Possible Causes for accentuated s1 Chronic Bronchitis A 49-year-old woman complained of cough and a purulent sputum (about 40 ml/day). She kept budgerigars for a period of 30 years, she first noticed a productive cough 10 years previously. Her chest roentgenogram revealed a diffuse reticulonodular pattern. She was diagnosed as having a chronic type of budgerigar[…] [ncbi.nlm.nih.gov] Sinus Tachycardia Inappropriate sinus tachycardia is a disease which is relatively rarely found and sometimes difficult to treat. Up to now it has been mostly treated with a beta-blocker or verapamil. If this did not work sinus node modulation was considered. Since the relatively new selective IF-stream blocker ivabradine has been[…] [ncbi.nlm.nih.gov] Mitral Valve Stenosis S1 Accentuation or Delay S1 is normally caused by closure of the mitral valve and is often accentuated or delayed in the context of mitral stenosis. [pathwaymedicine.org] Auscultation of heart sounds will reveal a loud, accentuated S1 early in mitral stenosis and soft S1 in severe mitral stenosis (see Heart Sounds Topic Review). [healio.com] However, S1 accentuation and delay tend to become mild or disappear all together in late stages of the disease. [pathwaymedicine.org] Thyrotoxic Heart Disease A 29-year-old woman at 34 weeks' gestation with uncontrolled hyperthyroidism and thyrotoxic heart disease was admitted to urgency Cesarean section. After preoperative sedation and good communication, low-dose spinal anesthesia (7.5 mg 0.5 % bupivacaine) combined with epidural anesthesia (6 ml 2 % lidocaine) was[…] [ncbi.nlm.nih.gov] Lown-Ganong-Levine Syndrome BACKGROUND Lown-Ganong-Levine syndrome, includes a short PR interval, normal QRS complex, and paroxysmal tachycardia. The pathophysiology of this syndrome includes an accessory pathway connecting the atria and the atrioventricular (AV) node (James fiber), or between the atria and the His bundle (Brechenmacher[…] [ncbi.nlm.nih.gov] Wolff-Parkinson-White Syndrome Myocardial bundles working as accessory pathways in Wolff-Parkinson-White (WPW) syndrome are generally tiny tissues, so elucidating the culprit histology of atrioventricular (AV) myocardial connections requires careful serial sectioning of the AV junction. We performed a postmortem examination of accessory AV[…] [ncbi.nlm.nih.gov] Atrial Myxoma Note loud S1 and S2. Additional late systolic sound is also present. This patient had severe pulmonary hypertension; that is why S2 was accentuated. [cardiacauscultation.com] Right Atrial Myxomas Right atrial myxomas are associated with a loud, early systolic, widely split S1 due to expression of the tumour from the right ventricle. [atlasgeneticsoncology.org] A pulmonary ejection murmur with a delayed and accentuated pulmonic second sound may be heard. There may also be an early, late or prolonged diastolic murmur heard. [atlasgeneticsoncology.org] Tricuspid Stenosis A 47-year-old man with history of familial cardiomyopathy and orthotopic heart transplant at the age of 34 years presented severe tricuspid stenosis (TS) with a mean transvalvular gradient of 10 mm Hg. The patient opted against tricuspid valve replacement and was offered percutaneous transcatheter tricuspid[…] [ncbi.nlm.nih.gov] Pulmonary Edema Mitral stenosis produces a low pitched, rumbling diastolic murmur associated with an opening snap at the apex which accentuates on expiration and produces loud S1. [ncbi.nlm.nih.gov] Mitral regurgitation produces a blowing, high pitched pan-systolic murmur best heard at the apex, radiating to left axilla and accentuating on expiration, produces soft S1 [ncbi.nlm.nih.gov] Hypertensive Heart Disease S1 is normal in intensity and character. [emedicine.medscape.com] S2 at the right upper sternal border is loud because of an accentuated aortic component (A2); it can have a reverse or paradoxical split due either to increased afterload [emedicine.medscape.com] Scarlet Fever [11] Symptoms of mitral stenosis increase with exercise and pregnancy[11] On auscultation of a patient with mitral stenosis, typically the most prominent sign is a loud S1 [en.wikipedia.org] Another finding is an opening snap followed by a low-pitched diastolic rumble with presystolic accentuation.[11][10] The opening snap follows closer to the S2 heart tone with [en.wikipedia.org] Mitral Valve Insufficiency Auscultation of heart sounds will reveal a loud, accentuated S1 early in mitral stenosis and soft S1 in severe mitral stenosis (see Heart Sounds Topic Review ). [healio.com] When pulmonary hypertension develops, the P2 component of the S2 heart sound will be accentuated. [healio.com] […] the mitral valve leaflets become significantly more calcified, their mobility declines and they are unable to be separated a great deal, resulting in a soft or even absent S1 [healio.com] Aortic Valve Stenosis Diminished or absent A2: The presence of a normal or accentuated A2 speaks against the existence of severe aortic stenosis Paradoxical splitting of the S2: Resulting from [emedicine.com] […] presence of left ventricular systolic dysfunction Hyperdynamic left ventricle: Unusual; suggests concomitant aortic regurgitation or mitral regurgitation Soft or normal S1 [emedicine.com] Heart Valve Disease S1, and an opening snap followed by a diastolic rumble with presystolic accentuation heard best at the apex in the left lateral decubitus position. [ncbi.nlm.nih.gov] [11] Symptoms of mitral stenosis increase with exercise and pregnancy[11] On auscultation of a patient with mitral stenosis, typically the most prominent sign is a loud S1 [en.wikipedia.org] Classification of Mitral Stenosis Severity Physical Examination Classic physical examination findings in patients with MS include a normal apical LV impulse, an accentuated [ncbi.nlm.nih.gov] Dilated Cardiomyopathy [11] Symptoms of mitral stenosis increase with exercise and pregnancy[11] On auscultation of a patient with mitral stenosis, typically the most prominent sign is a loud S1 [en.wikipedia.org] Another finding is an opening snap followed by a low-pitched diastolic rumble with presystolic accentuation.[11][10] The opening snap follows closer to the S2 heart tone with [en.wikipedia.org] Dilated Cardiomyopathy Type 1NN [11] Symptoms of mitral stenosis increase with exercise and pregnancy[11] On auscultation of a patient with mitral stenosis, typically the most prominent sign is a loud S1 [en.wikipedia.org] Another finding is an opening snap followed by a low-pitched diastolic rumble with presystolic accentuation.[11][10] The opening snap follows closer to the S2 heart tone with [en.wikipedia.org] Dilated Cardiomyopathy Type 1R [11] Symptoms of mitral stenosis increase with exercise and pregnancy[11] On auscultation of a patient with mitral stenosis, typically the most prominent sign is a loud S1 [en.wikipedia.org] Another finding is an opening snap followed by a low-pitched diastolic rumble with presystolic accentuation.[11][10] The opening snap follows closer to the S2 heart tone with [en.wikipedia.org] Dilated Cardiomyopathy Type 2B [11] Symptoms of mitral stenosis increase with exercise and pregnancy[11] On auscultation of a patient with mitral stenosis, typically the most prominent sign is a loud S1 [en.wikipedia.org] Another finding is an opening snap followed by a low-pitched diastolic rumble with presystolic accentuation.[11][10] The opening snap follows closer to the S2 heart tone with [en.wikipedia.org] Hyperkinetic Heart Syndrome Parasternal heave with normal S1 and accentuated P2. [lecturio.com] Accentuated S1 while S2 is narrowly or paradoxically split. [lecturio.com] Acute Aortic Regurgitation […] of the mitral valve. • A2 –normal or accentuated when AR is due to aortic root disease. • S2- absent or single or paradoxical splitting • S3 GALLOP - due to increased LV [slideshare.net] Physical findings Inspection and palpation • Evidence of LVH • Heaving apex • Apex displaced to the left and downward Auscultation • S1- may be soft due to premature closure [slideshare.net] Hydropericardium Physical Examination Right ventricular lift; palpable S1; opening snap (OS) follows A2 by 0.06 – 0.12 s; OS – A2 interval inversely proportional to severity of obstruction [curiozitatimedicale.blogspot.com] Diastolic rumbling murmur with presystolic accentuation in sinus Complications : Hemoptysis, pulmonary embolism, pulmonary infection, systemic embolization; endocarditis is [curiozitatimedicale.blogspot.com] Congenital Mitral Stenosis S1 Accentuation or Delay S1 is normally caused by closure of the mitral valve and is often accentuated or delayed in the context of mitral stenosis. [pathwaymedicine.org] Auscultation of heart sounds will reveal a loud, accentuated S1 early in mitral stenosis and soft S1 in severe mitral stenosis (see Heart Sounds Topic Review ). [healio.com] Cardiac auscultation: Heart sounds • The S1 is accentuated because of a wide closing excursion of the mitral leaflets. • The degree of loudness of the S1 depends on the pliability [slideshare.net] Cardiac Dilatation There is accentuation of the murmur just before S1, due to the increased pressure gradient when the LA contracts. EKG, electrocardiogram. [brown.edu] Neonatal Cardiac Arrhythmia The first heart sound (S1) is usually accentuated and slightly delayed. [quizlet.com] The murmur of mitral stenosis is a decrescendo low-pitched rumble usually limited to the apex with an accentuated opening S1 and opening snap that follows S2. [quizlet.com] It may be soft or loud and associated with a decreased S1. [quizlet.com] Rheumatic Aortic Valve Obstruction There is accentuation of the murmur just before S1, due to the increased pressure gradient when the LA contracts. EKG, electrocardiogram. [brown.edu] Diminished or absent A2: The presence of a normal or accentuated A2 speaks against the existence of severe aortic stenosis Paradoxical splitting of the S2: Resulting from [emedicine.medscape.com] […] presence of left ventricular systolic dysfunction Hyperdynamic left ventricle: Unusual; suggests concomitant aortic regurgitation or mitral regurgitation Soft or normal S1 [emedicine.medscape.com] Tricuspid Atresia accentuated -often Single S2 -Holosyst murmur if Q thru VSD or ejection murmur if RVOT -w incr Qp, can hear S3 or middiast rumble at apex -hepatomegaly, esp if restricted [sites.google.com] The first heart sound (S1)is single and may be accentuated. The 2nd heart sound (S2) is usually single. [merckmanuals.com] […] surgery) -dTGA -- Sx of pulm overcirc; hard to DDx (by exam) fr Type I if large VSD -Nl size newborn -LV impulse more prominent than RV - thrill if restrictive VSD -Single S1 [sites.google.com] Cardiac Dyskinesia This position accentuates or brings out aortic murmurs maximally. S1 The first heart tone, or S1, is composed of components mitral (M1) and tricuspid valve closure (T1). [textbookofcardiology.org] Cardiac Myxoma Note loud S1 and S2. Additional late systolic sound is also present. This patient had severe pulmonary hypertension; that is why S2 was accentuated. [cardiacauscultation.com] Right Atrial Myxomas Right atrial myxomas are associated with a loud, early systolic, widely split S1 due to expression of the tumour from the right ventricle. [atlasgeneticsoncology.org] A pulmonary ejection murmur with a delayed and accentuated pulmonic second sound may be heard. There may also be an early, late or prolonged diastolic murmur heard. [atlasgeneticsoncology.org] Cervical Aortic Arch Accentuated S1 & A2. Ejection click suggests bicuspid aortic valve. Murmur of coarctation: Best heard in the inter scapular region. [cardiologyforyou.blogspot.com] Congenital Aortic Valve Stenosis Diminished or absent A2: The presence of a normal or accentuated A2 speaks against the existence of severe aortic stenosis Paradoxical splitting of the S2: Resulting from [emedicine.com] […] presence of left ventricular systolic dysfunction Hyperdynamic left ventricle: Unusual; suggests concomitant aortic regurgitation or mitral regurgitation Soft or normal S1 [emedicine.com]
