Page 1 of 1: GENERAL MEDICINE

drpsg · Credits: 6198 My Scrapbook

1.....third heart sound may be heard in all of following except
1)hypernephroma
2)uterine myomata
3)cushings syndrome
4)gastric malignancy
ans with explanation please

2......clinical signs of pericardial effu are seen after____ ml of fluid collects in pericardial cavity

3........for echo to detect how much minimum fluid to be present[/b]

nadu · Credits: 17500 My Scrapbook

S1

The first heart sound - S1 - is in time with the pulse in your carotid artery in your neck. The sound of the tricuspid valve closing may be louder in patients with pulmonary hypertension due to increased pressure beyond the valve. Non-heart-related factors such as obesity, muscularity, emphysema, and fluid around the heart can reduce both S1 and S2.
The position of the valves when the ventricles contract can have a big effect on the first heart sound. If the valves are wide open when the ventricule contracts, a loud S1 is heard. This can occur with anemia, fever or hyperthyroid.
When the valves are partly closed when the ventricule contracts, S1 is faint. Beta-blockers produce a fainter S1. Structural changes in the heart valves can also affect S1. Fibrosis and calcification of the mitral valve may reduce S1, while stenosis of the mitral valve may cause a louder S1.

S2

The second heart sound marks the beginning of diastole - the heart's relaxation phase - when the ventricles fill with blood. In children and teenagers, S2 may be more pronounced. Right ventricular ejection time is slightly longer than left ventricular ejection time. As a result, the pulmonic valve closes a little later than the aortic valve.
Higher closing pressures occur in patients with chronic high blood pressure, pulmonary hypertension, or during exercise or excitement. This results in a louder A2 (the closing sound of the aortic valve).
On the other hand, low blood pressure reduces the sound. The second heart sound may be "split" in patients with right bundle branch block, which results in delayed pulmonic valve closing. Left bundle branch block may cause aortic valve closing (A2) to be slower than pulmonic valve closing (P2).

S3

During diastole there are 2 sounds of ventricular filling: The first is from the atrial walls and the second is from the contraction of the atriums. The third heart sound is caused by vibration of the ventricular walls, resulting from the first rapid filling so it is heard just after S2. The third heart sound is low in frequency and intensity. An S3 is commonly heard in children and young adults. In older adults and the elderly with heart disease, an S3 often means heart failure.

S4

The fourth heart sound occurs during the second phase of ventricular filling: when the atriums contract just before S1. As with S3, the fourth heart sound is thought to be caused by the vibration of valves, supporting structures, and the ventricular walls. An abnormal S4 is heard in people with conditions that increase resistance to ventricular filling, such as a weak left ventricle.

Other Abnormal Heart Sounds:

opening snap
is caused by a noncompliant valve, such as a mitral valve in a patient with a history of rheumatic fever

ejection click
is a high-pitched sound occurring shortly after S1. It is associated with a dilated pulmonary artery or septal defects

pericardial friction rub
is a to-and-fro sound that waxes and wanes with diastole and systole. It is present even when the patient holds his breath

murmur
is a vague sound associated with turbulent blood flow through a heart valve. Turbulent blood flow may be the result of:
increased flow across a normal valve
forward flow across an irregular or constricted valve, or into an enlarged heart chamber
back-flow through an insufficient valve

thrill
is a vibration, high in frequency and sustained. If a vibration is felt but no murmur is heard, the vibration is not called a thrill

pericardial knock
is a high-pitched sound best heard during diastole. Pericardial knocks are caused by a thick pericardium limiting expansion of the ventricle during the filling phase (diastole)

The Third Heart Sound - S3
The abnormal, or pathological third heart sound, may be heard in individuals with coronary artery disease, cardiomyopathies, incompetent valves, left to right shunts, Ventricular Septal Defect (VSD), or Patent Ductus Arteriosus (PDA). The pathological S3 may be the first clinical sign of congestive heart failure.

drpsg1 · Credits: 78855 My Scrapbook My Reading List 262569 Books

8) thanks nadu for the explanation but i didnt get my answer
can u plz suggest the ans with explanation ok
thanks

guest · Credits: 78855 My Scrapbook My Reading List 262569 Books

The answer should be uterine myomata. In other cases there may be hyperdynamic circulation. In cushing's syndrome: due to fluid retention, in hypernephroma: due to polycythemia, in gastric malignancy due to carcinoid syndrome. In general S3 is associated with increased end-diastolic volume, and S4 is associated with decreased ventricular compliance. These two lines are sufficient to tell the conditions where they may or may not be present.

Regarding pericardial effusion: Clinical manifestations of pericardial effusion are highly dependent upon the rate of accumulation of fluid in the pericardial sac. Rapid accumulation of pericardial fluid may cause elevated intrapericardial pressures with as little as 80 cc of fluid, while slowly progressing effusions can grow to 2 liters without symptoms.

During 2D echocardiography we just see the thickness of fluid arond the heart. Large pericardial effusions are defined as greater than 1 cm thick on echocardiography, completely surrounding the heart. Small effusions are less than 1 cm and often localized, usually posteriorly. the separation of periaridal layers can be detected in echocardiography, when the pericardial fluid exceeds 15-35 ml.

drsunu · Credits: 752 My Scrapbook

hi chand,,,,,, could you please tell me how polycythemia in hypernephroma cause a s3 or indirectly heart failure????

guest · Credits: 78855 My Scrapbook My Reading List 262569 Books

Dr Sunitha, polycythemia causes high output heart failure. Wherever left ventricle has more blood in diastole, it produces S3. In high output states the ventricle has more blood. Same is seen in anemia, pregnancy, hyperthyroidism etc.

drsunu · Credits: 752 My Scrapbook

thanks chand
chand? is this your full name?

suneet · Credits: 6840 My Scrapbook

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