Wide and fixed 2nd heart sound seen in -
(A) (ASD) 632. Davidson 21st (1922 - 24 - H 19th)Atrial septal defect* Wide fixed splitting of the second heart sound wide because of delay in right ventricular ejection (increased stroke volume and right bundle branch block) and fixed because the septal defect equalizes left and right atrial pressures throughout the respiratory cycle.* A systolic flow murmur over the pulmonary valve.* ECG - incomplete RBBB (right bundle branch black)VENTRICULAR SEPTAL DEFECT:* Pansystolic murmur usually heard best at the left sternal edge but radiating all over the precardium.* A small defect often produces a loud murmur (maladie-de-Roger) in the absence of other haemodynamic disturbances.* Most congenital defects are "perimembranous" i.e. at the junction of the membranous and muscular portions.* ECG shows bilateral\ ventricular hypertrophy.TETRALOGY OF FALLOT:* Cyanosis with a loud ejection systolic murmur in the pulmonary area* ECG right ventricular hypertrophy* X-ray chest 'boot shaped heart'PATENT DUCTUS ARTERIOSUS:* A continuous ''machinery" murmur is heard with late systolic accentuation, maximal in the second left intercostals space below the clavicle.* It is frequently accompanied by a thrill, pulse are increased in volume.* ECG is usually normalAORTIC STENOSIS:A harsh ejection systolic murmur radiates to the neck with a soft second heart sound particularly in those with calcific valve, low pitched, rough and rasping in character.The murmur is often likened to a saw cutting wood and may (especially in older patients) have a musical quality like the 'new' of a seagull.* Slow rising carotid pulse, narrow pulse pressure.* Thrusting apex beat (LV pressure overload)* Sign of pulmonary venous congestion (e.g. crepitations),ECG - LV hypertrophy, ST - segment depression and T. wave inversion (LV - 'strain*)Lutembacher's syndrome consist of - ASD and MS
ASD
VSD
Aortic stenosis
PDA
C.V.S.