Loud first heart sound is heard in –
a)Mitral stenosis
b)M.R.
c)M.V.prolapse
d)Calcified mitral leaflet
ANS IS A i.e mitral stenosis
The intensity of the first heart sound (S1) is influenced by (1) the position of the mitral leaflets at the onset of ventricular systole:- [The loud S1 in mitralstenosis usually signifies that the valve is pliable and that it remains open at the onset of isovolumetric contraction because of the elevated left atrial pressure.]; if AV flow is increased because of high cardiac output or prolonged because of mitral stenosis.;S1 is louder if diastole is shortened because of tachycardia ,or if atrial contraction precedes ventricular contraction by an unusually short interval, reflected in a short PR interval
a)Mitral stenosis
b)M.R.
c)M.V.prolapse
d)Calcified mitral leaflet
ANS IS A i.e mitral stenosis
The intensity of the first heart sound (S1) is influenced by (1) the position of the mitral leaflets at the onset of ventricular systole:- [The loud S1 in mitralstenosis usually signifies that the valve is pliable and that it remains open at the onset of isovolumetric contraction because of the elevated left atrial pressure.]; if AV flow is increased because of high cardiac output or prolonged because of mitral stenosis.;S1 is louder if diastole is shortened because of tachycardia ,or if atrial contraction precedes ventricular contraction by an unusually short interval, reflected in a short PR interval
(2) the rate of rise of the left ventricular pressure pulse;A soft S1may be due to slow rise of the left ventricular pressure pulse AND a long PR interval,
In short PR interval and Tachycardia both position and rate of rise of left ventricular pressure pulse increases the First heard sound loudness
(3) the presence or absence of structural disease of the mitral valve; a Soft S1 may be due to imperfect closure due to reduced valve substance, as in mitral regurgitation.S1 is also soft when the anterior mitral leaflet is immobile because of rigidity and calcification, even in the presence of predominant mitral stenosis.
(4) the amount of tissue, air, or fluid between the heart and the stethoscope.:-A soft S1may be due to poor conduction of sound through the chest wall.
Current management options that have been reported include tracheotomy, laser partial excision, open surgical resection, systemic or intralesional steroids, and systemic interferon alfa-2A
Infantile subglottic hemangiomas occur in children a few months of age and present as a lateral subglottic submucosal bluish mass, causing respiratory symptoms. These lesions, if mildly symptomatic, are managed conservatively with corticosteroids and observation. They usually involute spontaneously with time; however, a tracheotomy is occasionally needed when severe airway compromise is present. Healy and others[3] reported the use of the carbon dioxide laser for the management of this condition.[3] The carbon dioxide laser is used to vaporize the tumor until an adequate airway is achieved.
The Nd:YAG laser, although ideal for low-flow venous malformations, is not recommended for subglottic hemangiomas because these lesions are more compact capillary-type vascular lesions. The depth of penetration of the Nd:YAG laser presents a serious risk to the infant’s larynx and trachea, with potential stricture formation or tracheal perforation, and is not recommended for the management of these lesions.
In short PR interval and Tachycardia both position and rate of rise of left ventricular pressure pulse increases the First heard sound loudness
(3) the presence or absence of structural disease of the mitral valve; a Soft S1 may be due to imperfect closure due to reduced valve substance, as in mitral regurgitation.S1 is also soft when the anterior mitral leaflet is immobile because of rigidity and calcification, even in the presence of predominant mitral stenosis.
(4) the amount of tissue, air, or fluid between the heart and the stethoscope.:-A soft S1may be due to poor conduction of sound through the chest wall.
Current management options that have been reported include tracheotomy, laser partial excision, open surgical resection, systemic or intralesional steroids, and systemic interferon alfa-2A
Infantile subglottic hemangiomas occur in children a few months of age and present as a lateral subglottic submucosal bluish mass, causing respiratory symptoms. These lesions, if mildly symptomatic, are managed conservatively with corticosteroids and observation. They usually involute spontaneously with time; however, a tracheotomy is occasionally needed when severe airway compromise is present. Healy and others[3] reported the use of the carbon dioxide laser for the management of this condition.[3] The carbon dioxide laser is used to vaporize the tumor until an adequate airway is achieved.
The Nd:YAG laser, although ideal for low-flow venous malformations, is not recommended for subglottic hemangiomas because these lesions are more compact capillary-type vascular lesions. The depth of penetration of the Nd:YAG laser presents a serious risk to the infant’s larynx and trachea, with potential stricture formation or tracheal perforation, and is not recommended for the management of these lesions.
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