From the Guidelines
An accentuated P2 heart sound is most commonly caused by conditions that increase pulmonary artery pressure, with pulmonary hypertension being a primary cause, as seen in a case report of a 24-year-old female with suspected PH, where an accentuated second heart sound over the pulmonic valve was noted 1. The main causes of an accentuated P2 heart sound include:
- Pulmonary hypertension
- Atrial septal defect
- Mitral stenosis
- Pulmonary embolism
- Chronic obstructive pulmonary disease (COPD)
- Left ventricular failure These conditions lead to increased pressure in the pulmonary arteries, causing the pulmonic valve to close more forcefully and producing a louder P2 sound, as described in a scientific statement from the American Heart Association, where patients with chronic thromboembolic pulmonary hypertension (CTEPH) may exhibit a loud P2 sound of pulmonary valve closure 1. To differentiate between these causes, additional clinical information and diagnostic tests are usually required, such as:
- Echocardiography
- Chest X-ray
- ECG
- Blood tests Treatment will depend on the underlying cause and may involve medications, lifestyle changes, or surgical interventions, as seen in the case report where oral specific PAH therapy with an endothelin receptor antagonist was initiated 1.
From the Research
Conditions Causing Accentuated P2
- Pulmonary hypertension is a condition that can cause an accentuated P2 (second heart sound) 2, 3.
- The accentuated P2 is a common sign of pulmonary hypertension, particularly in more advanced cases 2.
- Other conditions that can lead to pulmonary hypertension and potentially cause an accentuated P2 include:
- A loud pulmonic component of the second heart sound (P2) is a physical examination finding that can support the diagnosis of pulmonary hypertension 3.
Diagnostic Approaches
- Transthoracic Doppler echocardiography is a useful screening test to detect pulmonary hypertension 2.
- Right heart catheterization is required to confirm the diagnosis of pulmonary hypertension 2, 3.
- A comprehensive, multidimensional diagnostic work-up is essential to identify the cause of pulmonary hypertension 5.
- Physical examination findings, such as a loud P2, can be used in conjunction with other diagnostic tests to support the diagnosis of pulmonary hypertension 3.