Posted: January 11th, 2023
Mrs. K is a 60-year-old white female who presented to the ER with complaints of her heart “beating out of my chest.” She is complaining that she is having increased episodes of shortness of breath over the last month and in fact has to sleep on 4 pillows. She also notes that the typical swelling she’s had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day. In the past week, she’s been experiencing fatigue and decreased urine output S3 Heart Sound Pathophysiology Essay. Her past history is positive for an acute anterior wall myocardial infarction and coronary artery bypass surgery. She was a 2 pack a day smoker, but quit 8 years ago.
On physical examination, auscultation of the heart revealed a rumbling S3 gallop and inspiratory crackles. She has +3 edema of the lower extremities. Question: Discuss the pathophysiology of an S3 heart sound and include causes for an S3 gallop?
Pathophysiology of an S3 Heart Sound
The third heart sound (S3) is a rare occurrence in normal individuals more than 40 years of age, only occurring as an extra heart sound after the first heart two sounds lub-dub and is often associated with heart failure. Clinically S3 heart sound occurs as a displaced apical pulse (Shono et al., 2019). S3 Heart Sound Pathophysiology Essay The third heart sound is a low frequency, short lasting vibration that occurs at the end of diastole. Most often, clinicians refer to it as a ventricular gallop, a diastolic gallop, protodiastolic gallop. Jean-Baptiste Bouillaud first used the term gallop in 1847 by to describe the cadence of the three heart sounds occurring in rapid succession
The third heart sound is often associated with several disorders such as tachypnea, tachycardia, mitral regurgitation, dilated cardio myopathy, post myocardial infarction, ventral septal defects, and elevated left atrial and ventricular pressures and its pathogenesis lies in dysfunction of the ventricles. In the case of MI, the heart wall muscles undergo ischemia due to obstruction of the coronary arteries (Shono et al., 2019). This infarction can originate from an atherosclerotic plague, which acts a source of thrombi downstream thus leading to necrosis of the myocardium in about 24 hours. In the case of a left sided heart failure, the patient develops a dilated left ventricular wall due to increased resistance and decreased cardiac output. This in turn activates the renin angiotensin system that only worsens the conditions even further due to increase in systemic volume thus causing a volume overload to an already defective heart (Latha, Sabanayagam & Aneesh, 2017).
The third heart sound is an indicator of cardiovascular pathology that needs immediate action to save the life of a patient. If detected on physical examination or even echocardiography the patient needs adequate monitoring and management S3 Heart Sound Pathophysiology Essay.
Latha, R., Sabanayagam, A., & Aneesh, Y. M. (2017). Heart sound and abnormal heart sound detection method based on signal characteristic. International Journal of Mathematical Sciences and Engineering (IJMSE), 5(2), 99-103.
Shono, A., Mori, S., Yatomi, A., Kamio, T., Sakai, J., Soga, F., & Hirata, K. I. (2019). Ultimate Third Heart Sound. Internal Medicine, 58(17), 2535-2538 S3 Heart Sound Pathophysiology Essay.
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