random / physical exam

Question 1

when won’t you hear an S4 ever

Answer 1

A FIB OR A FLUTTER - b/c s4 requires atrial contraction!

Question 2

s4 - patho

Answer 2

d/t decreased ventricular compliance - heard in late diastole

Question 3

s4 causes

Answer 3

left: systemic HTN, AS, HCOM
right: PAH, pulmonic stenosis,
* CAD leading to MI or angina - s4 often early finding in acute MI, acute MR

Question 4

s3 - patho

Answer 4

early in diastole, can be PHYSIOLOGIC UNDER 40 - once over 40 abnl - c/w volume overload
-may be normal w/ high output states - anemia, thyrotoxicosis, pregnancy, athletes

Question 5

s3 causes

Answer 5

vol overload - MR, iatrogenic, CHF, dilated cardiomyopathy, VSD, post-mi
*any cause of ventricular dysfunction