Symptoms and signs of congestive heart failure
by Franklin B Saksena, Ranganathan Narasimhan, Sivaciyan Vahe

The Art and Science of Cardiac Physical Examination (With Heart Sounds, Jugular and Precordial Pulsations)

by Narasimhan Ranganathan, Vahe Sivaciyan, Franklin B Saksena
About Video

The audio recording is from a patient in his late 30s with history of excess alcohol intake presenting with symptoms and signs of congestive heart failure. The recording is taken from the apex area. All of the following statements are correct except: (A) The rhythm is irregular and suggestive of atrial fibrillation, (B) The extra sound in diastole is most likely S3, (C) There is a faint high frequency systolic murmur suggestive of mitral regurgitation, (D) The presence of S3 is suggestive of moderately severe degree of mitral regurgitation. The faint and high frequency murmur of mitral regurgitation indicates that the regurgitation is mild and is probably mostly due to pressure gradient between the left ventricle and the left atrium and not due to flow. The S3 must therefore be related to the elevated left atrial pressure secondary to left ventricular dysfunction and decreased compliance secondary to probable cardiomyopathy.

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