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AV fistulas are one cause of high-output cardiac failure. This person presents with heart failure, but it is due to chronically increased resting CO.
@nwinkelmann yes thats right, he has failing heart. but question is asking what is the finding of this patient, I understand the cause is Fistula causing high output failure, but they didn't ask the reason of his HF, they are asking the finding. I choose decrease Stroke VOlume :/
This was my logic and got to decreased stroke volume as well; they arent asking what caused his HF or anything it says what is the most likley finding in this patient. If his heart is failing due to LVH from consistent increased CO wouldnt he AT THIS VERY MOMENT WITH his heart failing have decreased stroke volume?..
What a weird question. I could definitely hear a fixed split heart sound. And it was loudest over the pulmonic valve too which makes it even more of a dirty question. But I guess what I was actually hearing was an S3 heart sound.
@the260guy I believe the splitting is being heard only during inspiration, making this normal physiologic splitting. Perhaps that's just my ears.
don't have adobe and couldn't download it, so I just chose whatever, but your explanation suddenly makes me feel dumb but grateful! Loving your tips! @benwhite_dotcom
@the260guy Have to agree with wutuwantbruv. I interpreted this as a physiological splitting, had the opportunity to hear it in a newborn as well.
Definitely S3. FA 2020 pg 287 "but can be normal in children, young adults, athletes, and pregnancy"
I swear to god it wasnt just during inspiration but what the hell do i know