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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
A third heart sound (S3) occurs after the second heart sound and is produced by high left atrial and LV filling pressures including volume overload and/or pressure overloaded ventricle. A left-sided S3 indicates LV failure, but it can be a normal finding in children, young adults and pregnant women.
Cardiovascular system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
8.1. The innocent (physiological) systolic murmur in an 8-year-old childusually changes intensity with posture.is inaudible posteriorly.is maximal in the 4th/5th left interspace.may be associated with a third heart sound.can be musical or high pitched in character.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Third and fourth heart sounds A third heart sound is usually a low-frequency sound best heard with the bell and occurring just after the second heart sound. It is caused by sudden distension of the ventricle at the end of the rapid filling phase in early diastole. A soft third heart sound may be heard at the apex in most normal children and adults less than 30 years of age: in older people it is abnormal and signifies unusually abrupt filling of the ventricle. This may arise from an abnormally large stroke volume or from increased ventricular filling pressure due to left ventricular failure (LVF).
Management of pulmonary arterial hypertension during pregnancy
Published in Expert Review of Respiratory Medicine, 2023
Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos
The greatest risk to pregnant women with PAH occurs at stages when the hemodynamic changes are most apparent, especially in the peri- and the postpartum period when there are significant volume shifts, as previously described. Reduced cardiac output and inability to meet the demands of the growing fetus can impact on the uteroplacental circulation and increase fetal mortality and morbidity. This can manifest as miscarriage, intrauterine growth restriction, preterm delivery, and stillbirth [5,18–21]. Pregnant women with PAH can present in cardiogenic shock if the cardiac output cannot meet the increased demands of pregnancy and delivery [9,22]. More often, patients present with nonspecific features of RV failure, including leg swelling, breathlessness, and ascites. Chest pain and syncope are also common modes of presentation [16,23]. Clinical examination is important and, beyond the features of PAH (loud pulmonary component of the second heart sound), may reveal a raised jugular venous pressure, right-sided third heart sound, and features of tricuspid and/or pulmonary regurgitation. Hepatomegaly may be difficult to assess in more advanced stages of pregnancy. Arrhythmias should be excluded. In women with PAH diagnosed during pregnancy, which accounts for approximately a third of cases, pathological signs and symptoms may be confused with those of normal pregnancy [24,25]. Deterioration early in pregnancy is a worrying feature and is associated with poor outcomes [16].
Assessing congestion in acute heart failure using cardiac and lung ultrasound - a review
Published in Expert Review of Cardiovascular Therapy, 2021
Øyvind Johannessen, Peder L. Myhre, Torbjørn Omland
The physical signs in congested AHF involve jugular vein distension (JVD), peripheral edemas with or without pitting, along with ‘crackles’ and ‘rales’ on lung auscultation. A typical third heart sound (S3) or ‘gallop’ rhythm is also common. With hemodynamic congestion defined as PCWP ≥ 18 mmHg, history, symptoms, and findings have poor predictive value for elevated PCWP. Dyspnea on exertion, orthopnea, edema, resting JVD, and S3 have been demonstrated to correlate poorly with congestion, with sensitivities ranging from 46% to 73%. The best accuracy was seen for S3 (sensitivity 73% and specificity 42%) and JVD (sensitivity 70% and specificity 79%) [20,22]. The ESCAPE trial found that the only parameters that were associated with elevated PCWP ≥ 18 mmHg were JVD and orthopnea [23]. Long-term invasive monitoring in HF patients with implantable cardiac devices shows that raised intra-cardiac pressures precedes physical signs of congestion. This discrepancy between actual hemodynamic congestion and overt signs and symptoms may explain the poor accuracy of the physical findings for elevated cardiac pressures [20,24,25].
A literature review of immersion pulmonary edema
Published in The Physician and Sportsmedicine, 2019
Manish Kumar, Paul D. Thompson
Individuals may experience symptoms as quickly as within ten to thirty minutes of immersion [10]. Ninety percent of IPE patients present with shortness of breath, cough, and sputum production [2,3,6,7,24]. More than 50% present with hemoptysis [2,13]. Other symptoms include weakness, frothy sputum, [2] chest discomfort, [2] orthopnea, loss of consciousness [8,24] and dizziness [2,3,7,9,13]. The clinical examination may reveal wheezes, [2] rales, a third heart sound, and a pan-systolic murmur suggesting functional mitral regurgitation [3]. The mean oxygen saturation may be low [2,13]. Cardiac disease, saltwater aspiration, gas-induced pulmonary toxicity, decompression sickness, and asthma can mimic IPE and should be included in the differential diagnosis [25].