A 72-year-old man with chronic uncontrolled hypertension (BP 168/98 mmHg, HR 88/min, RR 16/min) presents with exertional chest discomfort. Physical examination reveals a prominent S4 gallop. Recent troponin is negative, but electrocardiography shows left ventricular hypertrophy with strain pattern. He denies orthopnea and has no lower extremity edema. He takes lisinopril irregularly. Which of the following best explains the origin of this S4 gallop?
- A)Rapid passive filling into a volume overloaded ventricle
- B)Backflow across a stenotic aortic valve
- C)Oscillation of the pericardium during inspiration
- D)Closure of the mitral and tricuspid valves
- E)Atrial contraction into a stiff noncompliant ventricleGABARITO
Explicação
Atrial contraction into a stiff noncompliant ventricle is correct. An S4 occurs late in diastole when the atrium contracts against a stiff ventricle, as in concentric hypertrophy from chronic hypertension. It is absent in atrial fibrillation because organized ... Ver explicação completa e trilha adaptativa →