Question

Elderly patient has history of Atrial Fib and chronic kidney disease. What would you expect to hear when you listen to the 6 spots of his lungs? What about the 4 spots of his heart? Would you expect to see any edema in feet, hands or sacrum? If so why?

Answer 1

Atrial fibrillation causes a rapid , disorganised , and unco-ordinated twitching of atrial musculature.

CKD(chronic renal failure) is a progressive, irreversible deterioration of kidney function resulting in imbalanced metabolic, fluid and electrolyte levels.

1.Normal breath sounds are vesicular, bronchovesicular, bronchial (tubular) breath sounds.

Vesicular sounds- It is heard over emtire lung field except over upper sternum and between scapulae.

Broncho vesicular sounds- It is often heard in the 1 st and 2 nd interspaces anteriorly and between scapulae.

Tubular sounds- It is heard over the manubrium.

Crackles are noncontinous discrete sounds can be heard for this patient .

2.Normal heart sounds are S1 and S2 produced by closing of the heart valves.

S1 -first heart sound is heard over entire precordium especially at the apex of heart due to closure of mitral and tricuspid valves.

S2- second heart sound is heard at base of heart due to closure of aortic and pulmonic valves.

S3- A gallop sound occurring during rapid ventricular filling is called a third heart sound.

S4- Gallop sounds heard during atrial contraction called fourth heart sound.

In a elderly patient with atrial fibrilllation and CKD pericardial friction rub can be heard which is a harsh grating sound caused by abrasion of the pericardial surfaces during cardiac cycle.

3. Peripheral edema can be present due to fluid overload and accumulation in dependent areas of body( feet , legs and sacrum if patient is bedridden ) .Pitting edema also can be present.