About Video

This recording is taken from a patient with a congenital ventricular septal defect, who had developed severe pulmonary hypertension with evidence of central cyanosis and clubbing and reversal of the left to right shunt (Eisenmenger’s syndrome). The recording is taken from the 2nd left interspace. The S2 is quite loud and may be perhaps due to a loud P2 component. One would have to hear a split and be certain that it is the P2 that is loud. The S2 is however not well split to confirm this. At the bedside if one is able to palpate the S2 at the 2nd left interspace it probably means that the P2 is in fact loud. There is a short ejection systolic murmur preceded by a split S1 and the latter is probably due to the presence of an ejection sound. This may also suggest some dilatation of the pulmonary artery. There is no clear-cut variation noted in its intensity. This will however not be expected to vary like the valvular pulmonic ejection click (which will decrease and become soft on inspiration). Finally following the S2 there is a soft but definite high frequency blowing diastolic murmur, which sounds like an aortic regurgitation murmur. This is most likely due to pulmonary regurgitation murmur associated with the pulmonary hypertension. The latter is confirmatory of significant pulmonary hypertension if one can exclude aortic regurgitation.