Paradoxical splitting of second hea sound Heard in
Correct Answer: LBBB
Description: Ref Harrison 19 th ed pg 1447 Reversed or paradoxical splitting refers to a pathologic delay in aoic valve closure, such as that which occurs in patients with left bundle branch block, right ventricular pac- ing, severe AS, HOCM, and acute myocardial ischemia. With reversed or paradoxical splitting, the individual components of S2 are audible at end expiration, and their interval narrows with inspiration, the oppo- site of what would be expected under normal physiologic conditions.
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