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Narrow physiologic splitting of S2

• Pulmonary hypertension:
• P2 occurs earlier because of decreased pulmonary vascular capacitance.
• Intensity of P2 is also increased.

Single S2

• May be due to inaudible component(s) or sumultaneous closure.
• Single S2 - Inaudible component(s)
1. Calcific aortic stenosis
2. Hyperinflated chest
3. Severe pulmonic stenosis, atresia or leaflet immobility.
4. Displacement of pulmonic valve away from chest wall (transposition).
• Single S2 - Simultaneous closure
1. Ebstein’s anomaly: aortic and pulmonic incisurae occur together.