goodies
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"late diastolic murmur eliminated by atrial fibrillation." is this describing S4? for some reason, the explanation says it is associated with "mitral/tricuspid stenosis," which is weird b/c I thought S4 was associated with AORTIC stenosis. what heart sound can be described as: "late diastolic murmur eliminated by atrial fibrillation"???
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| SILVER
DoWhatYouGotToDo!
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S4 disappears with atrial fib. and S3 persists with atrial fib. S4 is assoc. with LVH, pulmonic stenosis, coronary artery disease, and aortic stenosis.
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| SILVER
DoWhatYouGotToDo!
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check out this site: http://courses.washington.edu/med665/student/card...
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| new_n_lost
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An audible S4 is abnormal in younger subjects and children; it is always abnormal when it is palpable, regardless of patient age. An abnormal S4 is most frequently observed in patients with decreased left ventricular distensibility. Thus, S4 is common in hypertensive heart disease, aortic stenosis, and hypertrophic cardiomyopathy. Left ventricular hypertrophy, which is present in all these conditions, contributes to decreased left ventricular distensibility.
An S4 is heard in the vast majority of patients during the acute phase of myocardial infarction
A loud S4 that is also usually palpable is a frequent finding in patients with acute and severe mitral or aortic regurgitation. It is almost always associated with an increased left ventricular end-diastolic pressure
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| new_n_lost
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S3 occurs as passive ventricular filling begins after actual relaxation is completed. It appears to be related to a sudden limitation of the movement during ventricular filling along its long axis. It coincides with the y descent of the atrial pressure pulse and the end of the rapid filling phase of the apical impulse, occurring usually 0.14 to 0.16 second after S2.
S4 occurs after the P wave on the electrocardiogram and coincides with atrial systole and a waves of the atrial pressure pulse, and with the apical impulse.
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| new_n_lost
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An abnormal S3 and S4 tend to be louder and of higher pitch (sharper) and are frequently referred to as gallops. S3 is the ventricular gallop and S4 is the atrial gallop sound. S3 and S4 can be fused during tachycardia to produce a loud diastolic filling sound, termed a summation gallop. At the bedside, carotid massage can cause separation of S3 and S4 as the heart rate slows. S3 and S4 may occasionally be intensified or precipitated by exercise or by sustained hand grip.
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| new_n_lost
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S3 is almost always present in patients with hemodynamically significant chronic mitral regurgitation; the absence of S3 is an important finding to exclude severe chronic mitral regurgitation. An S3 gallop in patients with chronic aortic regurgitation is frequently associated with a decreased left ventricular ejection fraction and increased diastolic volume; its recognition should prompt further evaluation.
An S3 gallop is an important and common early finding of heart failure in dilated cardiomyopathy. It occurs with equal frequency in patients with or without coronary artery disease. In patients with aortic valve disease, coronary artery disease, and congestive cardiomyopathy, an S3 gallop is associated with left atrial pressures exceeding 20 mmHg; absence of an S3 gallop usually indicates normal left atrial pressure.
S3 often occurs in high-output states such as thyrotoxicosis or pregnancy. It does not necessarily indicate left ventricular dysfunction in these circumstances
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| goodies
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how come with mitral/tricuspid stenosis... you get a late diastolic murmur eliminated by atrial fibrillation? why does this happen?
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| new_n_lost
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can u plz tell me where u have read this sentence cos as far as my limited knowledge goes it doesnt happen that way
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| vradojc1
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If it happens it is probably due to non-contracting atria that give the last "push" in stenotic valve diseases. So, since the late diastole coincides with atrial contraction, absence of contraction would eliminate the murmur. Makes sense to me.
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| new_n_lost
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yup in that way it cud happen
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