Book of Medical Disorders in Pregnancy - Tintash

Fourth Heart sound - This is rarely
heard and is thought to be caused by
very strong atrial contraction which
occurs against strong resistance. It is not
heard in normal heart.
Diastolic and Presystolic gallop -
When third heart sound is heard with
heart rate of more than 100 per minute,
the rhythm of heart is called diastolic
gallop. While presystolic gallop is
produced when fourth heart sound is
heard with a heart rate of more than 100
per minute.
It can only be shown by Phono-
Cardiogram that a gallop rhythm is due
to intensification of the true 3rd or true
4th heart sound. They are heard most
frequently in severe cardiac disease and
may in fact be due to continuation of
both increased 3rd and 4th sound
(summation gallop).
Ejection click - This occurs due to
increased blood pressure. The increased
pressure distends stiff walls of the aorta
or the pulmonary artery, and dilates
these stiff vessels and thus produce
ejection click.
Heart sounds in pregnancy - All
sounds usually increase in intensity. A
short systolic murmur is best heard at the
apex of the pulmonary area during
normal pregnancy. The murmur is
usually of ejection type, and is probably
produced by increase in blood volume
and blood flow through the heart. This
murmur is physiologically normal, starts
around 12 weeks of pregnancy and
automatically disappears within a week
after delivery. A number of murmurs can
be found in pathological heart conditions
one of which is mitral regurgitation.
Various diagnostic murmurs may be
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greatly decreased or even not heard
during pregnancy due to decrease in
peripheral resistance. The student should
realize that when heart disease is severe
the prognosis for the fetus is worst.
Cardiac disease and childbearing
ordinarily do not shorten the life expectancy
of the mother or cause permanent
cardiac ~status deterioration. When
maternal heart disease is congenital, pregnancy
may result in increased incidence
of fetal congenital heart disease.
In cases of heart disease the most
important factor in their management is
to prevent heart failure. This increases
the hemodynamic burden and causes
decompensation of the heart, which
usually causes death. The danger of
death is greatest when the hemo-
dynamic burden is severe.
Fig5.6: Shows radiograph with
enlarged heart
Valvular lesions:
The mitral valve can be Stenosed or
incompetent, which in turn can be mild,
moderate or severe.
Mild mitral stenosis - The valve between
the left atria and left ventricle is
narrowed. Most women will give a
history of past rheumatic fever. Until