Physiological splitting of the second heart sound during inspiration in a child:

Physiological splitting of the second heart sound during inspiration in a child:

• A. Is Normal
• B. Should Be Evaluated With An EKG
• C. Suggests An ASD
• D. Should Be Referred To A Cardiologist

Answer: (A)

Physiologic splitting of S2 during inspiration is a normal finding in children. The second heart sound comes from the closing of the aortic (A2) and pulmonic (P2) valves. With inspiration, there is more venous return to the right side of the heart, which delays the closure of the pulmonic valve and widens the interval between A2 and P2. This split typically becomes more pronounced with inspiration and narrows or disappears on expiration, which is a common, harmless variant in kids. If splitting were fixed and wide, or if other symptoms or findings were present, that would prompt further evaluation (for example, ASD can cause a fixed split). But isolated, inspiratory splitting in a child is a normal finding and does not by itself require EKG or cardiology referral.

Physiologic splitting of S2 during inspiration is a normal finding in children. The second heart sound comes from the closing of the aortic (A2) and pulmonic (P2) valves. With inspiration, there is more venous return to the right side of the heart, which delays the closure of the pulmonic valve and widens the interval between A2 and P2. This split typically becomes more pronounced with inspiration and narrows or disappears on expiration, which is a common, harmless variant in kids.

If splitting were fixed and wide, or if other symptoms or findings were present, that would prompt further evaluation (for example, ASD can cause a fixed split). But isolated, inspiratory splitting in a child is a normal finding and does not by itself require EKG or cardiology referral.