Heart sounds in ventricular septal defect

P2 (pulmonary component of second heart sound)is usually soft in small – moderate and large VSD because the murmur mask P2. 
P2 is loud in VSD with PAH and Eisenmenger syndrome.
Split in VSD  1.Split is absent in small VSD
2.Wide mobile split is heard in moderate to large VSD due to the following

• Shortening of left ventricular systole 
• Prolonged right ventricular systole 

3.Single S2 is heard in Eisenmenger VSD
S2 is single in Eisenmenger syndrome because the left and right ventricle act as a common chamber and it eject blood into the great vessels at equal resistance.

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3. Heart sounds in ventricular septal defect
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7. Pathophysiology of ventricular septal defect (VSD)