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Abnormal pulmonic sound during acute massive pulmonary embolism.
Chest
|July 1, 1978
Summary
Diagnosing acute massive pulmonary embolism (PE) can be aided by listening for abnormal respiratory splitting of the pulmonic sound. A normal splitting pattern
Area of Science:
- Cardiology
- Pulmonology
- Medical Diagnostics
Background:
- Massive pulmonary embolism (PE) can cause significant pulmonary hypertension.
- Abnormal respiratory movement of the pulmonic sound has been observed in PE patients.
- Phonocardiography can detect subtle changes in heart sounds.
Observation:
- Two patients with angiographically proven massive PE exhibited a wide and fixed split second heart sound.
- This abnormal splitting was characterized by a loud pulmonic component.
- Both patients had moderate pulmonary hypertension and abnormal respiratory movement of the pulmonic sound.
Findings:
- Heparin administration led to the normalization of pulmonic sound respiratory movement within two weeks.
- Pulmonary hypertension regressed in one patient and remained unchanged in the other.
- Changes in pulmonary artery impedance are hypothesized to cause the abnormal pulmonic valve movement.
Implications:
- Wide expiratory splitting of the second heart sound is a potential diagnostic clue for acute massive PE.
- Monitoring the reappearance of normal inspiratory splitting can serve as a bedside indicator of clot resolution.
- This phonocardiographic finding offers a non-invasive method for assessing PE treatment response.