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Pulsus alternans is a physical finding with arterial pulse waveform showing alternating strong and weak beats. [1] It is almost always indicative of left ventricular systolic impairment, and carries a poor prognosis.
If the heart rate is also very fast (tachycardia), it can become difficult to distinguish between S 3 and S 4 thus producing a single sound called a summation gallop. S 3 is a dull, low-pitched sound best heard with the bell placed over the cardiac apex with the patient lying in the left lateral decubitus position. This heart sound when present ...
These are the first heart sound (S 1) and second heart sound (S 2), produced by the closing of the atrioventricular valves and semilunar valves, respectively. In addition to these normal sounds, a variety of other sounds may be present including heart murmurs , adventitious sounds , and gallop rhythms S 3 and S 4 .
[2] [3] The major way health care providers examine the heart on physical exam is heart auscultation; [3] another clinical technique is palpation, which can detect by touch when such turbulence causes the vibrations called cardiac thrill. [4] A murmur is a sign found during the cardiac exam. Murmurs are of various types and are important in the ...
The murmur usually does not extend to S1. Early diastolic Left anterior descending artery stenosis This murmur, also known as Dock's murmur, is similar to that of aortic regurgitation and is heard at the left second or third intercostal space. A Coronary artery bypass surgery can eliminate the murmur. Early diastolic Cabot–Locke murmur
The fourth heart sound or S 4 is an extra heart sound that occurs during late diastole, immediately before the normal two "lub-dub" heart sounds (S 1 and S 2).It occurs just after atrial contraction and immediately before the systolic S 1 and is caused by the atria contracting forcefully in an effort to overcome an abnormally stiff or hypertrophic ventricle.
The resultant configuration of this murmur is a crescendo-decrescendo murmur. Causes of midsystolic ejection murmurs include outflow obstruction, increased flow through normal semilunar valves, dilation of aortic root or pulmonary trunk, or structural changes in the semilunar valves without obstruction.
Korotkoff sounds are the sounds that medical personnel listen for when they are taking blood pressure using a non-invasive procedure. They are named after Nikolai Korotkov , a Russian physician who discovered them in 1905, [ 1 ] when he was working at the Imperial Medical Academy in St. Petersburg , the Russian Empire.
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