38 30 歲女性，自幼便常有感冒症狀，並被告知有心雜音，身體診察所見如下：身高 160 cm，體重 60 kg，心跳規律，左上胸緣有三度收縮期射出性雜音（systolic ejection murmur），S2有固定性分裂（fixed splitting of S2），P2加重，最有可能的診斷是：
(A)心室中隔缺損（ventricular septal defect）
(B)心房中隔缺損（atrial septal defect）
(C)限制性心肌病變（restrictive cardiomyopathy）
(D)肺動脈高壓症（pulmonary hypertension）

答案：登入後查看
統計： A(14), B(48), C(0), D(9), E(0) #1050837

oneworldonefamily777

B1 · 2016/07/07

#1408554

B) ASD, left to right shunt, 右心血變多, fixed splitting S2

Fixed splitting S2:

ASD, Pulmonary Stenosis, Pulmonary Emboism, RBBB

A) VSD, left to right shunt, pansystolic (holosystolic) murmur, widely split S2

In tricuspid area (lower left sternal border, radiating to right lower sternal border)

Pansystolic (holosystolic) murmur:

MR, TR(tricuspid insufficincy), VSD, Restrictive cardiomyopathy (+S3 gallop)

D) Mid-systolic ejection murmur:

AS, PS, Dilation of aortic root or pulmonary artery (Pulmonary hypertension), Increased semilunar blood flowin anemia, pregnancy, or hyperthyroidism.

Late-systolic murmur: crescendo manner

MVP, TVP, Papillary muscle dysfunction (Ischemic mitral regurgitation), MR

C) RCM:

S3 gallop

Soft systolic murmurs of functional mitral and tricuspid valve regurgitation are also common