Web Reference: However, the subtle changes of the second heart sound can tell you a great deal about the heart. Here we discuss the basics of listening for the second heart sounds and review abnormal findings. It is physiologically normal to hear a "splitting" of the second heart tone in younger people, during inspiration and in the "pulmonary area", i.e. the second ICS (intercostal space) at the left edge of the sternum. The splitting of S2 occurs because inspiration brings more blood into the right ventricle. Right ventricular ejection is prolonged, and the pulmonary valve (P2) closes later. A loud, single S2 indicates either pulmonary hypertension or congenital heart disease involving one of the semilunar valves.
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