Term
Splitting of S1 at the apex |
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Definition
(not tricuspid related)
Usually mitral closure and S4 |
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Term
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Definition
@ lower left sternal border
- RBBB
- Atrial Septal Defect |
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Term
Increased intensity of S1 |
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Definition
hyperkinetic states
- increased contractility and myocardial tension
- anemia
- pregnancy
- anxiety
- anomalous AV conduction (short PR interval)
- mitral/tricuspid stenosis
- thickened valve leaflets |
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Term
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Definition
(S2 louder than S1 @ apex)
- Congestive Heart Failure
- Calcified Mitral Stenosis (severe)
- 1st degree AV block
- mitral valve almost closed at onset of ventricular contraction |
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Term
S1 varies in intensity from beat to beat |
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Definition
Regular Rhythm (AV dissociation)
- 3rd degree heart block
- ventricular tachycardia
- ventricular demand pacemakers
Irregular Rhythm
- Atrial Fibrillation |
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Term
At what position on the chest are both parts of S2 heard? |
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Definition
2nd and 3rd left intercostal space |
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Term
What indicates increased S2 intensity and what are its primary causes? |
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Definition
If S2 > S1 @ apex, S2 has increased intensity
- Pulmonary Hypertension
- Atrial Septal Defect |
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Term
Physiologic splitting of S2 |
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Definition
widens during inspiration (0.04-0.05 seconds)
- increased lung volume --> decreased vascular resistance --> increased ventricular ejection time --> delayed pulmonic valve closure
narrows during expiration (0.01-0.02 seconds)
- decreased lung volume --> increased vascular resistance --> decreased ventriculer ejection time --> earlier pulmonic valve closure
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Term
Wide physiologic splitting of S2 |
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Definition
(both components audible during expiration)
(Normal in young, pathological in old)
Longer RV ejection
- Pulmonary Stenosis
- RBBB
Shorter LV ejection
- Mitral Regurgitation
- Ventricular Septal Defect
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Term
Wide Fixed splitting of S2 |
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Definition
(both parts audible all the time, unchanging)
- Left-->Right shunts --> prolonged RV ejection
- Atrial Septal Defects
- Ventricular Septal Defects |
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Term
Reversed (paradoxic) splitting of S2 |
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Definition
P2 --> A2
(narrow during inspiration, wide during expiration)
prolonged LV ejection
- LBBB
- aortic stenosis
- hypertrophic obstructive cardiomyopathy
- RV demand pacemakers |
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Term
Progression of Pulmonary Hypertension |
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Definition
Mild --> Severe
- Audible S2 splitting @ apex due to increased intensity
- Narrow splitting of S2
- Palpable Px in 2nd Left IC space
- Wide splitting S2 with onset of RV failure |
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Term
Narrow physiologic splitting of S2 |
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Definition
Increased pulmonary vascular resistance --> RV ejection is shortened
- Pulmonary HTN
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