Ebook Evidence-Based physical diagnosis (4/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Evidence-Based physical diagnosis (4/E): Part 2
Ebook Evidence-Based physical diagnosis (4/E): Part 2
CHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filli Ebook Evidence-Based physical diagnosis (4/E): Part 2ing of one of the ventricles. They are collectively called gallops. The S3 differs from the S4 in timing and clinical significance.•Right ventricular gallops appear at the left lower sternal border, intensify with inspiration, and are associated with abnormalities of the jugular venous waveforms. Le Ebook Evidence-Based physical diagnosis (4/E): Part 2ft ventricular gallops appear at the apex and diminish in intensity during inspiration. All gallops are best heard with the bell of the stethoscope.•TEbook Evidence-Based physical diagnosis (4/E): Part 2
he S3 is an early diastolic sound. It is associated with a dilated ventricle, systolic dysfunction, and elevated filling pressures. The S3 often quickCHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filli Ebook Evidence-Based physical diagnosis (4/E): Part 2y ischemic, hypertensive, or hypertrophic cardiomyopathy. Once heard, the S4 usually persists unless the patient develops atrial fibrillation. Unlike the S3, the S4 does not predict the patient’s hemodynamic findings.I.INTRODUCTIONAlthough the third and fourth heart sounds (S3 and S4) are both sound Ebook Evidence-Based physical diagnosis (4/E): Part 2s that originate in the ventricle from rapid diastolic filling, they differ in timing and clinical significance. S3 appears in early diastole and, ifEbook Evidence-Based physical diagnosis (4/E): Part 2
the patient is older than 40 years of age, rhe sound indicates severe systolic dysfunction or valvular regurgitation. In persons younger than 40 yearsCHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filli Ebook Evidence-Based physical diagnosis (4/E): Part 2tricle is abnormally stiff from hypertrophy or fibrosis. If discovered in persons of any age, the S4 is an abnormal finding.In the late 19th century rhe great French clinician Potain accurately described most features of S3 and S4, their pathogenesis, and their distinction from other double sounds, Ebook Evidence-Based physical diagnosis (4/E): Part 2such as the split Sị or split S2.2 In his writings he called them gallops, a term he attributed to his teacher Bouillard.2’3II.DEFINITIONSSeveral diffEbook Evidence-Based physical diagnosis (4/E): Part 2
erent terms have been used to describe these diastolic sounds.A. GALLOP346 PART 8 THE HEARTB. THIRD HEART SOUND (S3)The third heart sound is sometimesCHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filli Ebook Evidence-Based physical diagnosis (4/E): Part 2ld first establish the cadence of the normal Sj (lub) and s2 (dup):tub duplub duplub dupand then add an early diastolic sound (bub):*lub du bublub du bublub du bubThe overall cadence of the S3 gallop (tub du bub) is similar to the cadence of the word Kentucky.c. FOURTH HEART SOUND (S4)The fourth hea Ebook Evidence-Based physical diagnosis (4/E): Part 2rt sound is sometimes called the atrial gallop or presystolic gallop.2 To mimic the sound, the clinician establishes the cadence of S| and s2 (lub dliEbook Evidence-Based physical diagnosis (4/E): Part 2
p) and then adds a presystolic sound (be):be lub dupbe lub dupbe lub dupThe cadence of the s4 gallop (be lub dup) is similar to the cadence of TennessCHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filli Ebook Evidence-Based physical diagnosis (4/E): Part 2g the events that produce S3 (rapid early diastolic filling) to coincide with those producing S4 (atrial systole). The resulting sound sometimes is louder than the patient’s S| or s2.Not all gallop rhythms in patients with tachycardia are summation gallops. The only way to confirm the finding is to Ebook Evidence-Based physical diagnosis (4/E): Part 2observe the patient after the heart rate slows. (In the past, slowing was often induced by carotid artery massage, although in elderly patients this iEbook Evidence-Based physical diagnosis (4/E): Part 2
s no longer recommended. See Chapter 16.) If slowing causes the gallop to disappear or evolve into two distinct but fainter sounds (i.e., S3 and s4), CHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filli Ebook Evidence-Based physical diagnosis (4/E): Part 2quadruple rhythm consists of S|, s2, and both S3 and S4.4 It is an uncommon finding, usually only evident in patients with slow heart rates. It is sometimes called the train wheel rhythm because the sound resembles that produced by the two pairs of wheels from adjacent train cars as they cross the c Ebook Evidence-Based physical diagnosis (4/E): Part 2oupling of a railroad track:317be lub du bubbe lub du bubbe tub du bub* To pronounce the S3 gallop with correct timing, the “p” of dup (S2) must he drEbook Evidence-Based physical diagnosis (4/E): Part 2
opped. In most patients the accent is on s2 (tub du bub), although in others it falls on S| or S3. The clinician can practice all three versions, alwaCHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filliCHAPTER 41The Third and Fourth Heart SoundsKEY TEACHING POINTS•The third and fourth heart sounds (S3 and S4) both originate from rapid diastolic filliGọi ngay
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