All of the following heart sounds are heard in chronic mitral stenosis except?
Correct Answer: Third heart sound
Description: Ans. b. Third heart sound (Ref: Harrison 19/e p1539, 18/e p1930)Mid diastolic murmur, opening snap and loud S1 are heard in chronic mitral stenosis but not the third heart sound.'Auscultatory Findings in MS: The first heart sound (S1) is usually accentuated and slightly delayed. The pulmonic component of the second heart sound (P2) also is often accentuated, and the two components of the second heart sound (S2) are closely split. The opening snap (OS) of the mitral valve is most readily audible in expiration at, or just medial to, the cardiac apex. This sound generally follows the sound of aortic valve closure (A2) by 0.05-0.12 s. The time interval between A2 and OS varies inversely with the severity of the MS. The OS is followed by a low-pitched, rumbling, diastolic murmur, heard best at the apex with the patient in the left lateral recumbent position; it is accentuated by mild exercise (e.g.. a few rapid sit-ups) carried out just before auscultation.'- Harrison 18/e p1930Third Heart Sound (S3): Ventricular Diastolic Gallop, Protodiastolic Gallop, and Pericardial KnockPhysiologic S3Pathologic S3* ChildrenQ* High cardiac output- AtheletesQ- FeverQ- PregnancyQ- ThyrotoxicosisQ- AV fistulasQ* Ventricular dysfunction (LVF/RVF): Poor systolic function increased end-diastolic and end-systolic volume, decreased ejection fraction, and high filling pressure.- Idiopathic dilated cardiomyopathy, Ischemic heart disease- Valvular heart disease, Congenital heart disease- Systemic and pulmonary hypertension* Excessively rapid early diastolic ventricular filling:- Hyperkinetic states, Anemia, ThyrotoxicosisQ- Arteriovenous fistula, Atrioventricular valve incompetenceQ- Left to right shuntsQ (VSD, PDA and ASD)* Restrictive myocardial or pericardial diseaseQ* Constrictive pericarditisQ (pericardial knock)* Restrictive cardiomyopathyQ* Hypertrophic cardiomyopathyQ Mitral stenosisAuscultatory findingsX-Ray findings* S1: AccentuatedQ* S2: Normally split S2Q with accentuated P2Q* Murmur: Low-pitchedQ, rumbling diastolic murmur with 'Pre-systotic accentuation', heard best at the apex in left lateral recumbent positionQ.* Opening snap: Brief, high pitchedQ, early diastolicQ sound, best heard at the lower left sternal borderQ.* Features suggesting severe MS- Proximity of S2-OS gapQ- Longer duration of mid-diastolic murmurQ* Straightening of the left border of cardiac silhouette* Prominence of main pulmonary artery* Dilation of upper lobe pulmonary veinsQ* Kerley B linesQ* Backward displacement of the esophagusQ
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