Split S2

Abstract: In this paper, we present a method of detecting the splitting of heart sound S2 based on a template matching approach. A mathematical model of normal S2 is created and tested on other normal S2 complexes for goodness of fit. The generalized mathematical model is used as a template for detecting splitting of S2 sounds, as they will not generate a good fit with a model of a normal S2 complex. This automated detection of splitting of S2 can be used in the detection of congenital heart diseases or pulmonary hypertension. We have provided an estimate of the fit results of the mathematically synthesized S2 complex with the split S2 complexes.

Abstract: Chapter 1. The Checklist in History Taking Advantages of a Checklist Reminder List History Etiologies Follow-Up Questions New York Heart Association Functional and Therapeutic Classification References Chapter 2. Cardiac Clues from Physical Appearance Skin Congenital and Acquired Facies Eyes Edema Extremities Chest and Respiration References Chapter 3. Arterial Pulses and Pressures Method of Arm Palpation Rates of Rise and Pulse Volume Pulsus Bisferiens Palpation of the Leg Pulses Estimating Systolic Blood Pressure by Palpation Alone Accurate Blood Pressure Measurement Korotkoff Sounds Chest Piece Placement and Choice Equipment Sources of Error Systolic Pressure Measurement Diastolic Blood Pressure Recording Accuracy of Blood Pressure Recording Summary of How to Take Arm Blood Pressures by Listening for Korotkoff Sounds Pseudohypertension Pulsus Alternans Blood Pressure and Pulses in the Legs Pulsus Paradoxus Capillary Pulsation Abdominal Aortic Aneurysm (AAA) How to Tell Cardiac Function by Blood Pressure Response to a Valsalva Maneuver References Chapter 4. Jugular Pressure and Pulsations Venous Pressure by Jugular Inspection How to Use the Internal Jugulars as a Manometer Method of Obtaining an Accurate Measurement of Venous Pressure How to Tell Jugular from Carotid Pulsations The Abdominal Compression Test (Hepatojugular Reflux) Jugular Pulse Contours References Chapter 5. Inspection and Palpation of the Chest Ventricular Enlargement from Examination of the Chest Cardiac Dilatation Signs in the Left Lateral Decubitis Position Right Ventricular Enlargement Left-Sided Causes of Left Parasternal Movement X-ray Evaluation of Cardiac Size Diagnosis of VentricularHypertrophy by Physical Examination of the Precordium References Chapter 6. The Stethoscope The Bell Chest Piece The Smooth Diaphragm The Tubing Air Leaks and Ear Tips Summary of Good Stethoscope Characteristics References Chapter 7. Diagramming and Grading Heart Sounds and Murmurs The Auscultogram Grading of Heart Sounds and Murmurs References Chapter 8. The First Heart Sound (S1) Physiology of the First Sound Components The M1 Plus Aortic Ejection Sound as the Cause of a Split S1 The Pulmonary Ejection Sound Loudness of the M1. References Chapter 9. The Second Heart Sound (S2) Physiology and Nomenclature for the S2 Explanation of Normal Splitting Sequence of S2 Physiology of the Normally Moving Split Loudness of the Components of S2 The Widely Split S2 The A2-P2 in Pulmonary Stenosis ASDs with Narrow Splits. Differential Diagnosis of the Fixed Split The Narrowly Split S2 The S2 Split in Pulmonary Hypertension The Reversed or Paradoxically Split S2 References Chapter 10. The Opening Snap Mechanism and Timing Relation Between the 2-OS Interval and the Severity of Mitral Stenosis The Loudness of the Opening Snap How to Tell an A2-P2 from an A2-OS References Chapter 11. The Third Heart Sound (S2) Nomenclature Timing Mechanism of Production The Physiological S3 Loudness of the S3 The Exaggerated Physiological S3 The Pathological S3 The Physiological Versus the Pathological S3 The Right Versus the Left Ventricular S3 The S3 Versus the Opening Snap References Chapter 12. The Fourth Heart Sound (S4) Nomenclature Mode of Production Recognizing the Rhythm of the S4 Gallop The Physiological S4 The Pathological S4 Loudness and A

Abstract: In a series of 38 complete right bundle branch blocks (RBBB) (17 "idiopathic" and 21 cardiopathies), auscultation and phonocardiograms disclosed a normal split second heart sound (S2 = A2-P2 less than or equal to 0.045 sec) in 27 and a wide split S2 (A2-P2 greater than or equal to 0.06 sec) in only 11 cases. Analysis of the initial and terminal vectors constructed from ECGs recorded at 250 mm/sec shows no valid correlation between a transseptal mode of depolarization of the right ventricle and the presence of either a normal or wide split of the 2nd heart sound. A review of the mechanisms generating the 2nd sound and discussion of the additional factors which may influence the duration of A2-P2 in RBBB (start of activation, length and quality of right ventricular systole, impedance of pulmonary arterial bed, possible delay of 2nd aortic sound) explain why wide splitting of the 2nd sound in RBBB is the exception rather than the rule.

Abstract: This paper is concerned with the identification of splitting patterns in the second heart sound (S2) of the phonocardiogram signal (PCGs). The second heart sound S2 consists of two acoustic components A2 and P2 , the former is due to the closure of the aortic valve and the latter is due to the closure of the pulmonary valve. The aortic valve usually closes before the pulmonary valve, introducing a time delay known as “split”. A technique based on the discrete wavelet transform (DWT) and the continuous wavelet transform (CWT) is developed in this paper to measure the split To quantify the splitting, the two components in S2 (i.e. A2 and P2) are identified and, the delay between the two components can be estimated. keywords : Second heart sound, phonocardiogram signal ,split S2, wavelet transform.