Summer.Thunder
Forum Elite
Topics: 71
Posts: 180
|
50 year old man, 10 year hypertension, pulse 96, resp. 16, left arm 226/120 mmhg, right arm 218/118 mm hg,
in the left lateral decubitus position, a late diastolic sound is heard best with bell at apex which is the most likely explanation?
anyone knows? i will post the choices later.
|
| me007
Forum Guru
Topics: 72
Posts: 799
|
you should tell that it is NBME question
|
| Summer.Thunder
Forum Elite
Topics: 71
Posts: 180
|
yes, how do u know, u did it?
|
| bangledoc
Forum Senior
Topics: 8
Posts: 130
|
4th heart sound
|
| Summer.Thunder
Forum Elite
Topics: 71
Posts: 180
|
http://www.uni-duesseldorf.de/WWW/MedFak/Herz-Kre...
An S3 is usually heard best with the bell of the stethoscope placed at the apex while the patient is in the left lateral decubitus position.
when the ventricle is forced to dilate beyond its normal range because the atrium has overloaded volume
I think that it should be S3. the answer key was wrong if you had one.
Edited by Summer.Thunder on 02/23/07 - 12:41 AM
|
| bangledoc
Forum Senior
Topics: 8
Posts: 130
|
It is 4th heart sound guys.The pt is hypertensive and has develoved concentric hypertrophy of lft ventricle.As the ventricle is stiff and non compliant lft atria needs more energy to empty last 20% of its content.And it emptys this blood with greater force and create a sound in late diastole.
listen goljan audio.hope this will help.
|
| goodies
Forum Junior
Topics: 19
Posts: 39
|
in goljan, there were certain situations where you could hear both S3 and S4. can someone explain when this would be???
|
| goodies
Forum Junior
Topics: 19
Posts: 39
|
so what kind of murmur would it be? mitral stenosis??? could it be aortic regurg? or can we not tell given this limited info?
|
|
| |
| | | | | | | | |
