This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: General anatomy, Subject name: Anatomy
Paradoxical splitting of second hea sound Heard in 
Select and explain. 
A. RBBB, B. ASD, C. VSD, D. LBBB
D: LBBB
Answer: D: LBBB 
Explanation: 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.