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NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Ess

NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays

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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. 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 NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.

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On physical examination, auscultation of the heart revealed a rumbling S3 gallop and inspiratory crackles. She has +3 edema of the lower extremities.

  1. Discuss the pathophysiology of an S3 heart sound and include causes for an S3 gallop?

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    • Mod 4 S3 Heart Sound/S3 GallopSubscribe
    • Candice Russell posted Feb 9, 2021 3:39 PM
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    •             “The heart is the organ that pumps blood with oxygen and nutrients into all the body organs by a rhythmic cycle overlapping between contraction and dilation” (Bourouhou et al., 2020, p. 64). Dwivedi et al. (2019) state “electrical activity of the cardiovascular system causes atrial and ventricular contractions that assist in blood circulation between the chambers of the heart and around the body” (p. 8318) “Mechanical interactions between the blood flow and the different valves that operate to regulate the circulation of blood, contribute to rhythmic heart sounds and murmurs” (Dwivedi et al., 2019, p. 8318).  The term gallop describes the cadence of the three heart sounds occurring in a rapid succession. Jean-Baptiste Bouillaud coined the term “gallop rhythm”. His pupil, Pierre Potain stated, “In addition to the two normal sounds, this burit completes the triple rhythm of the heart… this is the bruit de gallop” (Silverman 1990, as cited by Ramani & Weber, 2017). Pathological ventricular dysfunction during a third heart sound, the term gallop is used. S3 gallop is thought to occur “in the presence of volume overload and ventricular dysfunction when rapid filling phase ends abruptly” (Talley & O’Connor. 2013, as cited by Ramani & Weber, 2017). Symptoms reported by Mrs. K, she appears to be suffering from CHF, left-sided. Reference    Shono, A., Mori, S., Yatomi, A., Kamio, T., Sakai, J., Soga, F., Tanaka, H., & Hirata, K. I. (2019). Ultimate Third Heart Sound. Internal medicine (Tokyo, Japan), 58(17), 2535–2538. https://doi.org/10.2169/internalmedicine.2731-19                  less1 UnreadUnread6 Views Views
    • 1 RepliesReplies
    • View profile card for Caroline Otto
    • Last post February 15 at 2:21 AM by Caroline Otto
    • ‌
    •           Ramani, S. and Weber, B.N. (2017), Detecting the gallop: the third heart sound and its significance. Medical Journal of Australia, 206: 198-199. https://doi-org.wilkes.idm.oclc.org/10.5694/mja16.00613
    • Pechetty, R., & Nemani, L. (2020). Additional Heart Sounds-Part 1 (Third and Fourth Heart Sounds). Indian Journal of Cardiovascular Disease in Women. 5 (2), 155-164. https://doi.org/10.1055/s-0040-1713828
    • Bourouhou, A., Jilbab, A., Nacir, C., & Hammouch, A. (2020). Heart Sound Signals Segmentation and Multiclass Classification. International Journal of Online and Biomedical Engineering (IJOE), 16(15), 64. https://doi.org/10.3991/ijoe.v16i15.16817
    • A. K. Dwivedi, S. A. Imtiaz and E. Rodriguez-Villegas. (2019). “Algorithms for Automatic Analysis and Classification of Heart Sounds–A Systematic Review,” in IEEE Access, 7, 8316-8345, doi: 10.1109/ACCESS.2018.2889437 NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.
    • If a third heart sound is audible during auscultation, this is not necessarily due to heart disease. S3 heart sounds are often seen in young healthy individuals. Dwivedi et al. (2019) state, “S3 is noted as a benign sound in the case of young people, athletes, and during pregnancy” (p. 8319).  In cases not mentioned previously, a third heart sound is considered “an important indicator of reduced systolic function” (Dwivedi et al., 2019, p. 8319). Sono et al. (2019) stated “Among valvular diseases, a third heart sound is most commonly auscultated with mitral regurgitation” (p. 2537). The third heart is an indicator of left-sided heart failure. S3 is said to be “an initial clue to left heart failure and is associated with severe mitral regurgitation, a low ejection fraction, restrictive diastolic filling, functionally severe heart failure, and cardiovascular mortality” (Sono et al., 2019, p. 2537).
    •             First and second heart sounds, S1 and S2, are normal and expected findings, during auscultation. S1 and S2 are considered “fundamental” heart sounds. Third and fourth heart sounds, S3 and S4, are abnormalities. An S3 heart sound is produced during early diastolic filling in the ventricles, caused by blood rushing in from the atria (Dwivedi et al., 2019). When S3 is present, it’s a low-pitched sound, usually heard shortly after S2. Other terms used for third heart sound are ventricular gallop, early diastolic gallop, protodiastolic gallop, and ventricular early filling sound. Pechetty and Nemani (2020) defined the physiology of a third heart sound as, “in early diastole, when ventricular pressure falls below the atrial pressure, the atrioventricular valves open wide and blood drains rapidly from atria into the ventricles, producing S3” (p. 155).
    • Fritzinger NSG 530 Discussion Wk 4Subscribe
    • Cassie Fritzinger posted Feb 10, 2021 7:28 AM
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    • Mrs. K. presents to the Emergency Department with classic signs of Left sided heart failure. Her symptoms, which are classic signs of heart failure include: dyspnea (shortness of breath), orthopnea (dyspnea when lying down) fatigue, edema (increased swelling of her legs, ankles, & feet), as well as rapid or irregular heartbeat (Mayo Clinic, 2020). Mrs. K.’s history of smoking 2 packs a day placed her at risk of coronary artery disease (CAD), which subsequently resulted in her experiencing an anterior wall myocardial infarction and coronary artery bypass graft surgery (CABG). The anterior wall myocardial infarction is a result of an occlusion of the left anterior descending artery (LAD) causing infarction (tissue death) and subsequent organ dysfunction (Heuther, McCance, & Brasher, 2020). The anterior wall/LAD supplies blood to the left ventricle and anterior septum of the heart (Bansal & Nalabothu 2020). Left ventricle infarction/dysfunction causes the heart to become weak and unable to keep up with the metabolic demand of the body (Mayo Clinic, 2020). Ejection fraction may or may not be decreased in heart failure. Heart Failure with/without preserved ejection fraction can affect patients. However, Mrs. K’s most likely experiencing decreased ejection fraction, her decreased urinary output is most likely secondary to the decreased cardiac output (Michigan Medicine University of Michigan, 2021) NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.            Heart failure and decreased cardiac output are secondary to the decreased contractility, resulting in decreased cardiac output/stroke volume. In order to increase preload to improve or compensate and improve the stroke volume the heart dilates or stretches. This dilation eventually leads to a worsening dysfunction of the myocardium contractility and stretches of the coronary arteries which compromises the overall amount of cardiac output (Heuther, McCance, & Brashers, 2020).Bansal K, Gore M, Nalabothu P. Anterior Myocardial Infarction. (2020). StatPearls. Retrieved February 6, 2020.  from: https://www.ncbi.nlm.nih.gov/books/NBK562234/Heuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology (7th ed.). Elsevier.Michigan Medicine University of Michigan. (2021). Heart Failure: Compensation by the Heart and Body. Retrieved February 10, 2021. From https://www.uofmhealth.org/health-library/aa86963#:~:text=Low%2Doutput%20symptoms%2C%20which%20are,fatigue%2C%20and%20low%20urine%20output.less1 UnreadUnread6 ViewsViews
    • 1 RepliesReplies
    • View profile card for Aina Oluwo
    • Last post February 14 at 11:17 PM by Aina Oluwo
    • Mayo Clinic. (2020). Heart Failure. Retrieved February 6, 2020. From https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142
    •  Healio Learn the Heart. (2021). Heart Sounds Topic Review. Retrieved February 10, 2021. From https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/heart-sounds
    • References
    •             A normal cardiac cycle produces sounds from the closure of valves and the tensing of chordae tendineae. Normal heart sounds are called S1 and S2. Other cardiac sounds include a S3 and S4. The S3 is a low-pitch sound which at times can be normal (such as in children or pregnant females) or pathologic. The S3 is also known as the ‘ventricular gallop’. This sound occurs just after the normal S2 when the mitral valve opens, and passively allows the filling of the left ventricle. The S3 sound is created from a large amount of blood striking the over stretched left ventricle. The best location to hear the S3 with the bell of a stethoscope is the cardiac apex when the patient is in a left lateral decubitus position (Healio Learn the Heart, 2021) NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.
    • HeartSubscribe
    • Sheryl Dixon posted Feb 10, 2021 8:24 PM
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    • During ventricular contraction, the mitral and tricuspid valves are closed, and atrial pressure rises (V wave) from the continuing influx of venous blood into the atria. In early diastole, when ventricular pressure falls below atrial pressure, the atrioventricular valves open wide, and the blood rapidly drains from the atria (Y descent) into the ventricles. The ventricles quickly become distended, moving toward the chest wall, until the elastic distensibility of the ventricular wall is reached and the rapid inflow of blood is checked. At the termination of this early diastolic filling period, a third heart sound may occur. The genesis of this sound is controversial. Previously, it was thought to be an intracardiac sound arising from vibrations in the valve cusps or ventricular wall as diastolic inflow suddenly decelerated. Recent studies, however, have shown that the third heart sound is loudest external to the left ventricular cavity, implying that the sound is not radiating from an intracardiac source. Possible explanations include impact of the ventricle against the inner chest wall or a sound originating within the ventricular apex due to sudden limitation of longitudinal expansion (Health jade, 2019).The third heart sound tests the ausculatory skills of the examiner because it is often the most difficult heart sound to hear. This is caused by several factors:The sound does not radiate widely and is audible only over a small area of the chest wall.All extraneous noises—radio, television, visitors, hall noises—should be excluded so that the room is as quiet as possible. Any cause of a significant increase in the volume load on the ventricle(s) can cause an S3. Examples include valvular regurgitation, high-output states (anemia, pregnancy, arteriovenous fistula, or thyrotoxicosis), left-to-right intracardiac shunts, complete A-V block, renal failure, and volume overload from excessive fluids or blood transfusion. Health Jade, 2019.Third heart sound. Retrieved from https://healthjade.net/third-heart-sound/#Third_heart_sound_causesSullivan, M.E (2019).Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK342/more1 UnreadUnread3 Views Views NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
    • 1 RepliesReplies
    • View profile card for Beth Certain
    • Last post February 14 at 8:14 PM by Beth Certain
    • Huether, S. E., & McCance, K. L. & Brashers, V.L. (2020). Understanding Pathophysiology 7th ed. Elsevier Mosby
    •                                                         References
    • Although the third heart sound is a very important clue to heart failure or volume overload, it does not appear until the problem is relatively far advanced. In some patients, for reasons that are not clear or because of chest size, obesity, or lung disease, an S3 may never be heard despite severe hemodynamic impairment. Therefore, the absence of a third heart sound cannot be used to exclude ventricular dysfunction or volume overload. In addition, the intensity of the third heart sound is influenced by several factors and correlates only roughly with the clinical status of the patient (Sullivan2019).
    • Any cause of ventricular dysfunction, including ischemic heart disease, dilated or hypertrophic cardiomyopathy, myocarditis, cor pulmonale, or acute valvular regurgitation, may qualify. Myocardial ischemia without ventricular dysfunction or volume overload is not a cause of an S3. The presence of an S3 is the most sensitive indicator of ventricular dysfunction (Huether, McCance & Brashers, 2020).
    • Children and adults up to age 35 to 40 may have a normal third heart sound. The explanation for this “physiologic S3,” which is identical in timing and frequency with its pathologic counterpart, is unknown. Before age 40, the significance of the third heart sound must be judged by the presence or absence of significant heart disease. After age 40, a third heart sound is usually abnormal and correlates with dysfunction or volume overload of the ventricles.
    • The usual frequency (pitch) of the sound is near the lowest level that the human ear can detect. The inexperienced ear is unaccustomed to listening for a sound of this low frequency NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.
    • The sound is usually of very low intensity and is easily obscured by extraneous room sounds, lung or abdominal noise, or tightening of the chest wall muscles.
    • During diastole there are 2 sounds of ventricular filling: The first is from the atrial walls and the second is from the contraction of the atriums. The third heart sound is caused by vibration of the ventricular walls, resulting from the first rapid filling so it is heard just after S2. The third heart sound is low in frequency and intensity. An S3 is commonly heard in children and young adults. In older adults and the elderly with heart disease, an S3 often means heart failure.
    • Module four – the heartSubscribe
    • Beth Certain posted Feb 10, 2021 6:18 PM
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    • Module 4 – The heartAccording to Heart Sounds Topic Review (N.D.), reviewing the four heart sounds explains the S1 is the first heart sound resulting from the closure of the mitral ad tricuspid valves.The S3 sound is heard at the beginning of the middle third of diastole. Hall (2016) explained, “in the early part of diastole, the ventricles are not sufficiently filled to create enough elastic tension necessary for reverberation.” Interestingly, the S3 sound may be typical in children, adolescents, and young adults, whereas hearing the S3 in an older adult may indicate systolic heart failure.Heart sounds are described as intensity, pitch, location. Intensity means how loud the sound is. The sound can be intense (loud), decreased in intensity (soft), or absent. Pitch is the quality of the sound, high or low. The location of the heart sound can help determine the etiology.The 3rd heart sound can be a significant clue to heart failure or volume overload. Unfortunately, by the time a problem appears, it is relatively far advanced. Despite severe hemodynamic impairment, a 3rd heart sound may not be heard. Ventricular dysfunction or volume overload cannot be excluded by the absence of a 3rd heart sound (Health Jade (2019).Hall, J.E. (2016). Guyton and Hall textbook of medical physiology (13th ed.). Elsevier            https://healthjade.netthird-heart-soundHeart. Retrieved February 9, 2021, from https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/heart-soundsless1 UnreadUnread3 ViewsViews
    • 1 RepliesReplies
    • View profile card for Jennifer Bryant
    • Last post February 14 at 11:30 AM by Jennifer Bryant
    • Heart Sounds Topic Review (N.D.) Cardiology Reviews Topic Reviews. Helio Learn the
    • Health Jade. (2019). Third Heart Sound. By Health Jade team. Retrieved February 9, 2021
    • References
    • The 3rd heart sound is also known as the “ventricular gallop,” occurring just after S2 when the mitral valve opens, allowing passive filling of the left ventricle. The S3 sound is produced by a large amount of blood striking a very compliant LV (Heart Sounds Topic Review, N.D.). In most adults, the LV is not overly compliant, meaning the S3 is usually not loud enough to be auscultated. An S3 can be a normal finding in children, pregnant females, and well-trained athletes (Health Jade, 2019). It has been noted that an S3 can also be a normal variance in younger children, pregnant women, and athletes but is generally indicative of pathology in older adults.
    • The S4 heart sound is almost always abnormal, known as the atrial gallop, and occurs just before S1 when the atria contract to force blood into the LV,
    • The S2 sound is produced when the aortic and pulmonic valve close.
    • There are four sounds the heart produces. These include S1, S2, S3, and S4. Specific cardiac events are what make these sounds. Events such as the “closure of a valve or tensing of a chordae tendineae produce sounds (Heart Sounds Topic Review, N.D.). Heart Sounds Topic Review explains auscultation of the heart sounds can help to diagnose pathological cardiac conditions. Heart sounds can be discrete, short, and audible from a specific cause. Heart murmurs produce a different sound due to turbulence of blood flow and encompass all of systole or diastole.
    • The S3 Heart Sound PathophysiologySubscribe
    • Lois Chappell posted Feb 10, 2021 7:37 PM
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    •      The S3 heart sound is usually abnormal if auscultated in a patient greater than age 40 years old and is associated with ventricular dysfunction and volume overload (Heuther, McCance, and Brashers, 2020).  This syndrome is called heart failure and can have a variety of causes.  In our patient who has a history of myocardial infarct (MI), cardiac artery bypass graft (CABG), and smoking, the most likely cause is congestive heart failure from ventricular wall dysfunction due to long-standing hypertension, and damage of the left ventricle from the anterior myocardial infarct.  The S3 heart sound is noted when there is normal or greater than normal cardiac output combined with systemic vascular resistance and is highly specific but not sensitive in heart failure (Long, Koyfron, and Gotlieb, 2019).  There is also a decrease in after load which activates the neurohormones renin and angiotension and increases salt and water retention (Long, Koyfron, and Gotlieb, 2019).  In addition, remodeling of the ventricle occurs and there is a release of brain natriuretic peptides (BNP) that can lead to further deterioration of the patient.  The patient with congestive heart failure presents with orthopnea, edema, shortness of breath and fatigue due to the salt and water retention, and reduction of end organ blood flow which increases morbidity and mortality (Long, Koyfron, and Gotlieb, 2019) .ReferencesLong, B., Koyfman, A., and Gottlieb, M.  (2019).  Diagnosis of acute heart failure in the emergency department: and evidence-based review.  Western Journal of Internal     200 (6).  DOI: 10.5811/westjem.2019.9.43732. less1 UnreadUnread7 Views Views NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
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    • View profile card for Alfonsina Perez
    • Last post February 14 at 7:13 AM by Alfonsina Perez
    •      Medicine,
    • Huether, S., McCance, K., and Brashers, V.  (2020).  Understanding Pathophysiology 7th ed.  Elsevier, Mosby.
    •      In addition to the physical exam findings, we would want to perform laboratory testing including a BNP as this is chronically elevated in heart failure, and increases during an exacerbation, kidney function tests to assess end organ damage, and an electrocardiogram (EKG) to rule out presence of a new MI.  Treatment would include anti-hypertensives; a good choice would be a diuretic, oxygen, and consideration of morphine to increase vasodilation, reduce preload and improve oxygen delivery.  Mrs. K is also at risk for deep vein thrombosis (DVT) due to immobility and atherosclerosis.  Suspicion for DVT would increase if lower extremity edema were unilateral.  Prevention, screening, and detection of heart failure exacerbations, combined with aggressive treatment, can limit further end organ damage, and improve overall quality of life for patients with coronary artery disease (CAD) and associated complications.
    • Module 4Subscribe
    • Steven Bartos posted Feb 10, 2021 10:37 PM
    • Contains unread posts
    • In this scenario, Mrs. K has an S3 gallop, which is indicative of ventricular dysfunction or volume overload (Ramani & Weber, 2017). An S3 heart sound is commonly found in systolic heart failure, which is also called heart failure with reduced ejection fraction. This occurs when the ventricles eject less than 40% of their blood volume and they are unable to pump enough oxygenated blood throughout the body’s tissues, which would account for the other signs and symptoms of heart failure that Mrs. K is experiencing (Huether et al, 2020). The S3 heart sound occurs from the rapid draining of blood from the atria into the ventricles during ventricular diastole. It happens at the end of the rapid filling phase, right when the ventricles transition to the slow filling phase NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays. However, there seems to be debate as far as the exact mechanism which causes the S3 sound. Ventricular theory believes that the ventricular walls vibrate when the inflow of blood is halted from rapid to slow, causing an intracardiac sound. A second, valvular theory, proposes that the S3 occur due to the vibrations of valve cusps from the immediate decreased inflow of blood. Another theory, impact theory, states that S3 results from the ventricle moving closer to the chest wall when it fills with blood. The last theory, which in the research goes unnamed, suggests that S3 may arise when the ventricles don’t expand enough after early rapid filling. These theories suggest that S3 can be heard in the following situations: 1) when a normal ventricle receives too much incoming blood; 2) when a dilated ventricle receives equal to or less than normal amounts of blood; and 3) when a dilated ventricle receives too much blood and has volume overload (Pechetty & Nemani, 2020). It has been shown that the intensity of the S3 heart sound is affected by “age, atrial pressure, unobstructed flow across the atrioventricular valve, rapidity of early diastolic filling, compliance of the ventricle, blood volume, ventricular cavity size, and patient positioning” (Ramani & Weber, 2017, p. 198).Heuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.Ramani, S., & Weber, B.N. (2017). Detecting the gallop: the third heart sound and its significance. Medical Journal of Australia, 206(5), 198 – 199. https://doi-org.wilkes.idm.oclc.org/10.5694/mja16.00613less1 UnreadUnread7 ViewsViews
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    • View profile card for Amandeep Kaur
    • Last post February 13 at 11:15 PM by Amandeep Kaur
    • Pechetty, R., & Nemani, L. (2020). Additional heart sounds – part 1 (third and fourth heart sounds). Indian Journal of Cardiovascular Disease in Women, 5(2), 155 – 164. https://doi.org/10.1055/s-0040-1713828
    • References
    • Week 4 Discussion Post – The HeartSubscribed
    • Gisselle Mustiga posted Feb 8, 2021 11:37 PM
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    •           Mrs K. is exhibiting symptoms of Heart Failure. The S3 gallop heard during her physical exam auscultation represents the low-frequented, minimal vibrations during diastole after a rapid diastolic action in either ventricle. It begins a few seconds after S2 and generates a unique cadence. The condition only occurs after the middle third of diastole because ventricles are often unfilled sufficiently at the early diastole. This reasoning also gives it names such as ventricular gallop and protodiastolic rhythm. The frequency distinguishes it from the split s2. For instance, a distinct heart sound is existent in the left ventricle with the filling of the passive left ventricle. Such situations only occur when the left ventricle is compliant. Otherwise, the s3 gallop would be too inaudible for auscultation. Its prevalence is normal among patients who are less than forty years of age, expectant women, children, and athletes. Nevertheless, it can also be abnormal in other instances. In systolic heart failure, there is an over compliance on the part of the myocardium (Gocheva et al., 2018). Consequently, the left ventricle becomes dilated. The condition occurs due to causes such as an escalation in the ventricular filling and poor left ventricular function. The atrial pressure increases resulting in enhanced flows as in the case of heart failures. Subsequently, S3 gallops are considered as determinants of heart failure (Omar & Guglin, 2017). Dilated cardiomyopathy and ventricles also contribute to the gallop. Again, valvular regurgitation is also attributable to the condition. The rapid filling is mostly common in children while congestive heart failure is characteristic of adults. The sound is commonly heard when the patient lays in the alternate decubitus positioning and their heart sound is felt by a bell within their cardiac apex. Significantly, any underlying issues linked to the S3 gallop must be assessed as a treatment mechanism for the condition.Gocheva, K., Yordanova, D., Hinkova, Z., & Sativa, V. (2018). Case report of a heart failure caused by dilated cardiomyopathy. Scripta Scientifica Vox Studentium, 2, 94.Omar, H. R., & Guglin, M. (2017). Mitral annulus diameter is the main echocardiographic correlate of S3 gallop in acute heart failure. International journal of cardiology, 228, 834-836. less2 UnreadUnread12 ViewsViews
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    • View profile card for Melissa Morgan
    • Last post February 13 at 10:16 PM by Melissa Morgan
    •  
    • Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding Pathophysiology 7 th ed. Elsevier Mosby.
    • References
    • Mrs K. – S3Subscribe
    • Tallona Boddy posted Feb 10, 2021 12:05 PM
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    • Mrs. K appears to be suffering from congestive heart failure (CHF).  Her history of myocardial infarction, smoking and a coronary artery bypass surgery all contribute to the likelihood of Mrs. K developing CHF.  Upon physical examination the provider auscultated a S3 gallop.  The S3 gallop is an extra sound that is not typically heard in a 60 year old female.  Congestive heart failure, put simply could be described as the heart not pumping sufficiently (Mayo Clinic, n.d.).  When a patient has congestive heart failure, there is an abundance of blood in the heart, due to the heart’s inefficient pumping.  It’s thought that the S3 sound is made when the non-compliant ventricle is rapidly filling, hitting a surplus of fluid and causing the chordae tendinae to tense (University of Liverpool, n.d.).  The S3 sound can be auscultated as “Lub du bub” (Pinsky & Wipf, n.d.).  Mrs. K would benefit from a full cardiovascular exam to determine if a cause could be found for her probable CHF and to identify the most appropriate interventionsMayo Clinic. (n.d.). Heart failure. https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142University of Liverpool. (n.d.). Third heart sound. https://www.liverpool.ac.uk/~trh/local_html/heartdisease/third_heart_sound.htmless1 UnreadUnread2 Views Views NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
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    • View profile card for Hilary Szpara
    • Last post February 13 at 10:10 PM by Hilary Szpara
    • Pinsky, L.E., & Wipf, J.E. (n.d.). Learning and teaching at the bedside (1st ed.) University of Washington Department of Medicine. https://depts.washington.edu/physdx/heart/tech2.html
    • References
    • S3-heart failureSubscribe
    • Jennifer Bryant posted Feb 9, 2021 11:36 PM
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    • Mrs. K is presenting with clinical manifestations of heart failure. Heart failure occurs when the heart is unable to generate adequate cardiac output. Left heart failure is categorized as reduced or preserved ejection fraction (Huether et al, 2020). The third heart sound (S3) is regarded as one of the earliest signs of heart failure and is typically assessed by auscultation clinically (Boehmer et al, 2018). Mrs. K has a history of myocardial infarction, the most common primary cause of decreased contractility.ReferencesBoehmer, J., Gardner, R., Nair, D., Cao, M., Schulze, C., Thakur. P. (2018) S3 heart soundHeart & Lung, 47(6) 650-655.Pathophysiology (7th ed.).  Elsevier.failure. Journal of Clinical Investigation, 128(9), 3716-3726.less1 UnreadUnread3 ViewsViews
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    • View profile card for Joanne Hogan
    • Last post February 13 at 9:16 PM by Joanne Hogan
    • Zhou, B., & Tian, R. (2018). Mitochondrial dysfunction in pathophysiology of heart
    • Heuther, S., McCance, K., and Brashers, V.  (2020).  Understanding
    •             amplitudes measured by accelerometer reflect auscultated S3 heart sound volume grades,
    • Pulmonary edema occurs from more venous blood return that causes a back-up of blood in the lungs. The extra fluid in the lungs are heard as crackles. Dypsnea, orthopnea and edema are also a result of poor perfusion. Mrs. K has shortness of breath, uses 4 pillows and most recently  increased fatigue and decreased urine output. Heart failure is a complex clinical syndrome that represent the final outcome of failed compensation for cardiac injury caused by a variety of etiologies (Zhou & Tian, 2018). Mrs K has likely had cardiac dysfunction following coronary artery bypass surgery. She should be evaluated for today’s dysrhythmia in addition to congestive heart failure NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.
    • Module 4 discussionSubscribe
    • Melissa Morgan posted Feb 10, 2021 10:51 PM
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    • Mrs. K is experiencing left heart failure (congestive heart failure). She has a risk factor of ischemic heart disease (history of myocardial infarction). Signs and symptoms of CHF include dyspnea, fatigue, decreased urine output, edema, inspiratory crackles, and an S3 gallop; all of which are present in this patient (Huether, McCance & Brashers, 2020). The reason for the third heart sound is the result of “pulmonary vascular congestion and inadequate perfusion of the systemic circulation” (Huether, McCance & Brashers, 2020, p. 620). The heart is not able to generate adequate cardiac output, and this causes damage to the tissues and increased diastolic filling pressure of the left ventricle which causes the pulmonary capillary pressure to increase (Huether, McCance & Brashers, 2020). “The third heart sound (S3) occurs during the early diastolic phase of passive blood movement into ventricles. Combining elevated ventricular filling pressure and reduced cardiac muscle compliance, the S3 becomes more intense as HF worsens” (Cao, et al., 2020, p. 1). This clinical manifestation brings with it a poor prognosis. Not only is it considered one of the earliest signs of heart failure, but it also carries with it an all-cause death and death by cardiovascular during hospitalization (Cao, et al., 2020). The S3 gallop represents the left ventricular distention that is rapidly filling with blood, and with an increase of the atrioventricular flow (Shono, et al., 2019). Detecting the third heart sound takes skill, precision, and practice. Since this heart sound represents cardiovascular mortality, it is essential for the nurse to follow up when this sound is auscultated. Cao, M., Gardner, R. S., Hariharan, R., Nair, D. G., Schulze, C., An, Q., Thakur, P. H., Kwan, B., Zhang, Y., & Boehmer, J. P. (2020). Ambulatory Monitoring of Heart Sounds via an Implanted Device Is Superior to Auscultation for Prediction of Heart Failure Events. Journal of cardiac failure, 26(2), 151–159. https://doi.org/10.1016/j.cardfail.2019.10.006Shono, A., Mori, S., Yatomi, A., Kamio, T., Sakai, J., Soga, F., Tanaka, H., & Hirata, K. I. (2019). Ultimate Third Heart Sound. Internal medicine (Tokyo, Japan), 58(17), 2535–2538. https://doi.org/10.2169/internalmedicine.2731-19less2 UnreadUnread5 Views Views NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
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    • View profile card for Tallona Boddy
    • Last post February 13 at 5:59 PM by Tallona Boddy
    • Huether, S., McCance, K., and Brashers, V.  (2020).  Understanding Pathophysiology (7th ed.).  Elsevier.
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    • The S3 GallopSubscribe
    • Caroline Otto posted Feb 12, 2021 10:48 PM
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    •  The S3 sound is evaluated by the; hearts atrial pressure, a smooth blood flow across the atrioventricular valve, the rate of early diastolic relaxation, the size of the ventricle, the amount of blood volume, ventricular capacity, diastolic momentum of the heart, the degree of contact the left ventricular muscle makes with the chest wall, the thickness and integrity of the chest wall, and most importantly the position of the patient.Mrs. K has a past medical history of having a acute anterior wall MI with cardiac bypass surgery and used to be a 2 pack a day smoker but she quit 8 years ago. Patients who have had an acute anterior wall MI develop acute heart failure. An acute anterior wall MI has a poor prognosis (Bansal, Gore &References:Harvey W. P. (1994). Cardiac pearls. Disease-a-month : DM, 40(2), 41–113. https://doi.org/10.1016/0011-5029(94)90002-7Johnston, M., Collins, S. P., & Storrow, A. B. (2007). The third heart sound for diagnosis of acute heart failure. Current heart failure reports, 4(3), 164–168. https://doi.org/10.1007/s11897-007-0036-zless1 UnreadUnread4 ViewsViews
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    • View profile card for Sheryl Dixon
    • Last post February 13 at 2:01 AM by Sheryl Dixon
    • Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology 7th ed. Elsevier Mosby
    • Bansal K, Gore M, Nalabothu P. Anterior Myocardial Infarction. [Updated 2020 Aug 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562234/
    • Nalabothu. 2020). Mrs. K is exhibiting signs and symptoms of left heart failure (Congestive Heart Failure). The clinical manifestations of left heart failure are the result of pulmonary vascular congestion and inadequate perfusion of the systemic circulation (Huether, et.al pg. 620). Mrs. K is experiencing increasing episodes of shortness of breath, paroxysmal nocturnal dyspnea, worsening of the swelling in her legs at the end of the day, and decreased urine output with a rumbling S3 gallop and inspiratory crackles.
    • An S3 heart sound is heard best when using the bell-side of the stethoscope (which is used for lower frequency sounds), and the left lateral decubitus position is the preferred position with the bell right over the apex of the heart, which is located in the 5th intercostal space at the midclavicular line (Harvey, 1994).
    • Children and adults up to age 35 to 40 may have a normal third heart sound, this is referred to as S3. The significance of the third heart sound is judged by the presence or absence of heart disease (Johnston, Collins, & Storrow. 2007).  After age 40, a third heart sound is considered abnormal, and the exact course should be isolated to identify its significance NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.
    • Amandeep KaurSubscribe
    • Amandeep Kaur posted Feb 9, 2021 10:22 PM
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    • There are many indications to an S3 heart sound, in some cases, these are abnormal findings. According to Mrs. K’s clinical symptoms and the presentation of a S3 heart sound she is most likely undergoing exacerbated heart failure. The symptoms included, decreased urinary output, fatigue, dependent edema and shortness of breath (Rosenkranz et al., 2020). The pathophysiology of a S3 heart sound is the rapid distention and filling of the left ventricle and a decrease in atrioventricular blood flow (Shono et al., 2019). This produces a low frequency sound in early diastole, heard at the apex of the heart (Dornbush & Turnquest, 2020). The higher the inflow from the mitral valve into the ventricular the greater chance of an S3 heart sound. The S3 sound can also be caused by an increase in left atrial volume (Dornbush & Turnquest, 2020). The sound can be asymptomatic and a normal physiologic finding in children and athletes (Dornbush & Turnquest, 2020). An S3 gallop is considered abnormal heart sound and can be caused by ventricular dysfunctions, heart failure, severe mitral regurgitation and low ejection fraction (Shono et al., 2019).Dornbush S., & Turnquest A.E. (2020). Physiology, Heart Sounds. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.Shono, A., Mori, S., Yatomi, A., Kamio, T., Sakai, J., Soga, F., Tanaka, H., & Hirata, K. I. (2019). Ultimate Third Heart Sound. Internal medicine (Tokyo, Japan), 58(17), 2535–2538.less1 UnreadUnread5 Views Views NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
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    • View profile card for Dennies Jones
    • Last post February 12 at 10:29 PM by Dennies Jones
    • Rosenkranz, S., Howard, L. S., Gomberg-Maitland, M., & Hoeper, M. M. (2020). Systemic Consequences of Pulmonary Hypertension and Right-Sided Heart Failure. Circulation, 141(8), 678–693.
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    • S3 heart sound
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    • Jazmin Jerez-Rivera posted Feb 9, 2021 4:44 PM
    • Heart sounds are made during the cardiac cycle as the blood flows through the chambers of the heart. During diastole (relaxation), blood fills the ventricles. Then systole is the ventricular contraction that pushes the blood through the ventricles and into pulmonary or systemic circulation (Huether et. al. 2020). Auscultation of heart sounds is one of the basics of a physical exam and can help determine if something physiologic or pathologic is going on in the heart (Dornbush et. al., 2020). S1 and S2 are commonly heard but S3 and S4 heart sounds can imply something maybe be wrong. An S3 heart sound is usually heard after S2 and is a low-pitched early diastolic sound. Research indicates that an S3 heart sound is “created from blood filling a volume-overloaded ventricle., like during an acute heart failure exacerbation” (Dornbush et. al. 2020, p 4). Pechetty & Nemani suggest that an S3 gallop is associated with “increased left atrial pressure and increased left ventricular end diastolic pressures” (2020, p. 4).Dornbush S., Turnquest A. E. (2020). Physiology, Heart Sounds. StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK541010/Pechetty, R. & Nemani, L. (2020) Additional Heart Sounds-Part 1 (Third and Fourth Heart Sounds). Indian Journal of Cardiovascular Disease in Women WINCARS, 5(02), 155-164. Retrieved from 861d0c2ceb8707f731d9fef70a5a1173a202.pdf (semanticscholar.org)less0 UnreadUnread
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    • View profile card for Gisselle Mustiga
    • Last post February 12 at 3:38 PM by Gisselle Mustiga
    • Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.).  Elsevier.
    • References
    • Discussion 4Subscribe
    • Alfonsina Perez posted Feb 10, 2021 9:18 PM
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    • In this weekend discussion, we learned about the case of a 60-year-old white female who presents to the ED with many of the typical signs and symptoms of a patient with heart failure. We learned that this patient, among other symptoms, has a S3 gallop sound which is heard upon auscultation by the clinician.  The third heart sound is used as an indicator of ventricular dysfunction (Ramani & Weber, 2017). Upon auscultation, an S3 gallop could be an indication of heart failure. Although, a correlation between hearing an S3 sound and severity of disease in heart failure patients has not been established, the presence of this third heart sound has been documented as a good clinical tool in the diagnosis of heart failure (Omar & Guglin, 2016). It is theorized that S3 gallop can be heard when the ventricles have reached their elasticity limit during diastole (Ramani & Weber, 2017). As the ventricles abruptly end their filling phase due to the lack of elasticity, as it is found in patients with heart failure, the S3 sound can be heard. It is also unclear which specific function is causing the third heart sound. It is believed that it could either be vibrations arising from the valve cups or the tautening of the papillary muscles (Ramani & Weber, 2017).        less1 UnreadUnread4 ViewsViews
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    • View profile card for Jazmin Jerez-Rivera
    • Last post February 12 at 2:02 PM by Jazmin Jerez-Rivera
    • 199. https://doi.org/10.5694/mja16.00613
    • significance. Medical Journal of Australia, 206(5), 198-
    • Ramani, S., & Weber, B. N. (2017). Detecting the gallop: The third heart sound and its
    • 834-836. https://doi.org/10.1016/j.ijcard.2016.11.254
    • correlate of S3 gallop in acute heart failure. International Journal of Cardiology, 228,
    • Omar, H. R., & Guglin, M. (2016;2017;). Mitral annulus diameter is the main echocardiographic
    • References NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
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    • Hilary Szpara posted Feb 10, 2021 3:46 PM
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    • A third heart sound (S3) is caused mainly “by the early-diastolic rapid distention of the left ventricle that accompanies rapid ventricular filling and abrupt deceleration of the atrioventricular blood flow” (Shono et al., 2019). It is believed that this sound occurs when there is volume overload or ventricular dysfunction, and there are many factors which affect S3, including: “age, atrial pressure, unobstructed flow across the atrioventricular valve, rapidity of early diastolic filling, compliance of the ventricle, blood volume, ventricular cavity size, and patient positioning” (Ramani & Weber, 2017). The S3 sound can be either physiological or pathological and it generally depends on a variety of factors. In asymptomatic children and young adults, it tends to be physiological. For people over 40 years old, S3 is usually pathological. The ventricular dysfunction that is present with the sound is typically caused by “ischaemic heart disease, cardiomyopathy, myocarditis, and cor pulmonale” (Ramani & Weber, 2017). The S3 can help clinicians detect congestive heart failure in patients as well determine their risk for mortality (Ramani & Weber, 2017). S3 serves as the initial clue for left side heart failure and is associated with “severe mitral regurgitation, a low ejection fraction, restrictive diastolic filling, functionally severe heart failure, and cardiovascular mortality” (Shono et al., 2019). Detecting this heart sound can be difficult, yet it is vital to allow patients to receive quicker, appropriate treatment (Shono et al., 2019).  Shono, A., Mori, S., Yatomi, A., Kamio, T., Sakai, J., Soga, F., Tanaka, H., Hirata, K. (2019). Ultimate third heart sound. Internal Medicine, 58(17), 2535-2538. https://doi.org/10.2169/internalmedicine.2731-19less1 UnreadUnread8 ViewsViews NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
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    • View profile card for Steven Bartos
    • Last post February 11 at 8:57 PM by Steven Bartos
    • Ramani, S. & Weber, B. N. (2017). Detecting the gallop: the third heart sound and its significance. The Medical Journal of Australia, 206(5), 198-199. https://doi-org.wilkes.idm.oclc.org/10.5694/mja16.00613
    • Heart Failure week 4 by Aina OluwoSubscribe
    • Aina Oluwo posted Feb 10, 2021 11:36 PM
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    • Coronary heart disease (CHD) is the leading cause of death worldwide (Chang et al., 2017). It is imperative for physicians and other medical professionals to be able to detect any abnormalities associated with the heart. Our patient Mrs. K is a 60-year-old white female with past history positive for an acute anterior wall myocardial infarction which is a precursor and etiology of S3 gallop. Notable causes of heart failure to include S3 findings are structural heart disease, decreased compliance of left ventricle all which are evident in ischemic heart disease.With the advent of increasingly complex diagnostic modalities in cardiovascular medicine, it is remarkable that simple bedside diagnostic tests such as cardiac auscultation detailed physical examination can quickly make the diagnosis of heart failure leading to the improvement in outcomes that occurs when proper diagnostic decisions are made early in the course of treatment NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.ReferencesKubzansky, L. D. (2017). Social integration and reduced risk of coronary heart disease in1937. https://doi.org/10.1161/CIRCRESAHA.116.309443[Internet]. Treasure Island (FL): StatPearls meetings/products-and-resources/guideline-education/heart-failureRamani, S., Weber, B. N., (2017). Detecting the gallop: the third heart sound and its significance.199. https://doiorg.wilkes.idm.oclc.org/10.5694/mja16.00613less1 UnreadUnread11 ViewsViews
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  • View profile card for Candice Russell
  • Last post February 11 at 8:31 AM by Candice Russell
  • The Medical Journal of Australia, 206(5), 198
  • Heart Failure. (2021). American College of Cardiology. https://www.acc.org/education-and-
  • Publishing; https://www.ncbi.nlm.nih.gov/books/NBK541010/
  • Dornbush S., & Turnquest, A.E. (2020, July 26). Physiology, Heart Sounds. In: StatPearls
  • women: The role of lifestyle behaviors. Circulation Research, 120(12), 1927-
  • Chang, S., Glymour, M., Cornelis, M., Walter, S., Rimm, E. B., Tchetgen, E., Kawachi, I., &
  • According to her symptoms, she has a diagnosis of acute decompensated heart failure based on physical examination to include auscultation of the heart revealing a rumbling S3 gallop and inspiratory crackles.  Additionally findings are notable for +3 edema of the lower extremities, which is synonymous with physical exam findings of decompensated heart failure (Huether et al., 2020). The American Heart Association (AHA)/American College of Cardiology (ACC) (2021) defines heart failure as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood”. The diagnosis however is that of a clinical finding based on a careful history and physical examination.  The reason for this is that the auscultation of S3 alone does not strictly indicate heart failure as it is important to note that the findings of physiologic S3 can also be heard as a benign finding in children, adolescents, and young adults.The S3 is a mid-diastolic, low pitched sound which is quite subtle and often best heard in early diastole. This sound will typically occur when the ventricular pressure falls below atrial pressure, and the atrioventricular valves open initiating rapid ventricular filling.  (Ramani and Weber, 2017). The ventricular filling slows as the ventricle reaches its limits of elasticity and S3 occurs in the presence of volume overload or ventricular dysfunction as the rapidly filling phase end abruptly. The sound can be easily missed as the level of clinical experience correlates with the ability to detect the low pitched short diastolic murmur NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays. The pathologic S3 is indicative of congestive heart failure or dilated cardiomyopathy The cause of S3 heart sounds has been known to be from “blood filling a volume-overloaded ventricle, like during an acute heart failure exacerbation” (Dornbush & Turnquest, 2020}.
  • Dennies JonesSubscribe
  • Dennies Jones posted Feb 10, 2021 7:35 PM
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  •          Mrs. K, a 60-year old white female, is suffering from Congestive heart failure. Base on her physical examination, she is showcasing symptoms of left-sided heart failure. Lungs are backed up due to the heart’s inability to pump the oxygenated blood to the rest of the body. Heart Failure (HF) is a complex clinical syndrome that develops in response to myocardial insult. It results in the heart’s inability to provide sufficient blood to meet the oxygen (O 2) needs of tissues and organs (Harding et al., 2019). Mrs. K complains of sleeping on four pillows at night, swelling in the feet and tachycardia, low urine output, and dyspnea. These symptoms are all common signs of heart failure. Left-sided heart failure creates a cascade of events in the body. Nigam and Jain (2017) mention pump failures are due to heart muscle disease, low output failure, ejection fraction < 35 %, and that left-sided ventricular failure is dominated by pulmonary edema hence the shortness of breath.   An, Q., Averina, V., Boehmer, J., Mark, G., & Thakur, P. (2020). Third Heart Sound During Atrial Fibrillation? Confirming the Existence of Cardiac Vibrations During Deceleration Phase of Early Diastolic Filling While in AF. Heart & Lung, 49(2), 211–212. https://doi-org.wilkes.idm.oclc.org/10.1016/j.hrtlng.2020.02.014    less0 UnreadUnread NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays
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  • Nigam, H., & Jain, R. (2017). Congestive Heart Failure (CHF). Homoeopathic Heritage, 43(5), 12–16.
  • Harding, Mariann M., Kwong, Jeffrey, Roberts, Dottie, Hagler, Debra, Reinisch, Courtney. Lewis’s Medical-Surgical Nursing E-Book (Kindle Locations 39975-39977). Elsevier Health Sciences. Kindle Edition.
  • References:
  •           Redistribution of fluid from the lower extremities into the lungs while in a supine position. The dyspnea is usually relieved by sitting up. Asking the patient about the number of pillows used under the head while sleeping or about sleeping in a recliner can reveal adaptive behaviors that aid breathing (Harding et al.,2019). upon auscultation of the heart, S3 sound was acknowledged. The third heart sound is caused by rapid deceleration of the blood against a stiff ventricular during early diastolic filling; this is an early and specific sign of heart failure and elevated filing pressure (An et al., 2020).  The galloping sound is a lower pitch heard best at the heart’s apex using the stethoscope’s bell. This sound is associated with any condition that causes the ventricle not to fill significantly to create enough force for a full contraction. Harding et al. (2019) stated, “the most common form of HF results either from the LV’s inability to empty adequately during systole or fill enough during diastole” (p.40031). The sound is said to be normal in athletes, young people, and pregnancy. Still, in Mrs. K’s situation, it’s an indication of decreased heart function related to her history of myocardial infarction.
  • Module, Eleany YaseinSubscribe
  • Eleany Yasein posted Feb 9, 2021 10:35 PM
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  •            The S3 sound can be described as a low-pitched sound that is caused when there is volume overload causing rapid filling in the ventricles or due to ventricular dysfunction (Ramani & Weber, 2017). Because of its low sound frequency (20-70 Hz), the sound of S3 is easy to miss. In addition, it also doesn’t radiate, and is also limited into a smaller section of the precordium. During early part of ventricular diastole, the pressure in the ventricles is lower than the atrial pressure. The atrioventricular valves allow rapid ventricular filling and when the walls of the ventricles reach their elastic limit, filling starts to slow NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays. The continuous ventricular overflow of blood/increased ventricular filling pressure will cause the S3 sound. S3 sound is normal during early childhood and young adults. However, it is pathological in older adults. It can originate from the left or right ventricles. Ischemic heart disease, cardiomyopathy, myocarditis, as well as cor pulmonale are some of the known causes of S3 gallop (Ramani & Weber, 2017).  References less0 UnreadUnread
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  • Shono, A., Mori, S., Yatomi, A., Kamio, T., Sakai, J., Soga, F., Tanaka, H., & Hirata, K. (2019, May 22). Ultimate Third Heart Sound. Internal Medicine, 58(17), 2535-2538. doi: 10.2169/internalmedicine.2731-19
  • Ramani, S., & Weber, N. B. (2017, March 20). Detecting the gallop: the third heart sound and its significance. The Medical Journal of Australia, 206(5), 198-199. Retrieved from https://doi-org.wilkes.idm.oclc.org/10.5694/mja16.00613
  •             The symptoms that Mrs. K is having including shortness of breath, decreased urine output, edema, and inspiratory crackles can indicate heart failure.
  •             S3 gallop can suggest a left heart failure (Shono et al., 2019). It is commonly related with mitral regurgitation, low ejection fraction, diastolic filling that’s restrictive, and even worse, mortality of the cardiovascular. That being said, it’s very important to recognize the third heart sound when it comes to immediate treatment. Nevertheless, when it comes to auscultation of the third heart sound, experience, total-commitment, as well as training are important factors for success (Shono et al., 2019).
  • Module 4Subscribe
  • Joanne Hogan posted Feb 9, 2021 5:12 PM
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  • Module 4Mrs. K’s history supports the diagnosis of congestive heart failure due to myocardial hypertrophy as evidenced by her past MI and coronary artery bypass surgery scarring the myocardial walls NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays. Her symptoms of shortness of breath, increased edema, and fatigue are all indicative of an acute flare of CHF. Mrs. K is experiencing decreased urinary output due to poor renal perfusion secondary to low cardiac output. Arginine vasopressin or ADH can contribute to fluid retention in the kidneys (Huether et al., 2020, p. 620). Her shortness of breath and edema is caused by fluid overload in the body due to sodium retention and back up of fluid into the lungs (Huether et al., 2020, p. 620).ReferencesHuether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.Pechetty, R., & Nemani, L. (2020). Additional heart sounds—part 3 (third and fourth heart sounds). Indian Journal of Cardiovascular Disease in Women WINCARS, 5(02), 155–164. https://doi.org/10.1055/s-0040-1713828
  • Omar, H. R., & Guglin, M. (2017). Mitral annulus diameter is the main echocardiographic correlate of s3 gallop in acute heart failure. International Journal of Cardiology, 228, 834–836. https://doi.org/10.1016/j.ijcard.2016.11.254
  • Gologorsky, R. C., & Roy, S. (2019). Ultrafiltration for management of fluid overload in patients with heart failure. Artificial Organs, 44(2), 129–139. https://doi.org/10.1111/aor.13549
  • An S3 heart sound can be normal in pregnancy, some people under the age of 35, and may also be heard in athletes (Pechetty & Nemani 2020). An S3 heart sound is commonly pathological and indicative of congestive heart failure in the left ventricle and occurs right after S2 during early diastole (Pechetty & Nemani, 2020). S3 commonly occurs when there is an increase in mitral valve inflow during early diastole and impaired expansion of the ventricle (Omar & Guglin, 2017). The sound that occurs in S3 is a result of blood hitting the ventricle walls with force which creates a vibration, an occurrence common with volume overload. In people with heart failure, the ventricles become stiff due to hypertrophy and poor contractibility (Gologorsky & Roy, 2019).  This stiffening and poor contractibility can be caused by a multitude of reasons, most often due to atherosclerosis or scar tissue that is formed after an MI which causes poor perfusion to the myocardium (Gologorsky & Roy, 2019). Myocardial hypertrophy creates a higher oxygen demand due to the larger muscle size while creating less ability to pump out the needed oxygen due to shrinking coronaries from the hypertrophy leading to an inability to meet the bodies demands (Gologorsky & Roy, 2019) NSG-530-IKC – Advanced Pathophysiology – S3 heart sound /Gallop Discussion Essays.

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