).

Hope that helps...

Yah...that's right
Krazykritter gave the easy way of eliciting S2 splitting.
That's great. 👍​