Cardiac Conditions Associated with Sudden Death

Ebstein's Anomaly Sounds

This is an example of Ebstein's Anomaly as heard at the tricuspid area.

The first heart sound is increased due to thickening of the tricuspid valve leaflets.

The second heart sound is normal.

A rectangular murmur of tricuspid regurgitation fills all of systole.

An opening snap occurs 100 milliseconds into diastole followed by a decrescendo-crescendo murmur of mitral stenosis.

These findings are all a manifestation of downward displacement of the tricuspid valve into the right ventricle

In the anatomy tab you can see the enlarged right atrium and the small right ventricle. The upward plume from the right ventricle to the right atrium represents the systolic murmur.

The downward plume from the right atrium to the right ventricle represents the diastolic murmur.

This abnormality is congenital in nature.

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The recommended auscultation position for the stethoscope is the Tricuspid position. For this sound, use stethoscope's Diaphragm.

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The recommended patient position is Supine

Phonocardiogram

This waveform plots sound amplitude on the vertical axis against time on the horizontal axis.

Heart Animation

Lessons

1	Hypertrophic Cardiomyopathy
2	Aortic Stenosis - Severe 2
3	Arrhythmogenic RV Dysplasia
4	Mitral Valve Prolapse (Click with Late Systolic Murmur)
5	Myocarditis
6	Commotio Cordis
7	Ebstein's Anomaly

Practice Drill

Listening Tips
A synopsis of important sound features and timing for this abnormality.
S1: Increased intensity. Possible splitting.
Systole: Rectangular.
S2: Possible splitting..
Diastole: Opening snap followed by decrescendo-crescendo murmur.

CaseID	117
CourseID	29
CourseCaseOrder	6
ID	109