Dilated Cardiomyopathy: The Daily PANCE Blueprint
A 62-year-old man with a history of chronic alcohol use and hypertension presents to the clinic with complaints of progressive shortness of breath, fatigue, and swelling of the legs over the past three months. On physical examination, there is jugular venous distension, hepatomegaly, and bilateral pitting edema. Cardiac auscultation reveals an extra heart sound. Which of the following is most likely to be seen in this patient with dilated cardiomyopathy?
A. 3 Sign on Chest X-Ray
B. Thumbprint Sign (on X-ray)
C. S4 heart sound
D. S3 heart sound
E. Boot-Shaped Heart
Answer and topic summary
The answer is D. S3 heart sound
The presence of an S3 heart sound is commonly associated with dilated cardiomyopathy. The S3 heart sound is an extra heart sound that follows the normal lub-dub (S1 and S2) heart sound in early diastole. S3 is thought to be caused by turbulent blood flow between the walls of the ventricles as blood flows from the atria in volume overloaded hearts.
Incorrect Answer Explanations:
- A. 3 Sign on Chest X-Ray: The “3 sign” is associated with coarctation of the aorta, not dilated cardiomyopathy. It is a radiographic finding that results from the indentation of the aorta at the site of coarctation.
- B. Thumbprint Sign (on X-ray): The thumbprint sign is indicative of epiglottitis, which is an inflammatory condition of the epiglottis, and is unrelated to cardiomyopathy.
- C. S4 heart sound: An S4 heart sound, also known as an atrial gallop, is typically associated with stiff ventricles and conditions like left ventricular hypertrophy or ischemic heart disease, rather than dilated cardiomyopathy. It occurs late in diastole and is associated with atrial contraction against a non-compliant ventricle.
- E. Boot-Shaped Heart: A boot-shaped heart on chest X-ray is indicative of Tetralogy of Fallot, a congenital heart defect, and is not associated with dilated cardiomyopathy. This finding results from right ventricular hypertrophy.
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