A 68-year-old man with long-standing hypertension presents with exertional dyspnea. On auscultation, you detect an extra heart sound just before S1. His ECG shows LV hypertrophy. Which of the following mechanisms explains this extra sound?
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اعرض الإجابة
الإجابة والشرح
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الإجابة: B. Forceful atrial contraction into a stiff ventricle
A sound just before S1 (late diastole) is S4. It is made by a forceful atrial kick pushing blood into a stiff, non-compliant ventricle. LVH from chronic hypertension is a classic cause. Option A, vibration during rapid ventricular filling, describes S3, which comes in early diastole with a dilated ventricle (systolic HF). An opening snap (C) and MR flow (D) are not sounds that come just before S1.
ليش كل خيار صح أو غلط
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A
ليش غلط
That describes S3: the abrupt end of rapid ventricular filling early in diastole with a dilated ventricle (systolic HF, dilated cardiomyopathy), not a sound just before S1.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 2 -
B
ليش صح
This is S4: the atrial kick late in diastole pushing blood into a less compliant ventricle. Causes include diastolic HF and anything causing LVH, such as chronic hypertension.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 2 -
C
ليش غلط
The sound from a stenotic mitral valve is the opening snap of mitral stenosis (valve bowing), followed by a decrescendo diastolic murmur at the apex; it is not the atrial-kick sound of an LVH patient.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 7 -
D
ليش غلط
Regurgitant flow from LV to LA in systole produces the holosystolic murmur of mitral regurgitation, heard at the apex; it is a systolic murmur, not an extra sound just before S1.
✓ 8• Heart Sounds & Murmurs [Notes].pdf · p. 6
- المصدر
- 8• Heart Sounds & Murmurs [Notes].pdf · p. 2
- المحاضرة
- Valvular Heart Disease · Cardiology · Module B
- ظهر في
- MED43 ♂ Quiz B