First heart sound S1
- Decrease in rate of LV pressure development. e.g.: Myxedema, cardiomyopathy, acute MI and MR.
- PR interval and velocity of valve closure. e.g.: Prolonged PR interval - first degree heart block.
- Mobility of the valve. e.g.: Severe calcification of the valve or reduced mobility of the valve - Long standing MS is associated with severe calcification of mitral valve and soft S1.
- Increased AV flow due to high cardiac output. e.g.: AV fistula and thyrotoxicosis.
- Increased AV flow due to left to right shunt. e.g.: atrial septal defect (ASD), patent ductus arteriosus (PDA) and other conditions.
- Prolonged AV flow due to stenosis. e.g.: Mitral stenosis (MS) and tricuspid stenosis (TS).
- Short PR interval (velocity of valve closure) - At short PR intervals, the mitral valve leaflets are maximally separated by atrial contraction. At the onset of LV systole, the mitral valve leaflets therefore close with a high velocity and with a large excursion resulting in loud S1.
- EKG: An EKG (electrocardiogram) is a simple test that detects and records the heart's electrical activity. An EKG shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through each part of the heart.
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