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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.
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 .
Heart murmurs are unique heart sounds produced when blood flows across a heart valve or blood vessel. [1] This occurs when turbulent blood flow creates a sound loud enough to hear with a stethoscope. [2] The sound differs from normal heart sounds by their characteristics. For example, heart murmurs may have a distinct pitch, duration and timing.
The loudness of the murmur does not correlate well with the severity of regurgitation. It may be followed by a loud, palpable P 2, [6] heard best when lying on the left side. [7] A third heart sound is commonly heard. [6] Patients with mitral valve prolapse may have a holosystolic murmur or often a mid-to-late systolic click and a late systolic ...
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 ...
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 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.
Peripheral physical signs of aortic regurgitation are related to the high pulse pressure and the rapid decrease in blood pressure during diastole due to blood returning to the heart from the aorta through the incompetent aortic valve, although the usefulness of some of the eponymous signs has been questioned: [23] Phonocardiograms detect AI by ...