ord
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50 year old man has a 10 year history of poorly controlled hypertension. Vital signs are : pulse 96/min, respiration 16/min, blood pressure left arm 226/120 mm Hg, right arm 218/118 mm Hg. While the patient is in the left lateral decubitus position, a late diastolic sound is best heard with the bell at the apex. Which of the following is the most likely explanation for this auscultatory finding?
A) Aortic insufficiency
B) Aortic stenosis
C) Mitral insufficiency
D) Mitral stenosis
E) Opening snap
F) Pulmonary insufficiency
G) Pulmonic stenosis
H) S3
I) S4
J) Tricuspid insufficiency
D?
Edited by ord on 07/01/06 - 07:53 PM
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| robin082006
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A
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| leen
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D..
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| Cedrick
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Apex of the heart, right
D.-Mitral something "stenosis"
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| vanshita
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S3
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| robin082006
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This patient has hypertension history, resulting in dilated ventricule--> aortic insufficiency, therefore we will hear late diastolic murmur.
I had 7 years of experience and sure about this question
Mitral stenosis: early diastolic murmur following opening snap
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| Cedrick
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I did not read the LATE diastolic murmur
yeah ok A
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| skb
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First Aid 2005, page # 265.
Mitral stenosis: Delayed rumbling late diastolic murmur.
Aortic regurgitation: Immediate high-pitched "blowing" diastolic murmur.
Therefore, I go with Mitral stenosis
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| robin082006
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SORRY S3
I DID NOT SEE THE CHOICE S3
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| skb
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Is'nt S3 associated with Mitral insuffeciency?
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| robin082006
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S 4 is more suitable in this case: late diastolic, and the patient may have ventricular hypertophy.
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| vamsi2004
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wats the final answer? S3 or S4
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| Cedrick
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hahaha so I was right ok guys
to much coffe
D.-mitral stenosis
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| waqastariq
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eft lateral decubitus position used to accentuate MS
late diastolic murmur at apex = MS
MS best heard with bell and MR with diaphragm
the blood pressure differnecs are less than 10 mmHg so insignifcant...
I go with MS...
DON!
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| waqastariq
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option D
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| Ivil
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Techniques: Heart Sounds & Murmurs Third & Fourth Heart Sounds
A triple rhythm in diastole is called a gallop and results from the presence of a S3, S4 or both.
Description:
Both sounds are low frequency and thus best heard with the bell of the stethoscope.
Location:
If originating from LV
If originating from RV
- Usually best heard over left lower sternal border Louder during inspiration
back to top Third Heart Sound S3
Description:
Low frequency sound in early diastole, 120 to 180 ms after S2
Sounds like:
Lub du bub S1S3S2 cadence similar to "Kentucky"
Clinical Significance:
Results from increased atrial pressure leading to increased flow rates, as seen in congestive heart failure, which is the most common cause of a S3. Associated dilated cardiomyopathy with dilated ventricles also contribute to the sound. See Accuracy in Diagnosis of CHF .
Less commonly, valvular regurgitation and left to right shunts may also result in a S3 due to increased flow.
May be normal physiological finding in patients less than age 40.
back to top Fourth Heart Sound S4
Description:
Low frequency sound in presystolic portion of diastole,
Sounds like:
Belub dup S1S4S2 cadence similar to "Tennessee"
Clinical significance:
Seen in patients with stiffened left ventricles, resulting from conditions such as hypertension, aortic stenosis, ischemic or hypertrophic cardiomyopathy.
In patient with mitral regurgitation, suggestive of acute onset of regurgitation due to the rupture of the chorda tendinae that anchor the Valvular leaflets.
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| Ivil
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I go with I) S4
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| shumaker
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I S4
untreated severe hypertension results in hypertrophied ,enlarged and stiff left ventricle and blood flow from left atrium to this poorly compliant compartment results in s4 which is heard in diastole
mitral stenosis ? the history does not seem to suggest much although its a diastolic murmur
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| tolito
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i also go with S4. same reason as shumaker
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| Cedrick
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ok Thanks
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| study_ing
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I d like to point out another approach to the Q
the very high diastolic and systolic cpressures wud rule out stenoses ( mitral, aortic...)
similarly a highy diastolic pressure wud rule out AR
so ABDE gone
DIAstolic murmur rules out C and J. location rules out rt sided murmurs.
that wud leave S3 and S 4
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| study_ing
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looking at the clincal picture and etiology pointed out by Ivil, chose S4
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| ord
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| mjl1717
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since this so unclear and no one is "slam dunk" sure Ill return. where is drpkaur?
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| docswapna
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late diastolic - better to go with S4
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