Family Nurse Practitioner Exam

During a sports physical, a split of the S2 heart sound is noted in a 14-year-old athlete. What does this finding typically indicate?

1. This is an abnormal finding and should be evaluated further

2. A stress test should be ordered

3. This is a normal finding in some young athletes

4. An echocardiogram should be ordered

The correct answer is: This is a normal finding in some young athletes

The finding of a split S2 heart sound in a 14-year-old athlete is typically considered normal and can be explained by physiological factors related to the growth and development of the cardiovascular system during adolescence. In young athletes, an enhanced dynamic of blood flow, increased venous return, and variations in heart rate due to physical training can lead to a splitting of the second heart sound. This occurs because the closure of the aortic valve and the pulmonic valve can become out of sync, particularly during inspiration when venous return to the right side of the heart increases. Such findings are relatively common in children and adolescents, especially in those who are physically active, and do not usually indicate any underlying pathology. In contrast, if split S2 is associated with other abnormal heart sounds or symptoms, further evaluation may be warranted, but in the context of an otherwise healthy young athlete during a routine physical, this is viewed as a benign phenomenon. Thus, recognizing this as a normal variant helps in understanding normal cardiovascular assessments in young populations.