Loud pulmonary component of second hea sound heard in
The loudness of each component of the second hea sound is propoional to the respective pressures in the aoa and pulmonary aery at the onset of diastole.P2 is relatively loud in young patients in whom the pulmonary aeries are quite close to the chest wall.The pulmonic component is considered to be abnormally loud in a subject over age 20 if it is greater than the aoic component in the second left inter-costal space (ICS) or if it is audible at the cardiac apex.This may be seen in pulmonary aery hypeension and ASDThe term Eisenmenger's syndrome is applied to patients with a large communication between the two circulations at the aoopulmonary, ventricular, or atrial levels and bidirectional or predominantly right-to-left shunts because of high resistance and obstructive pulmonary hypeension. Hence, the P2 is loud.However, in Eisenmenger&;s syndrome with a large ventricular septal defect (VSD), the pulmonary closure may get completely fused with aoic closure throughout the respiratory cycle. Here, the duration of right and left ventricular systole become viually equal. Hence, a single loud S2 is heard in both phases of respiration.Ref: Harrison's 18/e p1923
MR
TOF
Eissenmenger's syndrome
Pulmonary stenosis
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