Palpable Shock of Accentuated Heart Sounds
Palpable impulse that is produced by the accentuated heart sound is called shock.
Accentuation of heart sound means pathological loudness of heart sounds.
First heart sound
Palpable S1 produce tapping apex beat in mitral area
in Mitral stenosis
Pulmonary component of second heart sound
Produce palpable shock over pulmonary area
This is called as diastolic shock or diastolic knock and seen in pulmonary hypertension of any cause
Aortic component of second heart sound
Produced palpable shock over aortic area
Seen in aneurysm of aortic root and systemic hypertension
Third heart sound
Produce palpable shock over mitral area
Seen in Mitral regurgitation(MR), left ventricular failure(LVF)
Fourth heart sound
Produce palpable shock over mitral area
Seen in Aortic stenosis, Hypertrophic obstructive cardiomyopathy HOCM
Palpable S4 (mitral area) is responsible for double apex beat in IHSS.
Mitral events can be better felt keeping the patient in left lateral position.
Aortic events are better felt, keeping the patient in sitting, leaning forward and breath held in expiration.
