Heart sounds (S3 versus Splitting) - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-01-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Stethoscope Heart sounds (S3 versus Splitting)

Hi,

I got a question about the heart sounds, in my opinion, one of the toughest topics in USMLE.

We have 2 normal heart sounds related to mitral and aortic vslve closures, S1 and S2 respectively.

and there are also 2 pathologic sounds - DCM and HCM, S3 and S4 respectively.

S3 is best heard in the beginning of diastole as the blood from the atrium rushes into the ventricle that has extra amount of blood left after sistole.
S4 is best heard right before S1 in late diastole and is referred to as an "atrial kick" - LA pushes with extra force into hypertrophic LV.

My question is about splitting of S2.
How to distinguish the splitting (normal or paradoxal) from S3?

Thank you!
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message



  #2  
Old 03-01-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 183
Threads: 79
Thanked 17 Times in 13 Posts
Reputation: 27
Default

it changes with inspiration
Reply With Quote Quick reply to this message
  #3  
Old 03-01-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

Quote:
Originally Posted by kenlee View Post
it changes with inspiration
fixed splitting doesnt change with inspiration (ASD)
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message
 
  #4  
Old 03-01-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 183
Threads: 79
Thanked 17 Times in 13 Posts
Reputation: 27
Default

Quote:
Originally Posted by DocSikorski View Post
fixed splitting doesnt change with inspiration (ASD)
then the location, intensity and sound quality.
left sided s3s4: mitral area
right sided s3s4 tricuspid area
s3:ken-tucky, slo--shing in
s4:Tene--sse, stiff--wall
http://www.med.ucla.edu/wilkes/Physiology.htm
Reply With Quote Quick reply to this message
The above post was thanked by:
DocSikorski (03-01-2012), koyi (03-02-2012)
  #5  
Old 03-02-2012
LatinGeorge's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 653
Threads: 47
Thanked 409 Times in 249 Posts
Reputation: 419
Default

another thing i may add, the clinical information that they give you in the vignette most of the times helps you pick an option between 2 differentials in your head. So knowing why s3 happens, will def help you.
Reply With Quote Quick reply to this message
The above post was thanked by:
DocSikorski (03-02-2012)
  #6  
Old 03-02-2012
DocSikorski's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,353
Threads: 94
Thanked 877 Times in 507 Posts
Reputation: 890
Default

Quote:
Originally Posted by LatinGeorge View Post
another thing i may add, the clinical information that they give you in the vignette most of the times helps you pick an option between 2 differentials in your head. So knowing why s3 happens, will def help you.
yes, thats true.
I guess the only way to make a 2nd year med student to distinguish a sound in his headphones is to provide an adequate clinical or social history...

But I think there is no way to do that in real life having only stethoscope on hand...
__________________
Ambition is a dream with a V8 engine. EP
Reply With Quote Quick reply to this message



Reply

Tags
Cardiovascular-, Clinical-Signs, Physiology-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Skipping Heart Sounds in the exam! rose USMLE Step 1 Forum 2 01-26-2012 11:41 PM
Help about Heart Sounds!!! drnrpatel USMLE Step 1 Forum 4 09-29-2011 10:11 AM
Splitting Versus Primitive Idealization insomnic USMLE Step 2 CK Forum 0 05-10-2011 12:23 AM
S3 vs S4 heart sounds, especially in restrictive cardiomyopathy Tig2575 USMLE Step 1 Forum 4 04-23-2011 05:11 PM
Third and Fourth Heart Sounds Hasky USMLE Step 1 Bits & Pieces 0 02-27-2010 07:14 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)