Figure 200c

Top panel: Normal physiologic splitting. During expiration A2 and P2
eight are separated by less than 30 ms and are appreciated as a single sound. During inspiration the splitting interval widens and A2and P2 are
clearly separated into two distinctively audible sounds. Bottom panel: audible expiratory splitting . In contrast to normal physiological splitting
two distinct sounds and easily heard during expiration. Wide hysiological splitting is due to delay . Reverse splitting is due to delay inA2, resulting in paradoxical movement; that is, with inspiration P2 moves toward A2 and the splitting interval narrows. Narrow physiological splitting is seen in pulmonary hypertension, and both A2 and P2 are heard during the expiration at a narrow splitting interval due to increased intensity and high-frequency composition of P2.

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