About Video

Please note when reference is made in these annotations to the locations from where the recordings have been taken and a particular intercostal space is mentioned, it automatically indicates the locations to be near the sternal border (left interspace at the left sternal border and the right interspace at the right sternal border as the case may be). Please note that the normal respiratory noise is usually heard only on inspiration. Expiration does not produce any noise in the recording. At the bedside obviously one can watch the patient’s respirations directly. Remember deep breaths taken by the patient either voluntarily or under instruction from the examiner, will often cause too much interference to cardiac auscultation from the respiratory noise. One may be able to instruct a cooperating patient to follow the hand gestures of the examiner to control the rate and the depth of the respirations. Also the heart rate generally increases on inspiration due to respiratory sinus arrhythmia. This will also help also in the recognition of the phase of the respiration. One can imitate a split S2 with the syllable DrP in the background rhythm of S1 and S2. Lubbb…….Dup………….Lubbb…….Dup………….Lubbb…….DrP………….If one wants to imitate a good separation between the two components of S2 one can use the syllable, PaDa Lubbb…….Dup………….Lubbb…….Dup………….Lubbb…….PaDa………….Listen to this recording taken at the 3rd left interspace from a young patient who happened to have mild congenital pulmonary regurgitation. (The latter was not considered hemodynamically significant).Q. 1. Is the S2 single or Split? Q2. If the S2 is split, is it split all the time or only sometime? Q2. If the S2 is split only sometime, is the patient breathing in or out? Q.3. Could you make out, if so how? Ans 1. Note that the S2 is single sometime and appears to have two components or split at other times. Therefore the S2 is only intermittently split. Ans 2. The heart rate appears to be increasing when the split S2 is heard. In addition one can hear a soft inspiratory noise in the background. Therefore the patient must be breathing in at the time. This would confirm an inspiratory split of the S2 with single S2 on expiration making this a normal physiologic split of S2.